Patellar Chondromalacia: Symptoms, Causes, and Concerns

Q: Patellar Chondromalacia: Symptoms, Causes, and Concerns

Dear netizens： Patellar chondromalacia is a type of patellofemoral pain syndrome characterized by widespread anterior knee pain when the patient uses the patellofemoral joint. <br>This pain is particularly exacerbated during activities such as climbing stairs, running, squatting,

Patellar chondromalacia

I am 20 years old and currently serving in the military.
In my childhood, I experienced impacts to both knees and received treatment at a martial arts clinic.
At that time, there were no significant issues, just occasional discomfort similar to rheumatism.
However, after starting my military service, possibly due to increased foot activity, I began to experience some problems.
After undergoing a knee arthroscopy at the 802 Military Hospital, the doctor diagnosed me with patellar chondromalacia and mentioned that this condition is difficult to treat.

I have looked up various online resources regarding patellar issues and noticed that my condition seems somewhat different, perhaps not as severe as those described.
I would like to ask the doctor if there are any obvious symptoms associated with this type of chondromalacia.
In the advanced stages, will it cause deformities in the foot similar to rheumatoid arthritis? Additionally, my foot sometimes experiences intermittent soreness—just soreness without pain.
What could be the reason for this? I would greatly appreciate your answers to my questions.
Thank you very much.

A Yi, 20~29 year old female. Ask Date: 2004/12/16

Dr. Shi Qiming reply Orthopedics

Dear netizens: Patellar chondromalacia is a type of patellofemoral pain syndrome characterized by widespread anterior knee pain when the patient uses the patellofemoral joint.
This pain is particularly exacerbated during activities such as climbing stairs, running, squatting, or kneeling.
For example, a person weighing 90 kilograms experiences approximately 600 pounds of force on the knee joint surface while walking, which can increase to 3,000 pounds during running.
The causes of this condition are multifactorial and related to overuse or excessive load on the patellofemoral joint.
While some individuals may have associated patellar malalignment, most cases are not related to this issue.
The term "patellar chondromalacia" is often used to describe pathological changes in the articular cartilage of the patella, but it is not necessary for such changes to be present for a diagnosis of patellofemoral pain syndrome.
Some patients may show signs of patellar chondromalacia during arthroscopic examination without experiencing anterior knee pain, making the term "patellofemoral pain syndrome" more appropriate.
Patients typically report widespread aching in the anterior knee, which becomes more pronounced after prolonged sitting (such as during long car or airplane trips), climbing stairs, hiking, jumping, or prolonged squatting.
Some patients also complain of joint instability, while others report a tight sensation behind the knee.
Usually, there is no swelling in the joint, but some individuals may notice symptoms following an injury or after direct trauma to the knee, which brings attention to the anterior knee pain.

Physical examination should assess the patient's standing posture, looking for any inward rotation or bowing of the knee, as well as any underdevelopment or atrophy of the quadriceps muscle.
The angle formed between the anterior superior iliac spine to the center of the knee and from the center of the knee to the tibial tuberosity (also known as the Q angle) must be measured.
In females, the Q angle is approximately 22 degrees when the knee is fully extended and about 9 degrees when flexed to 90 degrees; in males, these angles are approximately 18 and 8 degrees, respectively.
An angle exceeding these values is considered abnormal.
Additionally, the external rotation of the femur should be assessed; an angle greater than 30 degrees is deemed abnormal.
The position of the patella during knee flexion and extension should also be evaluated, along with its mobility.
A normal knee should have the patella positioned centrally when fully extended (i.e., the patella should be aligned with the midpoint of the femoral condyles).
If there is lateral displacement or subluxation of the patella, the patient may exhibit signs of apprehension during the examination.
X-ray imaging can help differentiate between arthritis (such as osteophytes, joint space narrowing, or deformities), patellar instability (with lateral displacement or subluxation visible on axial views).
Special imaging techniques like computed tomography or magnetic resonance imaging are not necessary as they do not significantly aid in diagnosis.

