Chondromalacia Patella

Chondromalacia patella is when there is softening and damage to the cartilage on the back of the patella (kneecap). This leads to front knee pain, swelling and clicking/grinding noises when moving the knee.

It tends to affect young, healthy and often sporty people. It most commonly affects adolescents and young adults, and is more common in women. It is commonly misdiagnosed as Runners Knee.

To fully understand Chondromalacia Patellae we first need to understand how the kneecap (patella) normally works. The patella is a small bone that sits inside the muscles at the front of the thigh (quads). It rests in a special groove (patella groove) on the front of the thigh bone (femur) where it moves up and down as you move your leg.

The patella is lined with the thickest cartilage in the whole body which:
1) ensures that the patella glides smoothly over the knee bones
2) works as a shock absorber

Causes of Chondromalacia Patella

Chondromalacia patella occurs when the kneecap rubs against the bones rather than gliding over them. This causes small tears in the cartilage which get inflamed and cause pain. There are a number of reasons for this:

1) Muscle imbalance: a combination of muscle tightness in the quads muscles and other structures e.g. the retinaculum on the outside of the knee and muscle weakness on the inside of the knee (VMO) affects the position of the kneecap in the patella groove. Instead of gliding easily up and down the centre of the groove, it is pulled out to the side which causes a lot of friction and ends up damaging the cartilage. This is also known as patella maltracking. The good news is that it can easily be fixed with the right exercises

2) Poor alignment of the kneecap: where the patella doesn’t sit in the right position, but tends to be either too high or too low. Some people are born this way, but it doesn’t become apparent until adolescence

3) Overuse of the leg: Anything whereby lots of force goes through the knee (e.g. running, jumping, twisting)

4) Flat feet: this changes the way the forces are distributed through the knee and makes the cartilage more prone to damage

Chondromalacia Patellae Symptoms

The most common symptoms of Chondromalacia Patella are:

1) Front Knee Pain: tends to be achy rather than sharp
2) Pain On Stairs: tends to worse going downstairs rather than upstairs
3) Pain After Prolonged Rest: when you first get up after sitting down for a while
4) A grating/grinding sensation: when moving the leg (crepitus)
5) Minor Swelling: usually around the patella
6) Tenderness: with any pressure through the kneecap

How is it Diagnosed?

Your doctor will normally diagnose patella chondromalacia from your description of symptoms and by carrying out some simple tests (looking at the movement of the knee, and putting pressure through it).

Standard x-rays don’t usually show up the problem, although a “skyline view x-ray” taken from the side of the leg can be used to see the back of the kneecap. MRI scans are occasionally used to confirm diagnosis.

Treatment Options

To treat chondromalacia patellae it is vital to discover what is causing the problem in the first place, so your doctor should refer you to a physiotherapist who will look more closely at your leg muscles.  Treatment may include:

Medications  

To manage pain, your doctor may advise:

• Over-the-counter medication, such as ibuprofen or acetaminophen
• Topical pain medication—creams or patches that are applied to the skin to help with soft tissue pain
• Prescription pain relievers

Rest  , cold , Compression , Elevation

Your knee will need time to heal. Avoid activities that place extra stress on your knee:

• Do not do activities that cause pain. This includes running, jumping, and weight lifting using the leg muscles.
• If normal walking hurts, shorten your stride.
• Do not play sports until your doctor has said it is safe to do so.

 Compression can help prevent more swelling. Your doctor may advise an elastic compression bandage around your knee. Be careful not to wrap the bandage too tight.

After treatment, you may need an elastic knee sleeve with the kneecap cut out to help support the knee joint.

Elevation can also help keep swelling down. Keep your knee higher than your heart as much as possible.

Apply an ice or a cold pack to the area for 15-20 minutes, four times a day, for several days after the injury. Do not apply the ice directly to your skin. Wrap the ice or cold pack in a towel.

Exercises - A full knee rehabilitation program with specific exercises should be done. Exercises are usually aimed at increasing the strength of the vastus medialis muscle on the inside of the knee and stretching the lateral quadricep muscle on the outside of the knee. Sports massage can help relax the lateral structures of the knee.

Laser therapy

intensity lasertherapy can be used to lessen the pain and discomfort of many degenerative medical conditions such as chondromalacia patella . The use of this therapy is believed to generate healing at the cellular level and promote pain relief by increasing blood flow to an affected area of the body. Lasertherapy has also been shown to increase endorphin and serotonin levels in the body, promoting significant pain relief.  low intensity lasertherapy is used to increase the blood flow to the knee area and promote the re-growth of cartilage behind the kneecap.

In all degenerative conditions, there has been some form of cellular or nerve damage. By using this non-invasive therapy, patients can experience pain relief and increased range of motion without serious surgery and drug treatments that may cause unwanted side effects. Addition to chondromalacia patella Low intensity lasertherapy is also used to treat degenerative disorders such as osteoarthritis, calcium growths, discogenic and vertebrogenic radiculopathy and spinal stenosis.

Physical Therapy

Physical therapy focusing on strengthening the quadriceps, hamstrings, adductors, and abductors can help improve your muscle strength and balance. Muscle balance will help prevent knee misalignment.

Non-weight bearing exercises are typically recommended, such as swimming or riding a stationary bike. Additionally, isometric exercises that involve tightening and releasing your muscles can be used to maintain muscle mass.

2) Knee Brace Straps and taping

 Wearing a strap directly under the kneecap helps take pressure off the joint, dramatically reducing pain. They are simple to use and very effective. Visit the knee strap section to find the best strap for you.also Taping Can help to take the pressure off the kneecap. This is particularly useful for when you are playing sports. A physical therapist can teach you how to do this

7) Modifying your Activity: Limit running and instead try swimming or cycling. If you want to run, ensure you are wearing good shoes with cushioned shoes, and stay off hard surfaces e.g. concrete

8) Shoe Insoles: Insoles known as orthotics can help to correct flat feet and reduce the force through the kneecap

10) Surgery: This is only considered if nothing else works and the pain is really affecting you. It is done arthroscopically, where they make 2-3 small holes around the knee and insert a camera. They will then cut any tight ligaments to allow the patella to sit in the right place in the groove and/or shave off any damaged bits of cartilage.

Recovery Process

Chondromalacia Patellae usually settles down with medication and exercises but it is likely to take a few months. The sooner you get going with exercises, the sooner it will get better. Check out the strengthening exercises and stretches sections for exercises you can do at home to help. Surgery is rarely necessary.

Prevention

To reduce your chances of chondromalacia patella, take these steps:

• Maintain a healthy weight to reduce stress on your knees.
• Properly warm up before exercising or doing any physical activity.
• Maintain proper strength by exercising the quadriceps, calf muscles, and hamstring muscles.
• Use proper footwear for your sport. You may need orthotic support to help correct misalignment.
• Slowly increase activity to avoid stress on the knee.
• Use proper form and technique for any sport.