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Chondromalacia Patella
(Patellofemoral Syndrome)

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

Your Knee Pain: Is It Chondromalacia?

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Barbara K. Hecht, PhD

Chondromalacia is a common cause of chronic knee pain.Chondromalacia, technically termed chondromalacia patellae, is the most common cause of chronic knee pain. The condition develops due to softening of the cartilage beneath the knee cap (the patella), resulting in small areas of breakdown and pain around the knee. Instead of gliding smoothly over the knee, the knee cap rubs against the thigh bone (the femur) when the knee moves. The changes can range from mild to complete erosion of the cartilage. This process is sometimes referred to as the patellofemoral syndrome.

Chondromalacia commonly occurs in females. Girls in their teens are at elevated risk because the cartilage of the knee is subjected to excessive and uneven pressure due to the structural changes that accompany rapid growth. Chondromalacia may also occur in adults over age 40 as part of the wear-and-tear process that eventually leads to osteoarthritis of the knee joint. Other factors that may precipitate chondromalacia include trauma, overuse, or abnormal forces on the knee joint. It can develop in skiers, runners, cyclists, and soccer players, especially if someone is knock-kneed or flat-footed.

Find out how chondromalacia is diagnosed and treated »

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.




Next: What causes chondromalacia patella? »

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Chondromalacia Patella (Patellofemoral Syndrome)

Pain Management »

Introduction to pain management

Pain management can be simple or complex, depending on the cause of the pain. An example of pain that is typically less complex would be nerve root irritation from a herniated disc with pain radiating down the leg. This condition can often be alleviated with an epidural steroid injection and physical therapy. Sometimes, however, the pain does not go away. This can require a wide variety of skills and techniques to treat the pain. These skills and techniques include:

  • Interventional procedures
  • Medication management
  • Physical therapy or chiropractic therapy
  • Psychological counseling and support
  • Acupuncture and other alternative therapies; and
  • Referral to other medical specialists

All of these skills and services are necessary because pain can involve many aspects of a person's daily life.

How is pain tre...

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