Chondromalacia patella is the affliction of hyaline cartilage on the posterior articular surface of the patella. It is one of the conditions that are collectively known as the runner’s knee.
The condition begins with the loss of density in cartilage, making it soft and swollen. The matrix turns from a bluish-white, glistening, smooth to a dull, yellowish-white substance. As the condition progresses, the tissue tears break into fragments and erode.
It is a multifactorial condition that causes pain in multiple regions within the knee. It hampers the individual’s range of motion in the knee. Hence, a deeper understanding of the causes and treatment options for chondromalacia patella is crucial in managing and preventing the condition.
Causes of Chondromalacia Patella
Below are some of the chondromalacia causes that you must know.
- Overuse of the Knee Joint
Overuse of the knee joint exerts sustained pressure on the articular cartilage that does not allow the required time for cartilage to restore its structure and composition at rest. It causes wear and tear and softens the tissue.
- Abnormal Tracking of the Kneecap
Q-angle is the angle between an imaginary line drawn between the center of the anterior iliac spine and the center of the patella. It joins the mid-portion of the patella to the tibial tubercle and represents the relative force exerted by the quadriceps and patella tendon. Q-angle greater than 20 or 25 leads to chondromalacia patella.
- Trauma or Injury to the Knee
Injuries to the knee cause wear and tear of hyaline cartilage, leading to chondromalacia patella. On the other hand, direct impact on the patella causes quadriceps atrophy, decreasing the pull of quadriceps on the patella. It eventually leads to the softening of hyaline cartilage.
- Muscle Imbalances or Weakness
Weakness in one of four constituent muscles of the quadriceps called Vastus Medialis Oblique (VMO) leads to the condition. Weak general core muscles also contribute to the chondromalacia patella.
- Genetic Predisposition
People with mutations in gene HAUS2 that codes for HAUS Augmin-like complex subunit 2 suffer from familial chondromalacia patella. It is a rare genetic disorder.
Symptoms of Chondromalacia Patella
Here are some of the chondromalacia patella symptoms that you must know.
- Pain or Tenderness in the Knee
Anterior knee pain is the most common chondromalacia patella symptom. Some patients may complain of insidious onset of vaguely diffuse pain in the retro patellar and prepatellar region.
- Swelling or Inflammation
Patients may observe swelling on the lateral surface of the knee due to the collection of fluid in response to inflammation. It also irritates the knee.
- Grinding or Popping Sensation
Patients feel a grinding sensation in the knee while moving stairs and standing up from a chair.
- Stiffness or Limited Range of Motion
Patients experience stiffness when they flex their knees. The range of motion of the knee reduces due to pain.
Diagnosis of Chondromalacia Patella
- Physical Examination
Clarke’s test is the physical examination to evaluate the knee for the chondromalacia patella. An examiner positions the patient in a supine posture with the knee extended.
The patient should gently and gradually contract the quadriceps while the examiner holds the leg straight by applying pressure on the region just above the patella. The pain upon contraction indicates chondromalacia patella.
- Imaging Tests
Radiography
X-ray is the radiographic modality that helps diagnose chondromalacia patella at later stages because it has low sensitivity and specificity to early pathological changes. Chondrosis, cystic changes, cartilage loss, or joint space loss are general radiographic observations indicating the condition.
CT Scan
CT scan helps evaluate patellofemoral alignment by determining trochlear geometry. Besides, it also helps identify and measure the lower limb’s torsional deformity, which indicates the relative thickness of cartilage damage.
MRI
This abnormal cartilage appears as high signal intensity on MRI films. Other variables used to assess the condition include sulcus angle, trochlear depth, patellar angle, and evaluating patellar tilt by measuring lateral patellar tilt angle.
Arthroscopy
Arthroscopy is the most precise diagnosis modality that reveals the cartilage lesions’ location and size.
Treatment Options for Chondromalacia Patella
- RICE Therapy
RICE is the primary measure recommended to prevent the worsening of the condition. Here are the steps to carry out this therapy:
Resting the knee reduces energy consumption and diverts it towards a self-healing mechanism.
Placing ice on the knee reduces the heat due to inflammation. It also reduces the intensity of inflammation and provides prolonged cooling that soothes surrounding muscles.
Compression mobilizes the affected cartilage, increases the lymphatic flow into the synovial fluid, and provides more anti-inflammatory factors.
Elevation helps reduce downward pressure on the knee, allowing cartilage to recover.
- Pain Relief Medication
Some NSAIDs, including naproxen, aspirin, and ibuprofen, control pain. They are more effective than steroids.
- Physical Therapy
Physical therapy includes exercises with a focus on strengthening the following muscles.
Quadriceps using closed chain short arc quadriceps exercises.
Vastus medialis oblique.
Hip external rotators.
Quadriceps strengthening exercises help reduce anterior knee pain at early stages.
- Knee Braces or Taping
Knee braces, often called patellar straps, support the kneecap and apply pressure to patellar tendons. As a result, it improves patellar tracking.
Besides, orthotics to reduce foot pronation prevents forces that travel from the foot upward toward the knee. Thus, they resist twists at the tendons in the articulations behind the knee cap.
- Injection Therapy
Injection of mesenchymal stem cells into the articular space is a safe and clinically effective modality of chondromalacia patella treatment. It is non-invasive, provides symptomatic relief, and inhibits inflammatory changes.
- Surgery
The choice of surgical intervention depends on age and degree of severity.
Patellar Cartilage Shaving
It involves removing damaged cartilage and allowing the healthy cartilage underneath to grow and refill the space.
Patellar Cartilage Drilling
It involves drilling holes in the damaged cartilage to allow space for the healthy cartilage to grow through the holes. The efficacy of the method is unknown.
Knee Prosthesis
It involves replacing the affected patellar with a prosthetic knee cap made of polyethylene. The limitation of this procedure is the artificial knee cap begins wearing the opposing articular surface after some time.
Patellar Realignment
It restores the biomechanical force axis of the patellofemoral joint improving its functions. However, it would result in the degeneration of the joint.
The surgeries that involve the removal of damaged cartilage must also address biomechanical deficits. The corrective procedures are as follows.
- Tightening of medial capsule
- Lateral release
- The medial shift of the tibial tubercle
- Partial removal of the patella.
Prevention of Chondromalacia Patella
- Warm-Up and Cool-Down Properly Before and After Exercise
Slow and low-intensity knee movements in a broad range of motion reduce the risk of wear and tear in the cartilage. Thus, warm-up and cool-down elements narrow the risk for chondromalacia.
- Strengthening Exercises for the Muscles around the Knee
Isometric quadriceps strengthening and stretching exercises improve patellar joint performance and correct patellar misalignment. Thus, decreasing the risk of chondromalacia patella.
- Wearing Proper Footwear
Footwear with soles that reduce foot pronation and improve lower limb mechanics help manage pain.
- Maintaining a Healthy Weight
Bodyweight beyond the weight-bearing capacity of knees exerts high pressure causing wear and tear in tendons, ligaments, and cartilage in and around the knee. Hence, maintaining a healthy body weight prevents the condition.
Conclusion
Chondromalacia patella progresses gradually rather than occurring instantaneously. Treating damaged cartilage of higher thicknesses is complex, and the prognosis is inefficient. Hence, the diagnosis at the initial stages helps prevent the burden of treatment at late stages.
Persistent pain management using over-the-counter medications help restore quality of life for the time being. But the pathological changes aggregate until the medicines do not help anymore. Therefore, patients should opt for a consultation with an orthopedic specialist.