CNY Orthopedic Sports Medicine, PC: TreatmentPrint: Chondromalacia Patella
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Injuries and Conditions: Chondromalacia Patella : 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:

Chondromalacia Patella Surgical Micro-Drilling Overview
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.

Evaluation of Patient for Surgery

  • Patients are given a complete physical examination which provides an assessment of the patient's overall health.
  • An examination is given of the range of movement in both the injured and uninjured knee.
  • Strength and walking (gait) ability is measured and analyzed.

    Post Operative Recovery

  • Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, although the effects of anesthesia can vary greatly from patient to patient.
  • The knee will remain tender and painful after surgery. The most intense discomfort is felt in the first 24-48 hours, after which the pain generally steadily decreases.
  • At the first post-operative visit to the doctor, the sutures are removed, motion is examined, and the patient may be directed to a physical therapist.
  • Braces are usually prescribed when patellar malalignment is present, to provide the patient greater control of the knee.
  • Close examination of the knee during the following four to six weeks is needed to ensure that the knee is healing correctly.
  • Some athletic activities like jogging are occasionally allowed after three months, though often only in a controlled environment such as on a treadmill.
  • Sport-specific exercises are allowed according to their intensity level and strain on the recuperating knee.

    Post Operative Instructions
  • If the surgeon has prescribed a brace, wear the brace at all times, except when bathing or showering.
  • Bear weight as tolerated in the brace with the knee locked in full extension.
  • Use crutches as needed.
  • Ice the knee three times a day for 20 minutes.
  • Keep the wound dry. The dressing can be removed for showering (with the knee wrapped in plastic kitchen film) as directed by your surgeon.
  • Three times a day, for 30 minutes each time, sit with a large towel roll under the heel with the brace locked in full extension.
  • It is normal to have some discomfort and swelling, as well as some blood-tinged drainage, following surgery. If this becomes severe or the patient develops a fever, calf pain, shortness of breath or chest pain; contact a doctor immediately.

    Long Term Expectations for Recovery

  • Surgically treated cartilage damage, if rehabilitated properly, will allow the patient to eventually regain some strength, stability, motion and control of the knee.
  • Patients with more severe symptoms that require surgery can expect a lengthy recovery. The knee may be gradually re-introduced to activity after a month, but only to moderate capacity. Ongoing physical therapy combined with modifications made to athletic activities will likely be required for more than three months.
  • To help maintain a healthy knee, continued gentle use of the knee will be required, running or other impact producing activities should be kept to a minimum.
  • In all cases, physical therapy is required to restore the muscle strength, flexibility and stability lost after any surgical procedure associated with the knee.

    Possible Complications and Risks

  • Risks during and after surgery include the possibility of infection and reactions to anesthesia.
  • Re-injury to the cartilage is possible if physical therapy or other activities during rehabilitation are overly strenuous, causing further damage to the area surrounding the cartilage defect.
  • The repaired cartilage structure is not as durable or long lasting as the body's natural cartilage.

    Conservative Treatment of Chondromalacia Patella Overview

  • 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.

    Rehabilitation Program
    Rehabilitation exercises for non-surgically treated chondromalacia patella include:

  • Isometric Quad Sets.
  • Straight Leg Raises.
  • Isotonic Hip.
  • Isotonic Hamstring.
  • Medication and Medical Products
    OrthoticsAn 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 SleevesKnee 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

    Long-Term Expectations for Recovery

  • Patients with minor damage can expect to recover after a month of physical therapy.
  • Patients suffering severe damage will require much longer to rehabilitate. In these cases, some degree of pain or discomfort may remain during movements that place pressure on the underside of the kneecap.
  • Patients that have not achieved full recovery will need to reduce their level of physical intensity to prevent further degradation to the knee. In some cases this will mean completely refraining from activities that place particular stress on the knee.
  • Recovery is more dependent on the condition of the joint before and after injury and how the internal structures have repaired, not the number of days, weeks or months since the injury occurred.

    Possible Complications and Risks

  • Re-injury to the cartilage of the patella is possible if physical therapy becomes too strenuous for the condition of the knee.
  • For patients with severe chondromalacia patella, physical therapy may not sufficiently recondition the knee joint for vigorous athletic activities.

    Surgical Hardware Considerations

    No hardware is implanted in the surgical procedure.


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