Hondromalacia Patella

Hondromalacia Patella

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The patella or kneecap normally glides up and down in the groove in the front of the lower end of the knee. When there is a problem with the alignment or when the knee is overused, there can be wear and tear of the cartilage behind the patella. This is called Chondromalacia patella (chondro=cartilage; malacia=softening).

Chondromalacia patella is a common problem of the knee. It affects the patella and the groove it slides in over the femur.

How does chondromalacia patella present?

The problem commonly develops in young athletes – soccer players, cyclists, tennis players, ballet dancers and runners. Wear and tear of the patella articular surface can develop due to many reasons:

  • Acute injury to the patella
  • Chronic friction between the patella and the femur
  • Degeneration as part of the aging process

The cause of knee pain in this condition is the increase in the stress and load on the patellofemoral joint as the patella tracks within the femoral groove as the knee moves.

How does chondromalacia patella present?

  • Pain under the patella
  • Pain is worsened by kneeling, running, squatting or climbing up and down stairs
  • The patella may feel like slipping out
  • Grinding or crunching sound in the knee when squatting or climbing stairs
  • Knee swelling

How is the condition diagnosed?

History and clinical examination of the knee usually clinch the diagnosis. X-rays can help identify if there is any patellar alignment problem. MRI may sometimes be needed to study the amount of cartilage damage and to rule out other problems of the knee. Occasionally, arthroscopy may needed to make the definitive diagnosis. In this key-hole procedure, the surgeon will be able to directly inspect the movement of the patella in the patellar groove and also study the amount of cartilage damage.

What is the treatment for this condition?

Nonsurgical Treatment

The condition usually responds to non-operative treatment. R.I.C.E. therapy (rest, ice, compression and elevation) and an anti-inflammatory medication will bring down the initial pain and inflammation. This is followed by a rehabilitation protocol to strengthen the knee and hip muscles and also stretch the hamstrings. Bracing or taping the patella can help to do exercises with less pain.

Surgery

If the non-operative treatment fails to improve your condition, surgery may be suggested. An arthroscopic (key-hole) procedure may be done to realign the patella or to smoothen the cartilage. Small defects in the cartilage can also be repaired arthroscopically.

What should I do after surgery?

After Surgery

The initial post-operative pain comes down with R.I.C.E. therapy. This is followed by a physical therapy progeam that suits the type of surgery done. The exercises help to regain muscle strength and knee movements.

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