Can Patellar Malalignment Cause Chondromalacia Without External Displacement?

Patellar malalignment is not a prerequisite for developing patellar chondromalacia?

Hello doctor, I experienced sudden pain above my right patella at the beginning of November.
Initially, I thought it was tendonitis, but after a long time, there hasn't been significant improvement, and it feels like my knee is not functioning properly.
At the first hospital, X-rays showed no issues.
When I went to the second hospital, the doctor noted that my patella was not dislocated, but it was laterally positioned and being compressed.
The doctor at the second hospital pointed out that my walking posture was unusual.
Before the injury, I had a bad habit of sitting with my right leg elevated on the chair and then putting it down.
I would like to know if a non-laterally displaced patella could still lead to patellar chondromalacia? I didn't sustain the injury from sports or any specific incident; it just happened inexplicably.
I also feel that when I sit, I can only sense one side of my ischium.
I'm concerned that my bad habits may have caused my pelvis to become misaligned, leading to issues with my knee.
Is this a possibility? Additionally, I sometimes feel tightness in my right glute.
I really hope that I won't be unable to play basketball at such a young age.

Niming, 20~29 year old female. Ask Date: 2017/12/07

Dr. Shi Guozheng reply Orthopedics

Patellar malalignment may occur without external rotation, and chondromalacia can still be present.
If there is external rotation, it can increase the pressure on the patella, leading to more pain or discomfort.
Maintaining proper sitting posture can help prevent bone and joint issues.
If external rotation is present, rehabilitation exercises focusing on strengthening the quadriceps can be performed to correct the alignment.
After a period of time, this may lead to improvement; if not, it is advisable to consult a physician for further treatment.

Reply Date: 2017/12/07

More Info

Patellar malalignment can indeed contribute to the development of chondromalacia patellae, even in the absence of external displacement of the patella. Chondromalacia patellae refers to the softening and breakdown of the cartilage on the underside of the kneecap (patella), which can lead to pain and discomfort, particularly during activities that involve bending the knee, such as climbing stairs or playing sports.

In your case, the symptoms you describe, including pain above the patella and a sensation that your knee is not functioning properly, could be indicative of chondromalacia. The fact that your patella is positioned laterally (to the outside) and that you have been noted to have an unusual walking posture may suggest that there is an imbalance in the forces acting on the patella. This malalignment can lead to abnormal tracking of the patella during knee movement, which can increase stress on the cartilage and contribute to its degeneration.

Your concern about your sitting habits potentially leading to pelvic misalignment is valid. Poor posture, such as sitting with one leg elevated, can lead to muscular imbalances and changes in the alignment of the pelvis and lower extremities. These changes can affect the biomechanics of the knee joint, potentially leading to conditions like chondromalacia. Tightness in the gluteal muscles, as you mentioned, can also contribute to altered movement patterns and may exacerbate the issue.

It is important to address these factors to prevent further deterioration of your knee condition. Here are some recommendations:
1. Physical Therapy: Engaging in a physical therapy program can help address muscle imbalances, improve flexibility, and strengthen the muscles around the knee. A physical therapist can provide you with exercises tailored to your specific needs, focusing on strengthening the quadriceps, hamstrings, and hip muscles, which play a crucial role in stabilizing the patella.

2. Posture Correction: Being mindful of your sitting and standing posture can help alleviate some of the stress on your knee. Try to avoid sitting with your leg elevated for prolonged periods and ensure that your pelvis is in a neutral position.

3. Activity Modification: While you may be eager to return to basketball and other activities, it may be beneficial to modify your activities temporarily to avoid exacerbating your knee pain. Low-impact exercises, such as swimming or cycling, can help maintain fitness without putting excessive strain on your knee.

4. Consultation with a Specialist: If your symptoms persist or worsen, consider consulting an orthopedic specialist who can provide a comprehensive evaluation of your knee. They may recommend imaging studies, such as an MRI, to assess the cartilage and other structures within the knee joint.

5. Bracing or Taping: In some cases, using a knee brace or patellar taping techniques can help improve patellar alignment and reduce pain during activities.

In conclusion, while patellar malalignment can lead to chondromalacia without external displacement, addressing the underlying issues through physical therapy, posture correction, and proper management strategies can help alleviate your symptoms and improve your knee function. It is essential to take proactive steps to ensure that you can continue to enjoy activities like basketball without long-term consequences.

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