- Also called:
- chondromalacia of the patella
chondromalacia patella
-
What is chondromalacia patella?
Chondromalacia patella is a condition where the cartilage on the underside of the kneecap softens or becomes damaged. It is an overuse injury common in athletes, especially those with anatomical abnormalities in the lower extremities, but can also result from acute knee injuries or be associated with osteoarthritis in older adults.
Symptoms include pain in the front of the knee, which worsens after prolonged sitting, walking up or down stairs, or standing up from a seated position. Patients may experience grinding sensations, stiffness, and sometimes knee swelling. Diagnosis involves physical examination, imaging studies, and arthroscopy.
Treatment usually starts with non-surgical methods such as physical therapy, activity modification, icing, and NSAIDs. In some instances, bracing or injection therapies may be considered.
1 Britannica SourceCreated from Britannica articles using AI. AI can make mistakes, so verify using Britannica articles. -
Where in the knee does chondromalacia patella occur?
Chondromalacia patella occurs on the undersurface of the kneecap, also known as the patella, where the cartilage becomes damaged or softened. This condition is often associated with abnormal tracking of the patella over the femoral groove at the lower end of the femur. Over time, the cartilage on the joint surfaces of these two bones begins to break down.
2 Britannica SourcesCreated from Britannica articles using AI. AI can make mistakes, so verify using Britannica articles. -
What are the symptoms of chondromalacia patella?
Chondromalacia patella symptoms often manifest gradually, with pain at the front of the knee that worsens after prolonged sitting, such as long drives or sitting in a theater. This symptom is sometimes called the "theater sign." Additional symptoms include grinding sensations, pain while walking up or down stairs, or pain when rising from a seated position. Stiffness and pain may also occur when standing after sitting for a long time. Patients commonly experience pain in both knees, and some may have knee swelling after prolonged walking or activity.
Chondromalacia patella is an advanced form of patellofemoral pain syndrome, which is associated with abnormal tracking of the patella over the femoral groove. Over time, the cartilage on the joint surfaces of these bones softens and breaks down.
1 Britannica SourceCreated from Britannica articles using AI. AI can make mistakes, so verify using Britannica articles. -
What happens to the cartilage in chondromalacia patella?
In chondromalacia patella, the cartilage on the undersurface of the kneecap (patella) softens or becomes damaged. The cartilage is often described as fissured, fibrillated, or blistered. The progression of chondromalacia patella is graded based on the severity of cartilage damage. In Grade I, there is swelling and softening of the cartilage. Grade II involves fissuring and softened areas. In Grade III, fissuring extends close to the subchondral bone, and in Grade IV, the cartilage is destroyed down to the subchondral bone.
1 Britannica SourceCreated from Britannica articles using AI. AI can make mistakes, so verify using Britannica articles. -
What can cause chondromalacia patella to develop?
Chondromalacia patella arises when the cartilage beneath the kneecap softens or gets damaged. It is often linked to patellofemoral pain syndrome, which involves the kneecap tracking abnormally over the femur.
Contributing factors include:
* Anatomical issues like femoral anteversion, tibial torsion, genu varum (bowlegs), or genu valgum (knock-knees)
* Foot pronation, patella alta (high-riding kneecap), or an increased Q angle
* Quadriceps muscle imbalance
* Traumatic injuries, such as a direct blow to the kneecap or recurrent subluxation
* Overuse, particularly in athletes
* Osteoarthritis in the patellofemoral joint in older adults2 Britannica SourcesCreated from Britannica articles using AI. AI can make mistakes, so verify using Britannica articles. -
How is chondromalacia patella diagnosed and treated by doctors?
Chondromalacia patella is diagnosed through physical examination, imaging, and arthroscopy. During a physical exam, a doctor will look for pain with compression of the kneecap, tenderness under the patella, and abnormal patellar tracking. X-rays can reveal arthritis signs, while MRI can show cartilage damage. Arthroscopy is needed for a definitive diagnosis.
Treatment usually starts with non-surgical methods like physical therapy to strengthen the quadriceps muscle. Other options include icing, NSAIDs, activity modification, bracing, and injection therapies. Surgery is considered if these methods fail and usually involves smoothing the cartilage or microdrilling. In cases of patellar tracking abnormalities, distal patellar realignment procedures may be performed.
