CNY Orthopedic Sports Medicine, PC: Treatment: Chondromalacia Patella
 
Injuries and Conditions: Knee: Chondromalacia Patella: Treatment Options
 
Overview
Damage to cartilage on the undersurface of the kneecap will not typically require surgery for a full recovery. Chondromalacia patella may range from minor tears to severe wearing away of the cartilage beneath the kneecap. These differences in the severity of degeneration or erosion will affect the treatment decision, as will the degree of activity that the patient wishes to pursue after treatment.

Some patients, even with quite severe damage, may choose to not undergo surgery. Surgery is not usually required, as the condition frequently cannot be helped surgically. However, damaged cartilage cannot rebuild itself. Surgery attempts to remove the damaged cartilage and restore a smooth surface by creating a fibrous clot, the first stage required to build fibrous cartilage, in the area of the cartilage defect.


 
Treatment options:
Conservative Treatment of Chondromalacia PatellaChondromalacia Patella Surgical Micro-Drilling



Non-Surgical Treatment: Conservative Treatment of Chondromalacia Patella
  • Initial care will focus on rest and avoidance of activities which aggravate the condition. Activity that involves bending the knee, such as squatting, kneeling and climbing stairs should be avoided. Most of these activities place stress on the kneecap and result in pain.
  • Physical therapy will work to increase strength and stamina within the quadriceps and hamstrings, which will help stabilize the kneecap.
  • If muscle imbalances are producing a poorly tracking or positioned kneecap, proper conditioning of the thigh muscles to re-establish a bio-mechanically efficient joint is of critical importance.
  • Weight loss, if applicable, is recommended. This will help reduce stress on the joint, particularly when bending or when the knee is in a flexed position.
  • Non-steriodal anti-inflammatory medication may be administered to reduce inflammation and swelling in the joint.
  • Therapists may recommend activity modification and specialized bracing to support the knee during movement or while it is under stress. This may include a knee brace or, in some severe cases, a knee immobilizer.
  • Bandages or functional taping may be applied to the knee in order to re-position the kneecap.
  • If over-pronation of the feet is a factor, orthodic shoe inserts may be used to correct the patient's stance, reducing strain on the kneecap.
  • Rehabilitation exercises for non-surgically treated chondromalacia patella include: isometric quad sets, straight leg raises and isotoni hip.


  • Non-Surgical Product Considerations

    Orthotics
    An orthotic insert fits inside a shoe and helps position the foot in an anatomically correct position while walking, running, or jumping. Frequently, abnormal foot motion and gait occurs as a result of over-pronation of the foot; most orthotics are used to treat this condition. Over-pronation is a tendency to roll the foot onto the inner edge, loading the inside of the foot and leaving the outer edge almost weightless. A professionally made orthotic insert will exactly contour to the bottom of the foot, and can compensate for over-pronation or other abnormal foot mechanics.

    One of two construction methods may be used to create an orthotic; one utilizes a plaster mold of the entire foot to make a moderately rigid insert, the other utilizes a foam impression of the bottom of the foot, creating a more flexible insert. In either case, the finished product must be tilted with small wedges, while other accommodations are made to protect sensitive areas of the foot. The choice of orthotics and design will vary according to the expected use, foot type, and body weight.

    Orthotics can be used to treat:

  • abnormal foot mechanics
  • patella dislocation or maltracking
  • patellar tendonitis
  • general knee pain
  • ankle instability

  • Knee: Compression Sleeves
    Knee compression sleeves give added support, increasing stability and helping to reduce swelling in an injured knee. Patients that have light sprains may be directed to use a compression sleeve during the early stages of rehabilitation. Other patients that have ongoing knee problems or chronic conditions may be recommended to use a sleeve on a daily basis. These sleeves are less restricting than most other knee supports and can be worn under loose fitting clothing.

    Knee compression sleeves can be used to treat:

  • Light swelling.
  • Light knee strains.
  • Chronic inflammation.
  • Degenerative joint disease.

  • Patella Supports

    Surgical Treatment: Chondromalacia Patella Surgical Micro-Drilling
    Chondromalacia patella is a rough, uneven surface on the patella's back surface. The first step in this procedure is to smooth this surface using a tiny deburring tool. Then, a series of very small holes are carefully drilled into the patella, which causes a small amount of bleeding and scarring. The blood forms clots and scars, which creates a hard, smooth surface on the bone. This natural substance partially mimics the function of cartilage, and facilitates improved, low-friction movement of the back surface of the patella.


    Surgical Product Considerations

    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.

  • Surgical Hardware Considerations
    No hardware is implanted in the surgical procedure.


     
    Factors in Transplant Source
    This surgical procedure does not involve transplanted material.


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