This condition must be differentiated from meniscal tears (which present with pain and locking, and may involve joint effusion), patellar malalignment (which can be identified on X-ray), patellofemoral arthritis, patellar tendinitis (pain at the tendon attachment site), quadriceps tendinitis (pain at the junction of the tendon and patella), and pathological knee plica (pain on the medial side of the knee, confirmed via arthroscopy).
The first step in treatment is to adjust activity levels to a point where the joint is pain-free and to begin strengthening exercises for the quadriceps and hamstrings.
The use of knee braces may provide some symptom relief, and some patients may benefit from analgesics or non-steroidal anti-inflammatory drugs.
If the patient is overweight, weight loss is recommended.
If conservative treatment is ineffective, surgical intervention may be considered to correct the joint pathology.
Hsinchu Hospital, Department of Orthopedics, Ministry of Health and Welfare.

Reply Date: 2004/12/16

More Info

Patellar chondromalacia, commonly referred to as "runner's knee," is a condition characterized by the softening and breakdown of the cartilage on the underside of the kneecap (patella). This condition is particularly prevalent among young athletes and individuals who engage in activities that put stress on the knee joint. Given your history of knee trauma and subsequent symptoms, it’s understandable that you have concerns about your diagnosis and its implications.

Symptoms of Patellar Chondromalacia
The symptoms of patellar chondromalacia can vary in intensity and may include:
1. Knee Pain: This is often felt around or behind the kneecap, especially during activities that involve bending the knee, such as climbing stairs, squatting, or sitting for prolonged periods.

2. Swelling: Some individuals may experience swelling around the knee joint.

3. Grinding Sensation: You might notice a grinding or popping sound when moving the knee, known as crepitus.

4. Stiffness: The knee may feel stiff, particularly after sitting for long periods or after physical activity.

5. Weakness: There may be a feeling of weakness in the knee, which can affect stability.

Causes of Patellar Chondromalacia
Several factors can contribute to the development of patellar chondromalacia:
- Previous Injuries: As you mentioned, past trauma to the knee can lead to cartilage damage.

- Overuse: Repetitive activities, especially those that involve running or jumping, can exacerbate the condition.

- Biomechanical Issues: Abnormalities in the alignment of the knee or foot can place additional stress on the patella.

- Muscle Imbalances: Weakness in the quadriceps or tightness in the hamstrings and iliotibial band can affect knee mechanics.

Concerns and Progression
You expressed concern about whether patellar chondromalacia could lead to deformities similar to those seen in rheumatoid arthritis. While patellar chondromalacia itself does not typically cause joint deformities, it can lead to chronic pain and functional limitations if not managed properly. Over time, if the cartilage continues to deteriorate, it may progress to more severe forms of osteoarthritis, which can result in joint changes and deformities.

The intermittent aching you experience in your knee, without accompanying pain, could be attributed to muscle fatigue or strain, particularly if you have increased your physical activity recently. It’s essential to differentiate between discomfort due to overuse and pain that signals a more severe issue.

Management and Treatment
Management of patellar chondromalacia typically involves:
1. Physical Therapy: Strengthening exercises for the quadriceps and stretching exercises for the hamstrings and iliotibial band can help improve knee function and alleviate symptoms.

2. Activity Modification: Reducing activities that exacerbate knee pain, such as high-impact sports, can be beneficial.

3. Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation.

4. Bracing or Taping: Some individuals find relief through the use of knee braces or taping techniques that help stabilize the patella.

5. Surgical Options: In severe cases where conservative measures fail, surgical interventions such as arthroscopy may be considered to repair or smooth the damaged cartilage.

Conclusion
It’s crucial to follow up with your healthcare provider to discuss your symptoms and treatment options. They can provide a tailored approach based on the severity of your condition and your activity level. Regular monitoring and proactive management can help prevent further deterioration and maintain knee function. If you have any further questions or concerns, don’t hesitate to reach out to your medical team for guidance.

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