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Chondromalacia Patella

Questions

What is Chondromalacia Patella?

Chondromalacia is the affliction of hyaline cartilage coating of the articular surface of the bone. Most commonly it is recognized as involving the extensor mechanism of the knee and accordingly is often referred to as Chondromalacia of the patellae, patellofemoral syndrome or runner's knee. Chondromalacia patellae is referred to as anterior knee pain due to physical and biochemical changes. The articular cartilage of the posterior surface of the patellae is going through degenerative changes which manifest as softening, swelling, fraying and erosion of hyaline cartilage underlying the patellae and the underlying bone.

Symptoms of Chondromalacia Patella

·         Chondromalacia patellae (CMP) affects just one side of the joint, the convex patellar side with excised patella’s show localized softening and degeneration of articular disc.

·         The main symptom of CMP is anterior knee pain, which is exacerbated by common daily activities that load the patellofemoral joint such as running, stair climbing, squatting, kneeling, or changing from a standing to sitting position.

·         The pain often caused the disability affecting the short-term participation of daily and physical activities.

·         Tenderness on palpitation on the medical and lateral border of patella

·         Crepitations felt on motion.

·         Minor swelling.

·         A weak vastus medialis muscle and a high Q angle which leads to weakness in quadriceps. Therefore, quadricep strengthening is essential.

Causes of Chondromalacia Patella

It is believed that the causes of chondromalacia are:

·         Injury

·         Generalized constitutional disturbance and patellofemoral contact.

·         Or as a result of trauma to chondrocytes in the articular cartilage (Leading to proteolytic enzymatic digestion of the superficial matrix.

·         Instability or malt racking of patellae which softens the articular cartilage.

·         Chondromalacia patellae, an overload injury is caused by malalignment of the femur to patellae and tibia.

Diagnosis of Chondromalacia Patella

Examination of knee is 4-fold;

·         Observation: joint appearance is usually normal but there appears to be slight effusion.

·         Mobility: passive movements are usually painless and free, but repeated extension of knee from flexion will produce pain and a grating feeling underneath the patella, especially if the articular surfaces are compressed together.

·         Feel: pain and crepitus will be felt if the patellae is compressed against the femur, either vertically or horizontally, with the knee in full extension. By displacing the patellae medially or laterally, the patellar margins and their articular surfaces may be felt. Resisting a static quadriceps contraction will generally produce a sharp pain under the patella.

·         X-rays: In most of the cases there is no convincing radiological change. In the later stages, patellofemoral joint space narrows and osteoarthritic changes begin to appear.

Tests:

There are specific tests for anterior knee pain syndrome;

·         Patellar grind test or Clark’s sign – The test detects the presence of patellofemoral joint disorder. A positive sign on this test is pain in patellofemoral joint.

·         Extension- resistance test – This test is used to provide a maximal provocation on the muscle-tendon mechanism of the extensor muscles and is positive when the affected knee demonstrates less power when trying to maintain pressure.

·         Compression test.

Treatment of Chondromalacia Patella

·         Exercise program –

ü  Isometric quadriceps strengthening and stretching exercises.

ü  Hamstring stretching exercise

ü  Temporary modification of activity

ü  Patellar taping

ü  Foot orthoses

ü  Hip strength and stability training

ü  Hip abductor strengthening

ü  Patellar realignment brace. 

·         Ice medication - may be used for reducing pain in an acute flare-up, but not as a long-term treatment protocol.

·         Taping and braces- Taping if patella is done to influence bits movement. It may provide short term relief.

·         Supporting the patella and the knee joint by bracing is a further way to reduce pain and symptoms, but will alter patella     tracking and reduce active function of quadriceps. Bracing may be useful in short term to offer patients some support and pain   relief.

·         Foam roller – It is useful for relieving tight musculature and reducing pressure over patella.

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