chondromalacia patellae

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Chondromalacia Patellae

 

Definition

Chondromalacia patellae refers to the progressive erosion of the articular cartilage of the knee joint, that is the cartilage underlying the kneecap (patella) that articulates with the knee joint.

Description

Chondromalacia patellae (CMP), also known as patello-femoral pain syndrome or patello-femoral stress syndrome, is a syndrome that causes pain/discomfort at the front of the knee. It is associated with irritation or wear on the underside of the kneecap, or patella. In a normal knee, the articular cartilage is smooth and elastic and glides smoothly over the surface of the thighbone, or femur, when the knee is bent. Erosion of the cartilage roughens the surface and prevents this smooth action.
CMP is most common in adolescent females, although older people may also develop it. An average of two out of 10,000 people develop this condition, many of them runners or other athletes.

Causes and symptoms

CMP is the result of the normal aging process, overuse, injury, or uneven pressures exerted on the knee joint. In teens, CMP may be caused by uneven growth or uneven strength in the thigh muscles. Growth spurts, common in teens, may result in a mildly abnormal alignment of the patella, which increases the angle formed by the thigh and the patellar tendon (Q-angle). This condition adds to the damage. Symptoms include pain, normally around the kneecap, and a grinding sensation felt when extending the leg. The pain may radiate to the back of the knee, or it may be intermittent and brought on by squatting, kneeling, going up or down stairs, especially down, or by repeated bending of the joint.

Diagnosis

Diagnosis is established during a physical examination performed by a general practitioner or an orthopedist, and is based on frequency of symptoms and confirmed by x rays of the knee. The CMP erosion can also be seen on an MRI, although this type of scan is not routinely performed for this purpose. The patient should inform the doctor about any previous injuries to the joint.

Treatment

Initial treatment may consist of resting the knee using crutches, along with aspirin, Tylenol, or a nonsteroidal anti-inflammatory drug (NSAID) such as Motrin for seven to 10 days. The person should limit sports activity until the joint is healed and may use ice followed by heat to decrease inflammation. When the doctor allows the patient to resume sports, a knee brace may be prescribed in the form of a stabilizer with a hole at the kneecap.
Treatment also includes low impact exercises to strengthen the quadriceps muscles which help stabilize the knee joint. Physical therapy may be suggested at the start of this program so as to help the patient learn the correct method of performing the exercises.
Approximately 85% of people do well with conservative CMP treatment. The remainder still have severe pain and may require arthroscopic surgery to repair the tissues inside the knee joint. In more severe cases, open surgery may be required to realign the kneecap and perhaps other corrections.

Alternative treatments

Physical therapy offers treatments that may help CMP patients. Aqua therapy has the benefit of exercising the knee without putting stress on it and it also strengthens the thigh muscles. Biofeedback can be used to learn tensing and relaxing specific muscles to relieve pain. These techniques have the benefit of no side effects. Massage therapy might be beneficial as well. Calcium, minerals, and vitamins as part of a balanced diet will aid healing and help prevent further problems.

Prognosis

In most teens with CMP, the prognosis is excellent since the damage is reversible when treatment starts before the cartilage begins to break down. With proper treatment and preventive techniques, teenagers will complete their growth without permanent damage to the joint. Only about 15% of patients require surgical intervention. Older people may go on to develop osteoarthritis in the knee.

Prevention

Proper exercises are the best preventive measure. Since tightness of thigh muscles is a risk factor, warming up before athletic activities is recommended, as well as participating in a variety of sports rather than just one. Stretching exercises increase flexibility of the quadriceps, hip flexors, and hamstrings. Strengthening exercises such as short arc leg extensions, straight leg raises, quadriceps isometric exercises, and stationary bicycling are also recommended.

Resources

Other

Chondromalacia patellae. 〈http://my.webmd.com/content/asset/adam_disease_chondromalacia_patellae〉.
Chondromalacia Patellae. http://www.orthoseek.com/articles/chondromp.html.
"Major Domains of Complementary & Alternative Medicine." 〈http://nccam.nih.gov/fcp/classify/〉.
Questions and Answers About Knee Problems. 〈http://www.cbshealthwatch.com/cx/viewarticle/202777〉.
Questions and Answers About Knee Problems. http://www.nih.gov/niams/healthinfo/kneeprobs/kneeqa.htm.

Key terms

Arthroscopic knee surgery — Surgery performed to examine or repair tissues inside the knee joint through a special scope (arthroscope).
Femur — The thigh bone.
Isometric exercises — Exercises which strengthen through muscle resistance.
Osteoarthritis — Degenerative joint disease.
Quadriceps, hip flexors, hamstrings — Major muscles in the thigh area which affect knee mechanics.

chondromalacia patellae

A condition characterized by progressive erosion of knee cartilage, more common in younger persons Clinical Pain with climbing, grinding sensation in knees

chondromalacia patellae

A mild form of OSTEOARTHRITIS affecting the CARTILAGE on the back of the knee-cap (patella) and causing pain and stiffness, especially when climbing or descending stairs.

chondromalacia patellae

painful condition resulting from the softening of the patellar articular cartilage. Also known as patellofemoral pain. Common in young athletes (causing discomfort with exercise) where its origin is suggested to be an alteration of the Q-angle due to malalignment of the lower limbs. Seen in overpronation of the foot and valgus deformity at the knee. Treatment involves attempts to restore the normal Q-angle via a quadriceps strengthening programme.

chondromalacia patellae

retropatellar cartilage degeneration and damage, secondary to patellar tracking disorders; characterized by patellar misalignment and recurrent subluxation; exacerbating factors include increased Q angle, vastus medialis weakness, lower-limb malalignments, increased tibial torsion and excessive foot pronation (see Table 1); presents as deep anterior-knee pain, soft-tissue (knee) and synovial fluid effusion, and weakness of vastus medialis; severe cases show positive patellofemoral 'grinding' test (see test, Clarke's); axial radiographs show osteophyte formation; treatment includes non-steroidal anti-inflammatory drugs, patella-stabilizing splints, RICE(P), ultrasound, antipronatory insoles, activity modification, specific quadriceps exercises and iliotibial band stretches; arthroscopic debridement of deep surface of patella may be indicated, and surgical release and realignment of vastus medialis may be required
Table 1: Stages in the pathology of chondromalacia patellae
StageClinical features
ISoftening or degeneration of the articular cartilage
IICleaving of articular cartilage
IIICleaving and fronding of the articular cartilage
IVErosion of cartilage and underlying bone sclerosis