Chondromalacia Patella (Patellofemoral Syndrome)

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Chondromalacia patella facts

  • Chondromalacia patella is the most common cause of chronic knee pain.
  • Chondromalacia patella has also been called patellofemoral syndrome.
  • The pain of chondromalacia patella is aggravated by activity or prolonged sitting with bent knees.
  • Abnormal "tracking" allows the kneecap (patella) to grate over the lower end of the thighbone (femur), causing chronic inflammation and pain.
  • Treatment involves improving the alignment of the patella during contraction of the thigh muscle.

What is chondromalacia patella?

Chondromalacia patella is abnormal softening of the cartilage of the underside the kneecap (patella). It is a cause of pain in the front of the knee (anterior knee pain). Chondromalacia patella is one of the most common causes of chronic knee pain. Chondromalacia patella results from degeneration of cartilage due to poor alignment of the kneecap (patella) as it slides over the lower end of the thighbone (femur). This process is sometimes referred to as patellofemoral syndrome.

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.

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Chondromalacia is a common cause of chronic knee pain.

Your Knee Pain: Is It Chondromalacia?

Chondromalacia, or chondromalacia patellae, is a common cause of chronic knee pain. In chondromalacia, the cartilage beneath the knee cap softens and breaks down. Because the bone of the knee cap rubs against the thigh bone during movement, pain results as a symptom.

What are the symptoms and signs of chondromalacia patella?

The symptoms of chondromalacia patella are generally a vague discomfort of the inner front of the knee, 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.

How is chondromalacia patella diagnosed?

Chondromalacia patella is suspected in a person with anterior knee pain, especially in teenage females or young adults. With manual compression of the kneecap while the quadriceps muscle is tightened, there can be pain. This is referred to as the positive "shrug" sign. Generally, there is no associated swelling (knee joint effusion).

X-rays or MRIs may be done to confirm the inflammation on the posterior part of the patella.

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 be helpful.

Selective strengthening of the inner portion of the quadriceps muscle helps 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. Infrequently, surgical correction of knee alignment is considered.

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 physical therapy 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.

What is the prognosis (outlook) with chondromalacia patella?

Under optimal circumstances, the patient should have a rapid recovery and return at full functional level. Chondromalacia patella is not felt to be a precursor to degenerative arthritis (osteoarthritis).

Can chondromalacia patella be prevented?

Chondromalacia patella can be prevented only in the sense that the symptoms can be prevented by avoiding any aggravating activities (running, jumping, etc.) or positions. Long-term prevention includes strengthening of the inner portion of the quadriceps muscle to help normalize the tracking of the patella.

Medically reviewed by Aimee V. HachigianGould, MD; American Board of Orthopaedic Surgery

REFERENCES:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003.

Ruddy, Shaun, et al., eds. Kelley's Textbook of Rheumatology. Philadelphia: W.B. Saunders Co., 2000.

Last Editorial Review: 10/29/2015

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Reviewed on 10/29/2015
References
Medically reviewed by Aimee V. HachigianGould, MD; American Board of Orthopaedic Surgery

REFERENCES:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003.

Ruddy, Shaun, et al., eds. Kelley's Textbook of Rheumatology. Philadelphia: W.B. Saunders Co., 2000.

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