Chondromalacia Patellae

Knee Pain Associated With Overuse in Young Athletes

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Chondromalacia patellae is a term used to describe the damage or softening of the cartilage on the underside of the kneecap. It is similar to patellofemoral pain syndrome (runner's knee) in which the pain is felt under and around the kneecap.

This condition is common among young athletics but may also occur in older adults who have arthritis of the knee.

Causes of Chondromalacia

Chondromalacia patellae is caused by an irritation of the underside of the kneecap.

It may be the result of the simple wear-and-tear on the knee joint as we age. In younger people, it is more often due to an acute injury such as a fall or a long-term overuse injury related to sports.

Chondromalacia is often related to improper knee alignment. There can be many reasons for this:

Among adolescents, chondromalacia can be caused by the uneven development of bone and muscles during growth spurts. This can cause a transient misalignment that will later correct itself.

Symptoms

The underside of the kneecap and the top of the thigh bone are both covered with a smooth (articular) cartilage that allows the two bones to slide easily over the other.

If the cartilage is damaged, the surface of the joint can become rough and easily irritated whenever the knee is flexed or extended. Depending on the extent of the damage, the pain can be anywhere from minor to severe.

The most common symptom of chondromalacia patellae is a dull pain under or around the kneecap that increases when walking down the stairs.

There may also be pain when climbing stairs or rising out of a chair.

A person with chondromalacia with will often describe the sensation of grinding or cracking whenever the knee is moved. The pain will often be worse after sitting or standing in place for a long period of time or during activities that place extreme pressure on the knees, including exercise. Swelling and inflammation of the kneecap are also common.

Diagnosis and Treatment

Chondromalacia patellae is diagnosed with a combination of a physical exam and imaging tests such as an X-ray or magnetic resonance imaging (MRI) scan. The X-ray can typically reveal bone damage and arthritis, while an MRI is good at spotting deterioration of the articular cartilage.

Based on the severity of the condition, the doctor may prescribe rest, ice application, restriction of movement, and a nonsteroidal pain reliever as first-line treatment. In some cases, an orthopedic knee brace may be needed to keep the knee in a fixed position.

If these conservative measures do not provide relief, arthroscopic surgery may be recommended. For this procedure, the surgeon would use specialized debriding tools to smooth the surface of the articular cartilage and clean out any fragments that may be causing the joint to catch during movement.

In both cases, physical therapy would be recommended to strengthen the quadriceps and surrounding muscles so that the knee is better protected from further injury. This usually involves low-impact exercises such as swimming or a stationary bicycle. Isometric exercises, which involve the controlled flexing and releasing of specific muscles, may also be used to build muscle mass.

Source:

Kusnezov, N.; Watts, N.; Belmont, P. et al. "Incidence and Risk Factors for Chronic Anterior Knee Pain." J Knee Surg 2016; 29(03):248-53. DOI: 10.1055/s-0035-1554921.

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