In the knee joint, the kneecap (patella) moves over the front part of thigh bone (femur) and allows bending of the knee and straightening of the leg. There are a few major ligaments situated around the knee joint which hold the joint firmly in position and contribute to the stability of the knee. Chondromalacia patellae is damage to the cartilage of the patella. It leads to roughness of patellar surface and formation of early arthritis.
Pain is the predominant symptom and is usually gradual in onset. Patients may experience a dull aching pain around the sides, below or behind the kneecap. Sometimes, climbing stairs and standing up or walking after prolonged sitting may produce a popping or cracking sound in the knee. The pain may also be present at night and be exaggerated by any repetitive knee bending activity such as jumping, squatting, running or weight lifting. Any changes in the activity level, playing surface or equipment may also result in pain.
Chondromalacia patellae usually develop due to improper movement of the kneecap causing it to rub against the lower end of the femur bone. This may occur secondary to an imbalance or poor flexibility of the thigh muscles that stabilize the knee joint, problems with alignment of the knee joint, flat foot, tightness or weakness of the front and back muscles of the thigh, excessive sports activities, improper sports training techniques or improper use of equipment.
Most patients respond to conservative treatment, which includes application of ice, rest and well-programmed rehabilitation exercises. Ice helps to relieve the swelling and inflammation, rest protects the joint from repetitive injury while stretching and mobilization exercises improve muscle strength, flexibility and range of motion. Sometimes, if needed, pain relieving medication and anti-inflammatory drugs may also be used. Surgical treatment is rarely indicated. In those patients who have a localized area of arthritis or who have flaps of the patella or trochlea groove that are catching when the knee bends and extends, there may be an indication for surgery.
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