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Chondromalacia Patellae - Causes, Symptoms & Treatment

Chondromalacia patellae is a softening and degeneration of the cartilage on the underside of the kneecap, causing knee pain and reduced mobility.

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Things worth knowing about "Chondromalacia patellae"

Chondromalacia patellae is a softening and degeneration of the cartilage on the underside of the kneecap, causing knee pain and reduced mobility.

What is Chondromalacia Patellae?

Chondromalacia patellae refers to the softening and breakdown of the articular cartilage located on the underside of the kneecap (patella). This cartilage normally provides a smooth, resilient gliding surface between the kneecap and the thighbone (femur). When it deteriorates, the surface becomes rough and irregular, leading to pain and discomfort. It is one of the most common causes of knee pain, especially in young adults and physically active individuals.

Causes

Chondromalacia patellae typically results from a combination of mechanical and biological factors:

Overuse: Repetitive stress from activities such as running, cycling, or squatting increases pressure on the patellar cartilage.
Patellar malalignment: A laterally displaced or unstable kneecap causes uneven friction against the femur, damaging the cartilage over time.
Muscle imbalances: Weakness or imbalance in the quadriceps or hip muscles negatively affects kneecap tracking.
Trauma: A direct blow to the kneecap can acutely damage the cartilage.
Anatomical factors: Conditions such as genu valgum (knock knees) increase the risk of developing this condition.

Symptoms

The hallmark symptom is a dull, aching pain behind or around the kneecap, which typically worsens during:

Climbing or descending stairs
Prolonged sitting with bent knees (known as the moviegoer sign or theater sign)
Squatting or kneeling
Physical exercise involving the knee

Additional symptoms may include a grinding or crunching sensation (crepitus), mild swelling, and a feeling of knee instability.

Diagnosis

Diagnosis is typically established through the following methods:

Clinical examination: Tenderness on pressing the kneecap, reproduction of pain by compressing the patella against the femur (Clarke test or Zohlen sign).
Imaging: X-rays to rule out bony abnormalities; MRI (Magnetic Resonance Imaging) for detailed assessment of cartilage integrity.
Arthroscopy: Direct visualization of the joint may be used in unclear or complex cases.

Severity is classified using the Outerbridge classification, ranging from Grade I (cartilage softening) to Grade IV (full-thickness cartilage loss with exposed bone).

Treatment

Conservative Treatment

Most cases of chondromalacia patellae respond well to conservative management:

Activity modification: Reducing or avoiding pain-provoking activities during the acute phase.
Physiotherapy: Targeted strengthening of the quadriceps, hip abductors, and core muscles to improve patellar tracking and stability.
Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for short-term pain relief.
Orthopedic aids: Knee braces or custom orthotics to correct patellar alignment.
Weight management: Reducing body weight to decrease mechanical load on the knee joint.

Surgical Treatment

Surgery is considered when conservative therapy fails or in severe cases:

Arthroscopic cartilage smoothing or debridement
Autologous chondrocyte implantation (cartilage cell transplantation)
Corrective osteotomy for significant malalignment

Prognosis

With early intervention and consistent physiotherapy, the prognosis is generally favorable. Most patients experience significant pain reduction and can return to their normal activities and sports. However, in advanced stages, the condition may lead to permanent cartilage damage and contribute to the development of patellofemoral osteoarthritis.

References

Insall J. N. et al. - Surgery of the Knee, 4th Edition. Churchill Livingstone, 2006.
Crossley K. M. et al. - 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat. British Journal of Sports Medicine, 2016;50(14):839-843.
Petersen W. et al. - Patellofemoral pain syndrome. Knee Surgery, Sports Traumatology, Arthroscopy, 2014;22(10):2264-2274.

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