Patellar Chondromalacia: Causes, Symptoms, and Treatment Options

Q: Patellar Chondromalacia: Causes, Symptoms, and Treatment Options

Hello： Based on what you described, the symptoms are quite evident, and with the presence of scoliosis, the imbalance in body weight will further exacerbate the wear on the patella. <br>Arthroscopic lavage treatment could be considered, followed by rehabilitation. <br>The specifi

Patellar chondromalacia

Doctor, six months ago, without any trauma or exercise, I started experiencing pain in the upper sides of both knees, significant soreness in the outer sides of my calves, and aching in my ankles.
The pain persists throughout the day, and my right foot feels very heavy.
I had X-rays taken, which showed that my left pelvis is rotated parallel and my spine has a 10-degree S-shaped scoliosis.
An orthopedic specialist diagnosed me with patellar chondromalacia and advised me to strengthen my muscles, but I am in constant pain and unable to exercise, fearing that it will worsen my condition.
I find it difficult to sit still; lying down, standing, or sitting with my legs straight all cause significant pain.
My patella feels very loose, and I have tried taping it, but I still experience a grinding pain.
Due to my inwardly rotated feet, my patella shifts inward when standing.
I have taken anti-inflammatory and pain relief medications, received steroid injections, and undergone rehabilitation (shortwave therapy and electrical stimulation), but my condition seems to be worsening, with increasing pain in more areas.
My knees are swollen with some fluid accumulation, but it is not enough to aspirate.
I would like to ask the doctor what I should do.
Thank you!

Xiao Ye, 30~39 year old female. Ask Date: 2015/11/22

Dr. Hong Ximing reply Orthopedics

Hello: Based on what you described, the symptoms are quite evident, and with the presence of scoliosis, the imbalance in body weight will further exacerbate the wear on the patella.
Arthroscopic lavage treatment could be considered, followed by rehabilitation.
The specific situation should be discussed with a specialist to formulate the best treatment plan.
Hong Hsi-Ming

Reply Date: 2015/11/22

More Info

Patellar chondromalacia, often 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 can lead to pain and discomfort in the knee, particularly during activities that put stress on the joint, such as running, squatting, or climbing stairs. Understanding the causes, symptoms, and treatment options for patellar chondromalacia is crucial for effective management and recovery.

Causes
The primary causes of patellar chondromalacia include:
1. Overuse: Repetitive stress on the knee joint from activities such as running, jumping, or cycling can lead to cartilage wear and tear.

2. Biomechanical Issues: Abnormalities in the alignment of the knee, such as patellar maltracking (where the patella does not move smoothly in its groove), can contribute to increased stress on the cartilage.

3. Muscle Imbalances: Weakness in the muscles surrounding the knee, particularly the quadriceps, can lead to improper patellar tracking and increased pressure on the cartilage.

4. Previous Injuries: Past injuries to the knee, such as fractures or ligament tears, can predispose individuals to chondromalacia.

5. Age and Degeneration: As individuals age, the cartilage can naturally degenerate, increasing the risk of chondromalacia.

Symptoms
Common symptoms of patellar chondromalacia include:
- Knee Pain: A dull ache around or behind the kneecap, which may worsen with activity or prolonged sitting.

- Swelling: Mild swelling around the knee joint, especially after activity.

- Grinding or Popping Sensation: A feeling of grinding or popping when moving the knee.

- Stiffness: Increased stiffness, particularly after sitting for long periods.

Treatment Options
Managing patellar chondromalacia involves a combination of conservative and, in some cases, more invasive treatments:
1. Rest and Activity Modification: Avoiding activities that exacerbate the pain is crucial. Low-impact exercises, such as swimming or cycling, may be beneficial.

2. Physical Therapy: A tailored physical therapy program focusing on strengthening the quadriceps and improving flexibility can help correct muscle imbalances and improve patellar tracking.

3. Orthotics: Custom shoe inserts may help correct biomechanical issues, especially if there are alignment problems in the feet or legs.

4. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation. In some cases, corticosteroid injections may be considered for more severe inflammation.

5. Knee Bracing or Taping: Supportive braces or taping techniques can help stabilize the patella and improve alignment during activities.

6. Surgical Options: If conservative treatments fail, surgical options such as arthroscopy to smooth the cartilage or realignment of the patella may be considered.

Recommendations for Your Situation
Given your symptoms of persistent pain, swelling, and the feeling of instability in your knee, it is essential to consult with an orthopedic specialist who can evaluate your condition comprehensively. They may recommend imaging studies, such as an MRI, to assess the cartilage and surrounding structures more accurately.

In the meantime, consider the following steps:
- Modify Activities: Avoid high-impact activities that exacerbate your pain. Focus on low-impact exercises that do not strain your knees.

- Strengthening Exercises: Engage in physical therapy focused on strengthening the quadriceps and hip muscles, which can help stabilize the knee.

- Ice and Elevation: Applying ice to the knee and elevating it can help reduce swelling and pain.

- Follow-Up: Regular follow-ups with your healthcare provider are crucial to monitor your condition and adjust your treatment plan as necessary.

In conclusion, managing patellar chondromalacia requires a multifaceted approach that addresses the underlying causes of the condition. With appropriate treatment and lifestyle modifications, many individuals can find relief from their symptoms and improve their knee function.

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