Chondromalacia Patella - A Runner's Knee

Do you have a knee pain with a grating sensation?

Introduction

Diagram showing normal knee and chondromalacia patella affected knee

The people with Chondromalacia patella (CMP) have pain in front of the knee, and also, feel a grating sensation while they flex the knee. Chondromalacia patella is a condition which occurs due to the abnormal wear or damage of the cartilage, called as hyaline cartilage, present under the patella or kneecap. The hyaline cartilage is responsible for providing the cushioning effect and the smooth movement between the patella and the thighbone. The condition is mostly seen in teenagers and young adults, but it is more common in females. The exact etiology of the condition is poorly understood, but in most of the cases, it is associated with the injury-related factors. This article will help you know about the early symptoms so that you can take help from your physician before it becomes a serious one.

Symptoms and causes of Chondromalacia patella:

Chondromalacia patella is often confused with patellofemoral pain (PFPS) as CMP syndrome often occurs as a result of PFPS. The patients with CMP usually have the following symptoms:

  • Pain occurs in front of the patella (under the kneecap)
  • Knee pain aggravates in walking, climbing stairs, or while sitting with knee flexed for a long period
  • Grating or grinding sensation you bend the knee
  • Pain with Swelling of the knee
  • Tenderness on less pressure on the kneecap and stiffness of the knee
  • Crepitus or crunching sound when you move the knee joint in the normal range of motion.
  • As mentioned above, the exact cause of the condition is not known, but it is believed that it is caused by the unusual or aberrant drag of the thigh muscles (quadriceps) on the patella/kneecap, which leads to the knee cap being dragged out from the normal groove, making it irritated.

    Risk Factors of Chondromalacia Patella:

    The factors which can increase the risk of having the condition are:

  • Weakness or tightness of quadriceps muscles
  • Misalignment of the kneecap
  • Overuse of the knee, such as jumping, running, playing soccer, twisting, etc.
  • Previous history of knee cap injury or trauma
  • Diagnosis of Chondromalacia patella:

    X-ray showing the affected knee with chondromalacia patella

    The diagnosis of Chondromalacia is typically based on the observation of the symptoms. So, the physician will evaluate the condition depending on the physical examination, with some orthopedic tests. He /she may also advise you to go for a normal X-ray. So, the tests are:

    An X-ray helps in evaluating the following things:

  • Whether the patella is properly aligned with the femoral groove or not.
  • Shows the wear and tear between the patella and femur
  • Other tests may include:

  • MRI (magnetic resonance imaging)
  • Clark's Sign Test
  • Arthroscopic exam (In some cases, an arthroscopic examination is advised to examine the knee joint visually)
  • Treatment for Chondromalacia patella:

    The treatment of Chondromalacia patella is usually based on the causative factors. Your doctor should refer you to a physiotherapist to look more closely at your lower limb muscles. Typically, the treatment includes the following:

    Exercises:

    Exercise and stretching can really help beat the symptoms of Chondromalacia patella. They also work excellent if there is any muscle imbalance, and improve the movement of the kneecap.

    Knee Brace belt:

    Using a strap directly below the patella helps relieve pressure on the joint, reducing the pain. It is easy to use, and proven to be very effective.

    PRICE:

    PRICE stands for protection, rest, ice, compression, and elevation. This therapy helps reduce the pain and inflammation and provides a speedy recovery.

    Medication:

    NSAIDs (Non-steroidal anti-inflammatory drugs) like, ibuprofen help relieve inflammation and pain.

    Ice:

    Using ice regularly and also before and after any stressful activity can help reduce the inflammation and pain.

    Taping:

    It can help relieve pressure on the kneecap. It is actually useful when you are playing sports. A physiotherapist can guide you to do it properly.

    The modification of activity:

    Modify the current activity, instead of trying to swim or ride a bicycle. If you want to run, make sure you are wearing good shoes which give you comfort, and also stay away from hard surfaces, such as concrete.

    Footwear insoles:

    Orthotics like footwear insole can help correct the flatfoot and reduce the force across the kneecap.

    Knee pad:

    Knee Pads work great to reduce pain and irritation when you kneel.

    Surgery

    Surgical procedures are considered if the non-surgical treatment does not work, and also when the pain is not relieved. The surgery is performed by Arthroscopy, which requires 2-3 small holes around the knee and then need to insert a tiny camera. Then, the tight ligament is cut to allow the kneecap to sit in the right place at the slot, and to shave the every bit of damaged cartilage. Arthroscopic surgery is also effective to examine the inside of the joint, and to determine if there is any misalignment of the knee. Other surgical options may involve smoothing the back of the kneecap, the implementation of a cartilage graft or relocating the thigh muscle attachments.

    Tips to prevent chondromalacia:

    You can reduce your risk of developing CMP by following the below mentioned tips:

  • Avoid repeated stress to your knees; use knee pads.
  • Create muscle balance by strengthening your quadriceps, hamstrings, abductors, adductors.
  • Wear insoles that help correct the flat feet. This will decrease the amount of pressure on the knees and can realign the patella.
  • Excess body weight can increase stress on knees. So, maintaining a healthy body weight can help relieve the pressure on the knees and other joints. You can take steps to lose weight by reducing the amount of fat you consume, and maintaining a balanced diet that includes fresh fruits, vegetables, and whole grains. A regular 30 minutes of exercise at least thrice in a week can also help to beat the excess weight.
  • Chondromalacia is a condition which can be easily treated if you visit your physician at the right time. Luckily, is can be managed very well by physical rehabilitation and orthotics in most of the cases to alleviate the pain, which makes you able to maintain the active lifestyle. So, if you are experiencing the similar symptoms, then take an active role to consult with your doctor, before it becomes too complicated!