What is Chondromalacia Patella? Causes, Symptoms, and Treatment

Introduction

Is chondromalacia patella causing knee joint pain? Most are still unsure about its precise meaning. If symptoms like pain around the kneecap or grinding noise are what you are experiencing, then you might be suffering from this fairly common disorder.

In this article, the causes, symptoms, and effective treatments of chondromalacia patella will be discussed in detail to give you a better insight into the condition and its management.

What is Chondromalacia Patella?

In simple terms, chondromalacia patella is a condition in which the cartilaginous tissues of the kneecap undergo a softening or deterioration, or get damaged. This cartilage is known as articular cartilage because it provides cushioning to the knee joint to facilitate smooth movement.

Degradation of this cartilage is the leading cause of pain, swelling, and other complications, which affects the proper function of the knee in chondromalacia patella. Abnormal knee alignment, muscle imbalances, and the overuse of the knee are other common contributing factors. All such abnormal stresses acting on the joint create an abnormal patella-femoral joint.

Thus, damage to the articular cartilage can invoke a biological reaction, which may lead to symptoms of inflammation and pain in performing different activities such as walking, running, or climbing stairs. Such a condition is not so uncommon among young athletes and active persons, but it can affect any age.

What Causes Chondromalacia Patella

Several causes are involved in the abnormal stress placed upon the knee joint, which eventually causes further damage to the cartilage. These causes are:

Over-activity and Repetitive Strain: Among them, running, jumping, or cycling activities that involve repetitive knee movement have worn the cartilage and may do so over time.
Knee Misalignment: Thereby leading to patellar tracking abnormalities, i.e., not following a smooth movement over the femoral groove, which would result in an uneven distribution of forces, thereby increasing the chance for cartilage damage.
Muscle imbalances: Weak or imbalanced muscles about the knee, particularly the quadriceps, can affect patellar alignment and movement, producing abnormal wear on the cartilage.
Prior Injury: Damage caused to the cartilage can be because of the following factors, namely, history of knee injuries such as ligament tears or fractures.
Aging and degeneration: As he grows older, the cartilage will undergo the normal wear and tear, and thus, get chondromalacia of the patella.
Genetic Factors: Genetic predisposition toward knee joint or cartilage abnormalities is found in some individuals, which causes a higher probability for the pathological condition.

Common Symptoms of Chondromalacia Patella

Some common symptoms of chondromalacia patella can vary considerably in severity, depending on the extent of the condition. These include:

Pain in the knee: Another prominent symptom is pain in the front of the knee, especially around or behind the patella, aggravated when climbing stairs, squatting, or sitting for long periods when the knee is bent.
Grinding or popping: Another signature symptom is the feeling of grinding, creaking, or popping in the knee during movement, especially while walking or bending the knee.
Swelling: Along with that, swelling or a feeling of fullness around the kneecap comes because of soft tissue inflammation around the joint.
Stiff knee: That is where they may experience stiffness, usually after long periods of inactivity or sitting.
Weakness or Instability: The knee often feels weak or unstable, making it uncomfortable to fully straighten the leg or bend it.
Tenderness: Tenderness around the kneecap may also give you a really tender point to touch, while pressing on the patella can also produce pain or discomfort.

Who is at risk for Chondromalacia Patella?

The following factors predispose certain individuals to develop chondromalacia patellae:

Athletes and Active Individuals: Those engaged in high-impact or repetitive activities of the knee, which include actions such as running, jumping, or cycling, are at higher risk due to constant stress on the knee joint.
Adolescents and Young Adults: Typical for this age group, especially during growth spurts, when the patella may not fit well in the femoral groove.
Women: More likely to be affected due to anatomical variations, wider hips, and an angle of the knees altering the patellar tracking.
Muscle Imbalance: Weak or uneven muscles around the knee, especially the quadriceps, can be primary factors for impaired patella movement and increased pressure on the cartilage.
Abnormal Knee Alignment: Structural problems like flat feet, tilted patella, or shallow femoral grooves result in the improper tracking and damage of the cartilage.
History of Injury on Knees: Previous dislocation injuries, ligament tears, or knee injuries can bring in additional changes in knee mechanics that increase injury susceptibility.
Older Adults: Natural wear of cartilage due to aging can contribute to the disease, in most cases without an antecedent injury.
Obesity: Extra body weight increases additional stress on the knees, prompting increased cartilage breakdown.

