Chondromalacia Patella
(Patellofemoral Syndrome)
Medical Author: William C. Shiel Jr., MD, FACP, FACR
What is the chondromalacia patella?
Chondromalacia patella is abnormal softening of the cartilage of the under the kneecap (patella). Chondromalacia patella is the most common cause of
chronic knee pain.
Chondromalacia patella results from degeneration of cartilage due to poor alignment of the kneecap as
it slides over the lower end of the thigh bone (femur). This process is, therefore, sometimes referred to as patellofemoral syndrome.
What are the symptoms of chondromalacia patella?
The symptoms of chondromalacia patella are generally a
vague discomfort of the inner knee area, aggravated by activity (running,
jumping, climbing or descending stairs) or by prolonged sitting with knees in a
moderately bent position (the so called "theater sign" of pain upon arising from
a desk or theater seat). Some patients may also have a vague sense of
"tightness" or "fullness" in the knee area. Occasionally, if chronic symptoms
are ignored, the associated loss of quadriceps (thigh) muscle strength
may cause the leg to "give out." Besides an obvious reduction
in quadriceps muscle mass, mild swelling of the knee area
may occur.
What causes chondromalacia
patella?
The patella (kneecap) is normally pulled over the end of
the femur in a straight line by the quadriceps (thigh) muscle. Patients with
chondromalacia patella frequently have abnormal patellar "tracking" toward the
lateral (outer) side of the femur.
This slightly off-kilter pathway allows the undersurface of
the patella to grate along the femur causing chronic
inflammation and pain. Certain individuals are predisposed
to develop chondromalacia patella: females, knock-kneed or flat-footed runners,
or those with an unusually shaped patella undersurface.
How is chondromalacia patella treated?
The primary goal for treatment and rehabilitation of
chondromalacia patella is to create a straighter pathway for the patella to
follow during quadriceps contraction. Initial pain management
involves avoiding motions which irritate the kneecap. Icing and
anti-inflammatory medications (for examples, ibuprofen
[Advil/Motrin] or
naproxen [Aleve]) can also be helpful.
Selective strengthening of the inner portion of the
quadriceps muscle will help normalize the tracking of the patella.
Cardiovascular conditioning can be maintained by stationary bicycling (low
resistance but high rpms), pool running, or swimming (flutter kick). Reviewing any changes
in training prior to chondromalacia patella pain, as well as examining running
shoes for proper biomechanical fit are critical to avoid
repeating the painful cycle. Generally, full squat exercises with weights are avoided. Occasionally, bracing with
patellar centering devices are required.
Stretching and strengthening the quadriceps and hamstring
muscle groups is critical for an effective and
lasting rehabilitation of chondromalacia patella. "Quad sets" are the
foundation of such a program. Quad sets are done by
contraction the thigh muscles while the legs are straight
and holding the contraction for a count of 10. Sets of 10
contractions are done between 15-20 times per day.
Next: What is the prognosis (outlook) with chondromalacia patella? »
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Last Editorial Review: 1/28/2008
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