Chondromalacia Patellae

Chondromalacia patellae is a condition affecting the articular cartilage covering the underside of the patella or knee cap. The back of the knee cap glides up and down in a groove on the femur as the knee bends and straightens.

With chondromalacia patellae the cartilage surface changes from being smooth, hard and shiny to being soft, pitted and roughened.

The condition mainly affects adolescents and is seemingly more commmon in females than males. The cause is thought to be related to the mechanics of the lower limb joints. The patella is subject to variations in pull and movement according to various factors. Some of these are quite complex biomechanical issues that involve

Strength of particular parts of the quadriceps controlling the last part of the knee straightening movement

The angle at which the quadriceps muscle pulls on the patella

The width of the pelvis which has a bearing on the pull of the quadriceps muscle

The structure and shape of the knee joint, the ankle and foot and the bones of the leg.

All of the above can have a bearing on the forces acting on the patella causing it to MALTRACK. These abnormal forces are thought to be responsible for this maltracking that results in wear on the underside of the patella.

Sufferers complain of pain behind the knee cap, made worse by quadriceps activity. For example: going up and down stairs and squatting. There is CREPITUS or grinding during knee movement and pain if the knee cap is compressed against the underlying femur. The knees may also feel stiff after rest.

Treatment

Treatment of chondromalacia patellae has been at the forefront of orthopedic medicine for a long time. However we still have not come up with a totally satisfactory way of treating it.

There will need to be a thorough assessment performed by a skilled professional looking at all the biomechanical aspects involved. They should be able to then determine what the major causative factors are and subsequently prescribe a course of treatment.

This may involve taping the patella temporarily to help correct any tracking problems, strengthening surrounding muscle groups to correctly support the knee and attain correct tracking of the patella or provision of orthotics (arch support etc) to correct any biomechanical abnormalities that are aggravating factors.

As you can see the problem can be a complex one to solve. A skilled and experienced practitioner should be able to go a long way towards getting a significant improvement in chondromalacia paelae with all the tools at his or her disposal.

Surgically there has been a history of an operation known as a LATERAL RELEASE, involving division of the lateral (outer) aspect of the capsule of the knee, This has generally only had mixed result in my experience and with all the other approaches available today is less commonly seen.

In many cases chondromalacia patellae will disappear on its own as sufferers reach skeletal maturity and/or possibly do less sporting activities. There are, however, a few unfortunate people, ladies in particular who seem to suffer with this into their thirties. These though tend to be the exception rather than the rule.

For further detailed information on the successfull treatment,management and rehabilitation of chondromalacia patellae please click here