Chondromalacia patella: symptoms, causes, diagnosis, treatment and prognosis?

Chondromalacia patellae, also known as patellofemoral syndrome, is a condition that affects the cartilage at the bottom of the kneecap (patella) and the groove (trochlea) at the end of the thigh bone (femur). This condition can cause several symptoms and may require treatment.


Symptoms:

  • Anterior knee pain: The most common symptom is pain in the front of the knee, often described as a dull, aching pain. The pain is usually aggravated by activities that involve bending the knees, such as climbing stairs, squatting, or sitting for long periods.
  • Cracking or popping sensation: Some people may experience a cracking or popping sensation in the knee when moving it.
  • Swelling: Swelling may occur around or behind the kneecap, especially after physical activity.
  • Weakness: Weakness in the quadriceps (thigh) muscles is common, as the pain can limit the ability to exercise or perform physical activities.

Causes:

  • Poor alignment: Improper tracking of the kneecap in the trochlea can cause increased pressure and friction, leading to cartilage damage.
  • Overuse or overuse: Activities that involve repetitive bending of the knee, particularly those that put additional pressure on the patellofemoral joint, may contribute to chondromalacia patellae.
  • Muscle Imbalances: Weakness or imbalances in the muscles around the knee, especially the quadriceps, can affect patellar stability.
  • Direct trauma: A direct blow to the knee can cause cartilage damage.

Diagnosis:

Clinical evaluation: A healthcare provider will perform a physical examination to evaluate kneecap movement, alignment, and the presence of any symptoms.


Imaging studies:

  • X-rays: X-rays can help identify a structural abnormality or osteoarthritis in the knee joint.
  • MRI (magnetic resonance imaging): An MRI is often used to visualize soft tissues, such as cartilage, to assess the extent of cartilage damage.

Treatment:


Conservative treatment:

  • Rest: Reduce or modify activities that exacerbate symptoms to allow the knee to heal.
  • Physical therapy: Physical therapy can provide exercises to strengthen the quadriceps and improve knee stability, as well as techniques to reduce pain and inflammation.
  • Orthotics: Custom or over-the-counter orthotic insoles can help provide adequate support for the foot, which can influence patellar alignment.
  • Knee Brace: Patella stabilizing straps or braces can help support the kneecap and relieve pain.
  • Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to control pain and inflammation.

Hyaluronic acid or corticosteroid injections: In cases of significant pain and/or inflammation, hyaluronic acid or corticosteroid injections may be considered.


Surgery: Surgical intervention is generally reserved for cases where conservative treatments are ineffective or in the presence of severe cartilage damage. Procedures may involve cartilage repair, realignment of the kneecap, or, in severe cases, replacement of the patellofemoral joint.