1 Britannica SourceCreated from Britannica articles using AI. AI can make mistakes, so verify using Britannica articles.
chondromalacia patella, condition in which the cartilage on the undersurface of the kneecap (patella) becomes softened or damaged. Classically, the term refers to pathologic findings at the time of surgery. It is one of several conditions that may be referred to as runner’s knee and is sometimes described as patellofemoral pain syndrome (pain around and behind the kneecap), though some experts consider the two conditions to be distinct. Chondromalacia patella is, generally, an overuse injury found in athletes with extrinsic anatomical abnormalities of the lower extremity. It can also be caused by an acute injury to the knee, such as in patellar dislocation or a direct blow to the knee. In the older population it is usually associated with osteoarthritis in the patellofemoral joint.
Anatomy
The knee joint consists of three bones: the femur (thighbone), the tibia (the larger bone of the lower leg), and the patella. The bottom of the patella and the ends of the femur and tibia are covered with cartilage. The cartilage allows the bones to glide smoothly over each other. The knee joint is often considered to have three compartments, areas formed by the joining of the femur and tibia (in two places: the medial [inner] and lateral [outer] compartments) and the joining of the kneecap and the femur (the patellofemoral compartment). The hinge action of the knee is controlled by the quadriceps mechanism, made up of two tendons that hold the patella in place and cause the knee to straighten and bend. The quadriceps tendon extends from the quadriceps muscle and attaches to the patella, and the patellar tendon (which technically is a ligament) attaches the patella to the tibia. The medial and lateral extensions of that tendon form the medial and lateral retinaculum of the patella.
Causes and symptoms
Chondromalacia patella can be considered an advanced form of patellofemoral pain syndrome, which is associated with abnormal tracking of the patella over the femoral groove at the lower end of the femur. Over time the cartilage on the joint surfaces of the two bones begins to soften and break down. The cartilage is often described as being fissured, fibrillated, or blistered. Conditions that can contribute to abnormal tracking are femoral anteversion (inward twisting of the thighbone), external tibial torsion (inward twisting of the tibia), genu varum (bowlegs) or genu valgum (knock-knees), foot pronation, patella alta (a kneecap positioned higher than average), increased Q angle (the angle measuring the relation of the femur and patella to the patella and tibia), and imbalance of the quadriceps muscles. A traumatic injury to the knee, such as a direct blow to the kneecap or recurrent subluxation (partial dislocation) of the patella, can also cause chondromalacia patella.
" height="20" alt="HEW Logo">
Symptoms
The symptoms of chondromalacia patella often come on gradually. Patients often complain of pain on the front of the knee that worsens after prolonged sitting, such as a long car drive or sitting in a theatre. The constellation of those symptoms may be referred to as the “theatre sign.” Other symptoms that patients will complain of are a grinding sensation, pain with walking up or down stairs, or pain when standing up from a sitting position. Standing after a prolonged period of sitting may result in stiffness as well as pain. It is not uncommon for patients to present with bilateral knee pain. And last, with prolonged walking or activity, some patients may complain of knee swelling.
Diagnosis
The symptoms of chondromalacia patella can resemble those of other knee problems. Arthroscopy is needed to make a definitive diagnosis, although useful clues may be obtained from the history and physical exam as well as from imaging studies.
On examination, patients will usually have pain with compression and rocking of the patella. They may also be tender on the undersurface of the patella and over the medial and lateral retinaculum. Patellar tracking abnormalities can also be observed while having the patient flex and extend the knee. If the examiner places a hand over the kneecap during flexion and extension, oftentimes grinding, or crepitus, can be felt.
X-rays looking particularly at the patellofemoral joint can show radiologic signs of arthritis that can suggest chondromalacia patella. For example, the presence of joint space narrowing or osteophyte formation on the undersurface of the patella could be indicative of chondromalacia patella. Magnetic resonance imaging (MRI) can show signs of fraying and cracking of the cartilage on the undersurface of the patella. Once the chondromalacia reaches grade III to grade IV, an MRI scan can reliably diagnose chondromalacia patella about nine-tenths of the time.
The trusted destination for professionals, college students, and lifelong learners.
SUBSCRIBE
The progression of the condition can be graded once the diagnosis is made. Grade I is present if there is swelling and softening of the cartilage. Grade II will have fissuring as well as softened areas. At grade III the fissuring extends just short of the subchondral bone (the bone beneath the cartilage), and at grade IV the cartilage is destroyed down to the subchondral bone.