About chondromalacia patella(patellofemoral syndrome)

What is chondromalacia patella(patellofemoral syndrome)?

Chondromalacia patella is abnormal softening of the cartilage of the underside the kneecap (patella). It is a cause of pain in the front of the knee (anterior knee pain). Chondromalacia patella is one of the most common causes of chronic knee pain. Chondromalacia patella results from degeneration of cartilage due to poor alignment of the kneecap (patella) as it slides over the lower end of the thighbone (femur). This process is sometimes referred to as patellofemoral syndrome.

What are the symptoms for chondromalacia patella(patellofemoral syndrome)?

The symptoms of chondromalacia patella are generally a vague discomfort of the inner front of the knee, 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 are the causes for chondromalacia patella(patellofemoral syndrome)?

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.

What are the treatments for chondromalacia patella(patellofemoral syndrome)?

The primary goal for treatment and rehabilitation of chondromalacia patella is to create a straighter pathway for the patella to follow during quadriceps contraction. Initial pain management involves avoiding motions which irritate the kneecap. Icing and anti-inflammatory medications (for examples, ibuprofen [Advil/Motrin] or naproxen [Aleve]) can be helpful.

Selective strengthening of the inner portion of the quadriceps muscle helps normalize the tracking of the patella. Cardiovascular conditioning can be maintained by stationary bicycling (low resistance but high rpms), pool running, or swimming (flutter kick). Reviewing any changes in training prior to chondromalacia patella pain, as well as examining running shoes for proper biomechanical fit are critical to avoid repeating the painful cycle. Generally, full squat exercises with weights are avoided. Occasionally, bracing with patellar centering devices are required. Infrequently, surgical correction of knee alignment is considered.

Stretching and strengthening the quadriceps and hamstring muscle groups is critical for an effective and lasting rehabilitation of chondromalacia patella. "Quad sets" are the foundation of such a physical therapy program. Quad sets are done by contraction the thigh muscles while the legs are straight and holding the contraction for a count of 10. Sets of 10 contractions are done between 15-20 times per day.

What are the risk factors for chondromalacia patella(patellofemoral syndrome)?

Chondromalacia patella is one of the most common causes of chronic knee pain. 

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