CNY Orthopedic Sports Medicine, PC: InjuryDetail: Chondromalacia Patella
 
Injuries and Conditions: Knee: Chondromalacia Patella: Medical Details
 
Overview
Chondromalacia is wear and degeneration of the articular (weight-bearing) cartilage covering the bones that make up the joint. Chondromalacia patella, occurring in the knee joint, is the most common location of this articular cartilage degeneration. This can be, but is not always, associated with malalignment of the patella.

Cartilage is found throughout the body, and depending upon its location, varies in its composition and structural qualities. In the ear or nose, it provides a flexible framework or support that can easily bend without injury or discomfort. In the knee, however, cartilage provides structure which supports the entire joint. The softer and nearly frictionless cartilage allows the bones to fit together and function with mechanical efficiency.

The underside of the kneecap (patella) is covered with cartilage, and during movement this cartilage provides critical insulation or cushion between the bones. Certain activities that require bending the knee, such as walking up stairs, place great pressure on the underside of the kneecap - up to six times the body weight - as it is pressed against the thigh bone. This cartilage helps smooth and distribute these forces across the femur and patella, as the cartilage covering the underside of the patella contacts the cartilage covering the femur. As the cartilage wears away, these bones gradually come closer to one another, and may eventually come in direct contact with each other. Any degeneration or injury to the cartilage of the kneecap reduces the smooth functioning of the joint, narrows the protective layer between bones, and increases the friction within the joint.

Cartilage will begin to wear in individuals and cannot be replaced or repaired by the body. The severity and rate of degeneration varies from person to person. The process of cartilage degeneration occurs in all individuals to the point that approximately 60% of all sixty year-olds will have some cartilage fraying or tearing.



Causes of Injury
  • Chondromalacia patella results from a combination of factors including heredity, intensity of athletic activity and the extent of previous injury.
  • Repetitive actions which impact or stress the knee from a particular motion can cause additional damage over time.
  • Over-pronation of the foot, which causes the lower leg to rotate inward, can accelerate the erosion, softening or degeneration of the cartilage. In this position, the kneecap is pushed to the outside (laterally) which can result in increased pressure and improper wear of the kneecap.
  • If the patient has weak thigh muscles, the kneecap is less likely to be held in its proper position during athletic activity, leading to increased wear on the underside of the kneecap.
  • Any muscle imbalances in the thigh can also contribute to injury. A common problem occurs when the muscles on the outside of the leg are much stronger than those on the inside. This causes the kneecap to be pulled toward the outside of the leg.
  • Women are more likely to have these muscle imbalances because the connection of the thigh muscles between their pelvis and knee is at a larger angle than in men. Women, who have a larger pelvis than men, may have an increased Q angle (when the hips are much wider than the knees), which increases the chances of the kneecap being pulled to the outside (lateral) of the knee.

  • Diagnosis
    The physical exam will include analysis of the knee's mechanical characteristics. The patella will be checked for any abnormalities in tracking, location or movement. Also, an examination of the tissue and ligaments around the kneecap will demonstrate any areas of tightness, inflamation or tenderness.

    Both the location of pain and the movements that cause pain are used to diagnose the condition. Pain will generally occur when abnormal or unequal pressure is placed on the underside of the kneecap. Squatting or other movements that bend the knee and cause pain centered beneath the kneecap may indicate damage. It is possible for some patients to have a long history of knee injuries and conditions which can cause similar types of pain. Additional tests to view the condition of the knee's internal structures can be used to assess the condition of the cartilage and the tracking of the patella.
    Symptoms:

  • Continual discomfort or irritation behind the kneecap or throughout the front of the knee.
  • Pain while extending the leg and while walking or running.
  • Particularly strong pain while climbing or descending stairs or during movements that place considerable force on the front of the knee.
  • Discomfort or pain after sitting or keeping the knee motionless in a flexed position for an extended period of time.
  • A feeling or sensation of grinding, popping or snapping in the knee during motion.
  • Usually, the more advanced the condition, the more severe the pain in the knee.
  • Anatomy
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     Product Considerations
    Knee: Patellar Supports
    Patella tracking supports are used to maintain the kneecap in its proper position while the knee is in motion. Patients that have a poorly tracking or misaligned kneecap will usually be directed to wear a support to prevent the kneecap from dislodging from the femural groove. Pressure applied by the support is adjustable, allowing changes to the support according to the condition of the knee. The support fits firmly around the knee with pressure to each side of the kneecap. Construction of the support is thin and elastic, which allows for easy movement and enables the support to be worn under loose fitting clothing.

    Patella tracking supports can be used to treat:

  • Patellar malalignment
  • Patellar dislocation
  • Patellar instability
  • Anterior knee pain

  • NSAIDs
    NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.


  • Knee: Cold Therapy
    Cold therapy is used to reduce pain and swelling and is a convenient method to apply cold to an injured or rehabilitating extremity, such as a knee or shoulder. A cuff fits like a sleeve around the extremity and utilizes cold water supplied by a connected thermos or canister to chill the extremity. Water flow into the cuff can be controlled by different mechanisms. The simplest way is gravity; elevating the canister fills the cuff and controls the amount of pressure against the extremity. Water flow may also be controlled by a pump which will automatically circulate the cold water to and from the cuff. After surgery or immediately following an injury, the canister should be refilled with cold water every one to two hours to maintain a proper temperature. The cold therapy may also be used during rehabilitation, especially after physical activity, reducing the inflammatory heat from exercise.

    Cold therapy can be used to treat: Knee, Shoulder, Elbow, Wrist and Hand, Back, Hip, and Foot & Ankle Injuries.

    Knee Examples include:

  • Pre-operative ACL/PCL injuries.
  • Non-surgical ACL/PCL injuries.
  • General knee pain or swelling.
  • Soft tissue injuries.


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