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Chondromalacia Patella – Treatment, Exercises, Surgery, Symptoms

What is Chondromalacia Patella?

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Patella commonly known as knee cap or kneepan, is a disc-shaped, triangular bone that is connected to the tendons of the femur and covers the front area of the knee joint. Its key function is to extend and protect the knee joint, especially during bending.

The patella is controlled by quadriceps muscles. If the muscle strength is not balanced in each direction, the patella  can be pulled toward the edge of the groove instead of being centered, causing irritation and chondromalacia patella (CMP). The word “chondromalacia” is derived from the original Greek meaning “softening of the cartilage.”

CMP is a painful disorder which involves degeneration and softening of the articular cartilage between the patella and the outer layer of the femur. The patellar cartilage becomes impaired and develops fissures, causing poor alignment and irritation in the kneecap.

Normally, the patella has a protective smooth cartilage on the underside which allows effortless gliding and bending of joints across the knee and effortless sliding in the groove of the femur. But in the CMP situation the kneecap rubs over one part of the knee joint, resulting in injury and blisters on the surface of the patella. Due to this, continuous irritation and pain in the knee will occur.

chodromalacia patella

Chondromalacia patella image

Image source: eorthopod.com

According to most studies, the cause of CMP is considered idiopathic, but other findings have reported that the degenerative changes are due to the following:

Trauma

Trauma most often occurs when the symptoms have subsided, but the imbalances caused by injury or misuse during recovery have not been corrected.

Repetitive micro-trauma

People with a history of previous trauma to the anterior knee are at a higher risk of developing CMP.

Postural distortion

Pulling or twisting out of shape produces abnormal movement of the patella in the trochlear groove.

First described in 1906, postural distortion occur frequently in adolescents, young adult females, athletes, and overweight people. Runners are more likely to develop CMP due to poor training regimens, rapid rise in duration or intensity of training, hard and uneven running surfaces, and inappropriate shoes.

Chondromalacia Patella Symptoms

Knee pain

Dull pain can be felt beneath or on the side of the patella. Pain is usually of gradual onset and becomes worse with the flexion and extension of the knees from activities such as squatting, climbing or descending stairs, and sitting for a prolonged period of time.

Crepitus

Crepitus is a grating sound or sensation produced by friction between the knee joint and cartilage, commonly heard when compression, active extension, and range of motion are applied.

McMurray sign

MacMurray sign is pain or trapping during circular movement.

Swelling

Redness and edema are also observed. Tenderness can be felt during palpation in the middle part and sides of the patella.

Increased quadriceps or Q angle and valgus posture of the leg may also be noted.

Diagnosis

Physical Examination

The physical examination is the initial examination that is done during consultation with the doctor who will assess the knee for signs and symptoms of CMP like stiffness and crepitus.

In some cases, a diagnostic procedure is necessary to confirm the diagnosis.

Knee X-ray

A Patello-femoral X-ray is done to inspect for any changes in the knee as well as extended cartilages or joints. Among the most helpful views – standing anteroposterior, lateral, and Merchant/sunrise views, the merchant/sunrise view can visualize the articulation in the patellofemoral part and the degree of narrowing of the joint space.

Computed Tomography (CT) Scan

A CT scan demonstrates subluxation and tilt more accurately from the posterior condyles of the femur.

Magnetic Resonance Imaging (MRI)

MRI is an effective tool that is used to evaluate the frontal area of the patella and abnormalities and defects in the focal cartilage. It can also serve as an accurate, non-invasive method to assess in the patellar cartilage. MRI can detect CMP with a sensitivity of 86 percent and an accuracy of 81 percent.

Grading:

  • Grade 1 – Softening of the cartilage due to broken vertical collagenous fibers.
  • Grade 2 – Blister formation, positive swelling, and thinning of articular cartilage due to the separation of the superficial layer of the articular cartilage from the deep layer of the articular cartilage.
  • Grade 3 – Thickness of cartilage with focal ulceration and surface fissuring (crabmeat cartilage)
  • Grade 4 – Ulceration, crater formation, and exposure of the subchondral bone

Arthroscopy

It provides an easy method to view the interior part of the patella and serves as a tool to confirm lesions.

CMP is graded according to degree of damage:

  • Grade 1 – Localized swelling and softening of the cartilage with a size of not less than 0.5 cm.
  • Grade 2 – Fissuring and fragmentation in an area that is less than 1-3 cm in diameter.
  • Grade 3 – Fissuring and fragmentation within an area that is more than 1-3 cm in diameter.
  • Grade 4 – Ulceration and erosion of subchondral bone.

Treatment of Chondromalacia Patella

CMP usually does not require treatment if there are no symptoms. If it is symptomatic, pain management and rehabilitative treatment are the primary options.

  • Cold Compress – Putting an ice pack over the patella will help reduce the pain and swelling in the area.
  • Assistive devices – Immobilization and t use of crutches are sometimes necessary to control the symptoms.
  • Anti-inflammatory medications – Non-steroidal anti-inflammatory drugs like ibuprofen, naproxeb, advil, or aspirin are taken to relieve pain and inflammation.
  • Stretching and isometric exercises – Strengthening the hamstring muscles and quadriceps will help restore the normal function of the patella. One of these is the quad setting; it is done by contracting the thigh muscles while the legs remain straight.
  • Knee support – It can be worn to immobilize the knee and avoid compression and motion of the patella and cartilage.
  • Surgery – An operative treatment is suggested to the patient with persistent pain and progression of the affected part after he or she has received the conservative treatment. Surgery is intended to correct the unequal tension of the patella or to remove loose or nonviable cartilage from the posterior patellar surface.

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