Diagnosis of Chondromalacia Patella

Diagnosis chondromalacia patellae, as specified above, includes an exhaustive medical history, thorough examination, and the preceding diagnostic imaging. This may include:

Medical History: The residence of the health officer looking after the person and of making inquiries; through such symptoms recorded by the patient to develop a timeline of the symptoms’ origin, duration, and nature of knee pain (for example, whether the patient has ever injured his knees, overused, or exerted them in physical activities).
Physical Examination: This is a comprehensive examination; to assess all parameters, such as knee alignment, mobility, and areas of tenderness, the doctor may do a couple of specific tests, like:

Patellar Compression Test: The doctor examines the knee, moving it through its range of motions, while applying a push against the patella, to be monitored for pain or discomfort that might signify cartilage damage.
Clark’s Test (Patellar Grind Test): The doctor will apply pressure to the patella and ask the patient to tighten their quadriceps muscle to evaluate the movement and possible grinding sensation.

Imaging Tests:
- X-Rays: Though X-rays will not be able to visualize cartilage damage directly, they can sometimes rule out other knee problems such as fractures, misalignment, or arthritis. Thus, the changed morphology of bones, narrowing of joint space, etc., are ways by which chondromalacia might be suggested by x-ray.
- MRI: An MRI is the best method for obtaining images where damage cannot be diagnosed through imaging techniques such as CT scans or X-rays due to poor resolution. This computerized tomographic scan provides an excellent view of the soft tissues, including articular cartilage, and changes in the knee.
- CT Scan: Sometimes, a CT scan might be used to view its bone structures and patellar alignment more clearly.
Arthroscopy: Rarely, after one or two rounds of botched conservative management, the doctor may call for an arthroscopic procedure to diagnose the ailment more definitively. Minimal invasive surgery introduced a small camera into the joint of the knee to look at the damage done directly to cartilage at the time of damage assessment.

Treatment Options for Chondromalacia Patella

Alter the Inability of the Articular Cartilage in the Patella or the so-called “Runner’s Knee.” This is caused by damage to cartilage underneath the kneecap, thus resulting in knee pain.

Treatments, therefore, depend on the severity of the condition, and in most cases, the initial non-surgical method of remedy is used.

Conservative (Non-Surgical) Treatments
- Rest and Activity Modification: Maintain activity levels low or try and go for low-impact exercises such as swimming or cycling; one must avoid high-impact activities. Ice therapy: Ice, applied for 15-20 minutes several times a day, is very effective for pain relief and helps reduce swelling.
- Physical Therapy: Strengthening and stretching exercises for the thighs and hips will improve patellar tracking. Bracing or taping: The knees will be supported, as well as reduced strain. NSAIDs: Ibuprofen and other non-steroidal anti-inflammatory drugs offer pain and inflammation relief.
Orthotics

- Footwear modification: Supportive shoes or insoles that could help enhance alignment and reduce stress on the knee.
- Customized orthotics: A correction in mechanics and pain alleviation would be aided by specific inserts.
Injection

- Corticosteroids provide relief, although it is temporary and does not last long.
- Hyaluronic Acid: Joint lubricant and increased mobility.

Surgical Options

- Arthroscopy: This is a type of procedure that minimizes the size of the opening used for removing or smoothing damaged cartilage.
- Realignment Surgery: Involves repositioning the kneecap so that it is better tracked. Cartilage Repair: There are some advanced procedures like ACI, microfracture, or OATS that may be able to restore some of the damaged cartilage.
Lifestyle & Prevention:
- Weight Management: The stress on the knee accelerates cartilage wear.
- Strength Training: Building strength in the core, hips, and thighs helps prevent a recurrence.

Conclusion

Chondromalacia patella, a painful condition that involves degenerating cartilage under the kneecap, is usually associated with pain, swelling, and limitation of movement. If detected at an early stage, treatment is mainly conservative and directed towards alleviating symptoms; surgery is warranted in more severe cases.

The condition typically lies within the discipline of orthopedics, which is a specialty dealing with disorders affecting the musculoskeletal system. Goyal Hospital has established a good reputation for its strategic management of cases of chondromalacia patella, focusing on recent advancements and therapies for improving knee function and relieving pain.