Chondromalacia patellae, also known as “runner’s knee”.
It is a condition where the cartilage on the undersurface of the patella deteriorates and soften.
This condition is common in young, athletic individuals, but may also occur in older adults.
poor alignment due to a congenital condition
repeated stress to knee joints, such as from running, skiing, or jumping
a direct blow or trauma to knee
weak hamstrings and quadriceps
muscle imbalance between the adductors and abductors
Age: Adolescents and young adults are at high risk
Pain around the knee.
The pain is usually located at the front of the knee, around or behind patella.
The pain is typically worse when going up or down stairs.
It may be brought on by sitting for long periods.
Rarely effusion of the knee joint.
Chondromalacia patella is graded based on the basis of arthroscopic findings, the depth of cartilage thinning and associated subchondral bone changes.
Moderate to severe stages can be seen on MRI.
Stage 1: softening and swelling of the articular cartilage due to broken vertical collagenous fibres.
Stage 2: blister formation in the articular cartilage due to the separation of the superficial from the deep cartilaginous layers.
Cartilaginous fissures affecting less than 1,3 cm2 in area with no extension to the subchondral bone.
Stage 3: fissures ulceration, fragmentation, and fibrillation of cartilage extending to the subchondral bone.
Stage 4: crater formation and eburnation of the exposed subchondral bone more than 50% of the patellar articular surface exposed, with sclerosis and erosions of the subchondral bone.
Osteophyte formation also occurs at this stage.
X-ray: a AP view of the patellofemoral joint is needed to detect any radiological change.
In all but the most advanced cases, there is no convincing radiological change.
In the latter stages, patellofemoral joint space narrows and osteoarthritic changes begin to appear.
Patellar grind test or Clarke’s sign
conservative treatment of chondromalacia patellae is both physical and highly advised.
Short-wave diathermy helps to relieve pain and to increase the blood supply to the area, improving nutrition supply to the articular cartilage.
Care must be taken when planning an exercise programme.
Isometric quadriceps strengthening and stretching exercises: restoration of good quadriceps strength and function is an important factor in achieving good recovery.
The most effective exercises are isometric and isotonic in the inner range.
stretching of the vastus lateralis and strengthening of the vastus medialis.
Hamstring stretching exercis
Temporary modification of activity
Hip strength and coordination training, as hip positioning and strength has a significant influence on anterior knee pain.
Hip abductors strengthening as an increased hip adduction angle is associated with weakened hip abductor
Although stretching can improve flexibility and knee function, it doesn’t necessarily directly improve pain.
Taping and braces
Supporting the patella and knee joint by bracing is a way to reduce pain and symptoms.
but it will also alter patella tracking and reduce active function of the quadriceps.
Bracing may be used in the short term goal patients some support and pain relief.