Anatomy & Background

The knee is the largest joint in the body. It was designed for bearing weight, stability and mobility. The knee is made up of four bones and three different bone-to-bone joints: the patella-femoral joint, tibio-femoral joint, and the tibio-fibular joint. The knee joint itself is surrounded by eleven separate bursae. A bursa is a fluid filled sack. It is used to help reduce the friction between tendons, and also between tendons and bone.

Function of the Patella

  • It protects the front of the knee.
  • It acts as a support to provide leverage, thus permitting the quadriceps tendon to perform more efficiently and allow for greater force when extending the knee.
  • The patella glides up and down in a groove formed between the two condyles of the femur (leg) bone.

Causes

Chondromalacia is the softening of the cartilage underneath the patella. Cartilage, a smooth surface on the patella, allows the patella to slide over the femur seamlessly. Common causes for injuries to this piece of cartilage include:

  • Breakdown of the cartilage due to joint degeneration or arthritis.
  • Misaligned movement of the patella on the femur may cause wear on the under-surface of the patella which causes chondromalacia.
  • An acute impact to the patella may cause the under-surface of the patella to be damaged

Symptoms

  • Pain in the patella area especially when squatting, kneeling, running and walking up and down stairs. Pain is probably more noticeable when walking descending the stairs.
  • A feeling of the knee buckling and giving way.
  • A feeling of catching, crackling, grinding or sandpaper underneath the knee cap.
  • Inflammation of the knee joint.
  • Pain when sitting for long periods of time. Pain may also be present when getting up from a seated position.
  • Inflammation may be lining either side of the patella.
  • Restriction or limitation in patella movement.

Treating Chondromalacia

  • Chondromalacia treatment should include avoiding any activities that produce pain or can possibly stress the patella such as jumping, running, kneeling, descending and climbing stairs and squatting.
  • Use ice to reduce any swelling and pain.
  • NSAIDS (non-steroidal anti-inflammatory drugs)
  • Physical Therapy
  • Use of a knee brace to stabilize the knee.
  • Patella taping can be used to improve the alignment of the knee cap during activity and exercise.
  • Surgery may be needed in severe cases, in order to release the tight structures of the outside of the knee. This procedure is known as a lateral release.

Medicine Intervenes

Activities that produce pain or stress should be avoided.

  • RICE: Rest, Ice, Compression and Elevation can be used to lower the strain on the bursa.
  • NSAIDS (non-steroidal anti-inflammatory drugs) to reduce pain and swelling.
  • Use of a knee brace to steady and improve proper directional movement of the patella
  • Surgery may be needed in severe cases. PLEASE NOTE: Only a specialist can diagnose whether surgery is needed or not.

Prognosis

Patients normally respond well to conservative treatment of chondromalacia. It is important that when the pain and swelling is reduced, the patella is tracking properly, and strength is restored, that the patient return slowly back to normal activities. In most cases, full recovery will take anywhere from four to six weeks. This is dependent on the severity of the condition. As a preventive measure individuals should:

Make modifications in work or daily activities.

Avoid kneeling, squatting, or use protective equipment to avoid sustained pressure or unanticipated impacts on the patella.

Maintain strength and flexibility to diminish stress on the patella and to keep from creating imbalances in the patellas’ tracking.

Avoid highly repetitive actions involving the patella whenever possible.