Chondromalacia

What is chondromalacia?

The knee joint is composed of two main articulations (bearing surfaces). The largest articulation is the point at which the femur (thigh bone) and tibia (shin bone) come in contact. The smaller, but no less important, articulation is where the undersurface of the patella (kneecap) comes in contact with the femur. In a normal knee these surfaces are covered by healthy tissue called articular cartilage. In combination with synovial fluid produced inside the joint, the articular cartilage provides a smooth surface on which the bones can glide. Chondromalacia is a softening and subsequent roughening of these surfaces and results in a decrease of the bones’ ability to move freely and without pain.

What causes chondromalacia?

Chondrolmalacia is usually associated with injury, overuse of the knee, and poorly aligned muscles and bones around the knee joint. These causes include:

  • Trauma to the kneecap, such as a fracture or dislocation
  • Repeated bending or twisting of the knee joint, especially during sports
  • Poorly aligned muscles or bones near the knee joint
  • An imbalance of the muscles around the knee (some muscles are weaker than others)
  • Injury to a meniscus (C-shaped cartilage inside the knee joint)
  • Rheumatoid arthritis or osteoarthritis
  • An infection in the knee joint

What are the symptoms of chondromalacia?

  • Swelling
  • Clicking and grinding within the knee
  • Pain that is aggravated by squatting, running and/or using the stairs

Symptoms for chondromalacia can be diverse in presentation and severity. The symptoms listed should only be thought of as a generalization of the symptoms associated with this disorder.

How is chondromalacia diagnosed?

Your physician will review your medical history to determine if there’s been a fracture, sprain, infection or arthritis in your knee that might be a contributing factor. A physical exam includes a check to see how your kneecap aligns with your thighbone, how your knee responds to bending and straightening, and how your painful knee compares with the normal one. Your doctor will also check for swelling, deformity, tenderness, and fluid in the knee joint. X-rays or an MRI may also confirm a diagnosis of chondromalacia.

How is chondromalacia treated?

The goal of treatment is to reduce the pressure on your kneecap and joint. Initial treatment may consist of resting, stabilizing, and icing the knee. The cartilage damage resulting in runner’s knee can often repair itself with rest. Your physician may also prescribe anti-inflammatory medications to reduce inflammation. If swelling, tenderness, and pain persist, physical therapy and non-weight bearing exercises may be recommended, such as swimming or riding a stationary bike. More advanced cases may require a cortisone injection or joint fluid therapy, which replaces the natural lubricants found in healthy joints.

If nonsurgical treatments are not successful, or if you have severe symptoms, your doctor may recommend arthroscopy. Arthroscopy is a minimally invasive operation in which the surgeon examines the joint with an arthroscope, a pencil-thin device equipped with a camera lens and light, while making repairs through a small incision. If necessary, your doctor also can correct the alignment of your kneecap or other parts of your knee to help to reduce wear and tear on your knee cartilage.

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