Chondromalacia Patellae

September 5, 2017 | By | Reply

What is chondromalacia patellae/runner’s knee?

Chondromalacia patellae, also known as runner’s knee, is a condition where the cartilage on the undersurface of the patella (kneecap) deteriorates and softens. This condition is common among young, athletic individuals, but may also occur in older adults who have arthritis of the knee.
Chondromalacia is often seen as an overuse injury in sports, and sometimes taking a few days off from training can produce good results. In other cases, improper knee alignment is the cause and simply resting doesn’t provide relief. The symptoms of runner’s knee are knee pain and grinding sensations, but many people who have it never seek medical treatment.

What causes chondromalacia patellae?

Your kneecap normally resides over the front of your knee joint. When you bend your knee, the backside of your kneecap glides over the cartilage of your femur or thigh bone at the knee. Tendons and ligaments attach your kneecap to your shinbone and your thigh muscle to the kneecap. When any of these components fails to move properly, it can cause your kneecap to rub up against your thigh bone. This abnormal rubbing can lead to deterioration in the patella, resulting in chondromalacia patellae.

Improper kneecap movement may result from:

  • Poor alignment due to a congenital condition
  • Weak quadriceps especially vastus medialis oblique.
  • Muscle imbalance between the adductors and abductors (the muscles on the outside and inside of your thighs)
  • Muscle tightness
  • Repeated stress to your knee joints, such as from running, skiing, or jumping
  • A direct blow or trauma to your kneecap

Who is at risk for chondromalacia patellae?

There are a variety of factors that may increase your risk for developing chondromalacia patellae.

  • Age: Adolescents and young adults are at high risk for this condition. During growth spurts, the muscles and bones develop rapidly, which may contribute to short-term muscle imbalances.
  • Sex: Females are more likely than males to develop runner’s knee, as they typically possess less muscle mass than males. This can cause abnormal knee positioning, as well as more lateral (side) pressure on the kneecap.
  • Flat feet: Flat feet may place more stress on your knee joints than in people who have higher arches in their feet.
  • Previous injury: A prior injury to the kneecap, such as a dislocation, can increase your risk of developing runner’s knee.
  • High activity level: If you have a high activity level or engage in frequent exercises that place pressure on your knee joints, this can increase the risk for knee problems.
  • Arthritis: Runner’s knee can also be a symptom of arthritis, a condition causing inflammation to the joint and tissue. Inflammation can prevent the kneecap from functioning properly.

What are the symptoms of chondromalacia patellae?

  • Chondromalacia patellae will typically present itself with anterior knee pain. You may feel sensations of grinding or cracking when bending or extending your knee.
  • Pain may worsen after sitting for a prolonged period of time or during activities that apply extreme pressure to your knees, such as standing for an extended period or running, stair climbing, squatting, kneeling, or changing from a sitting to a standing position.
  • Other symptoms are tenderness when you palpate under the medial or lateral border of the patella; minor swelling; a weak vastus medialis (quadriceps) muscle

Treatment options for chondromalacia patellae:

The goal of treatment is to reduce the pressure on your kneecap and joint. Resting, stabilizing, and icing the joint may be the first line of treatment, followed by exercises to correct the muscle imbalance.

  • Rest: Decreasing or even stopping the activities that make the pain worse is the first step in reducing the pain. You may need to stop athletic activities where your feet pound on hard surfaces (for example, running).
  • Ice: Icing 3-4 times a day would help decrease the pain and reduce the inflammation.
  • Taping: Sports tapes have been known to alleviate stress on the patella and reduce the adverse tracking of patella thus relieve some pain and inflammation associated with chonromalacia patellae.
  • Exercise:  Physical therapy for CMP involves a holistic approach with the key points as follows:
    • Stretching – stretching of Iliotibial band and hamstrings
    • Strengthening – strength training of quadriceps with focus on vastus medialis, gluteal muscles, hip abductors and adductor muscles.
    • Functional training
    • Sports specific agility training
  • Orthotics: Foot orthoses may be helpful in the pain relief of the knee if the patient has signs of an excessive foot pronation, or a lower extremity alignment profile that includes excessive lower extremity internal rotation during weight bearing.  When customized according to the need, the orthotics will cause biomechanical changes in the lower leg by preventing overpronation and providing a better support for normal feet.

  • Nonsteroidal anti-inflammatory medication: Drugs such as ibuprofen or naproxen reduce pain and inflammation.
  • Surgery: If conservative measures fail, though, there are a number of possible surgical procedures. These procedures take place when the symptoms remain the same after the conservative measures.

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