1. What is it?
Chondromalacia is the destruction of the cartilage under the kneecap. Normally, this cartilage is smooth and allows a normal gliding motion of the kneecap over the femur. However, with chronic knee problems, the kneecap may not track smoothly over the femur and as a result the areas in contact with each other become roughened causing pain.
2. What are the causes/predisposing symptoms of injury?
Any type of long term knee problem that causes improper tracking of the kneecap, such as muscle imbalances and quadriceps weakness, can lead to this condition. This may be the end stage of a chronic Runner’s Knee.
3. What are the symptoms?
The primary symptom is pain underneath the kneecap. Usually this pain is aggravated by stair climbing, squatting or prolonged periods of sitting. There may also be an associated grating or crunching sound when the knee is bent.
4. What can be done to prevent or treat this injury?
Prevention of this injury is common sense. It involves not letting any existing knee problem become chronic. If a problem is not responding to reducing mileage, ice massage, stretching and strengthening, seek outside help immediately.
Treatment of this condition involves restoring hamstring and quadriceps strength and flexibility, moist hot packs, ice therapy, knee braces, anti-inflammatory medication and, as a last resort, surgery.
just would like more informations on chondromalacia, I had surgery sept. 04 and nothing has changed. Still have pain, and swelling. need to know if more invasive surgery should be next step or just another arthroscopic cleaning several times? thanks
Dear Christina,
As it has been 6 months with no changes, we must determine why. Have you
been doing appropriate rehabilitation? As mentioned in my article you still
need to adress causes of why the cartilage deteriorated. In a nutshell,
rehab should consist of making sure all the muscle groups surrounding the
knee joint have adequate strength, flexibility, and endurance. If no
evaluation has been done as to the cause of this problem, get one done. As
far as multiple surgeries; I have had patients who have required these, but
none so soon as 6 months after the first, it is usually a few years between
procedures. I am not a surgeon, but if the procedure was done properly, this
would seem way too soon for another. A suggestion is to start supplementing
with 1500mg of glucosamine sulfate per day for at least 8 weeks to begin
with. Glucosamine sulfate has a protective effect on joints and appears to
stop degenerative changes from progressing (lots of studies to support this
exist). I have many patients taking this supplement and have had good
results with many types of joint problems. I hope this helps you out. If
you have further concerns consult your surgeon and ask if these results are
typical for his patients.
Kindest regards, Lee
Dr Miller,
I have just been diagnosed with chondromalacia. Last year I also was told I have a patellar tracking problem – laterally tracking. The orginal problem started in Feb 2004. Last year I underwent 5 months of physical therapy. This helped somewhat but the pain just came right back (under my knee cap and in my patellar tendon). as soon as I got out of PT. I am now going back to PT for more VMO exercises and quad exercises, but this is after a year of unsuccessful treatment. At what point does one consider surgery? Please help. My knee really hurts.
Also, I keep wondering, am I doomed to do VMO and quad exercises for the rest of my life? This is what my PT told me. I never had any knee problems before. (34 YO female) Depressing as I like to run and be an athletic person.
I just went to an orthopaedic who gave me the dx of
CHONDROMALACIA/tracking px. I am going back to physical therapy 3 times a week for one month. The exercises are VMO exercises and quad wall exercises, plus electrostim on the VMO. The last PT evaluated me and said I have a problem with the way the knee cap is tracking medially now. Not laterally. Also the knee cap is slightly tipped I guess. It is causing me a lot of pain. I also have a knee brace which does not help me. I will go back to the surgeon in 3 weeks. I will try to find out the biomechanical issues you mentioned such as the q-angle or rotation of the tibia. One other problem that I have is a bit knock kneed, but this has never caused me problems before in my 34 years. The surgeon I saw is very conservative about surgeory and so am I, but if this round of PT doesn’t help, I will find someone else. Thaznks for listening. I just want my knee back.