Chondromalacia Patella

Chondromalacia patella is when there is softening and damage to the cartilage on the back of the patella (kneecap). This leads to front knee pain, swelling and clicking/grinding noises when moving the knee.

It tends to affect young, healthy and often sporty people. It most commonly affects adolescents and young adults, and is more common in women. It is commonly misdiagnosed as Runners Knee.

To fully understand Chondromalacia Patellae we first need to understand how the kneecap (patella) normally works. The patella is a small bone that sits inside the muscles at the front of the thigh (quads). It rests in a special groove (patella groove) on the front of the thigh bone (femur) where it moves up and down as you move your leg.

The patella is lined with the thickest cartilage in the whole body which:
1) ensures that the patella glides smoothly over the knee bones
2) works as a shock absorber

Causes of Chondromalacia Patella

Chondromalacia patella occurs when the kneecap rubs against the bones rather than gliding over them. This causes small tears in the cartilage which get inflamed and cause pain. There are a number of reasons for this:

1) Muscle imbalance: a combination of muscle tightness in the quads muscles and other structures e.g. the retinaculum on the outside of the knee and muscle weakness on the inside of the knee (VMO) affects the position of the kneecap in the patella groove. Instead of gliding easily up and down the centre of the groove, it is pulled out to the side which causes a lot of friction and ends up damaging the cartilage. This is also known as patella maltracking. The good news is that it can easily be fixed with the right exercises

2) Poor alignment of the kneecap: where the patella doesn’t sit in the right position, but tends to be either too high or too low. Some people are born this way, but it doesn’t become apparent until adolescence

3) Overuse of the leg: Anything whereby lots of force goes through the knee (e.g. running, jumping, twisting)

4) Flat feet: this changes the way the forces are distributed through the knee and makes the cartilage more prone to damage

Chondromalacia Patellae Symptoms

The most common symptoms of Chondromalacia Patella are:

1) Front Knee Pain: tends to be achy rather than sharp
2) Pain On Stairs: tends to worse going downstairs rather than upstairs
3) Pain After Prolonged Rest: when you first get up after sitting down for a while
4) A grating/grinding sensation: when moving the leg (crepitus)
5) Minor Swelling: usually around the patella
6) Tenderness: with any pressure through the kneecap

How is it Diagnosed?

Your doctor will normally diagnose patella chondromalacia from your description of symptoms and by carrying out some simple tests (looking at the movement of the knee, and putting pressure through it).

Standard x-rays don’t usually show up the problem, although a “skyline view x-ray” taken from the side of the leg can be used to see the back of the kneecap. MRI scans are occasionally used to confirm diagnosis. 

Treatment Options

To treat chondromalacia patellae it is vital to discover what is causing the problem in the first place, so your doctor should refer you to a physiotherapist who will look more closely at your leg muscles.  Treatment may include:

1) Exercises: Kneecap exercises and stretches can really help with chondromalacia as well as general strengthening exercises. They all help to combat any muscle imbalance and improve how the kneecap moves. I have never known anyone with chondromalacia patella who has not had muscle imbalance

2) Knee Brace Straps: Wearing a strap directly under the kneecap helps take pressure off the joint, dramatically reducing pain. They are simple to use and very effective. Visit the knee strap section to find the best strap for you

3) PRICE: Protect, Rest, Ice, Compress, Elevate. This helps reduce pain and swelling and can speed up recovery. Visit the PRICE section to find out how to use it safely and effectively

4) Medication: Non-steroidal anti-inflammatories (NSAID’s) such as ibuprofen will help to relieve inflammation and pain

5) Ice: Using ice regularly and before and after activity can help reduce swelling and pain 

6) Taping: Can help to take the pressure off the kneecap. This is particularly useful for when you are playing sports. A physical therapist can teach you how to do this

7) Modifying your Activity: Limit running and instead try swimming or cycling. If you want to run, ensure you are wearing good shoes with cushioned shoes, and stay off hard surfaces e.g. concrete

8) Shoe Insoles: Insoles known as orthotics can help to correct flat feet and reduce the force through the kneecap

9) Knee Pads: Gel Pads are an excellent way to reduce pain and irritation when you do have to kneel

10) Surgery: This is only considered if nothing else works and the pain is really affecting you. It is done arthroscopically, where they make 2-3 small holes around the knee and insert a camera. They will then cut any tight ligaments to allow the patella to sit in the right place in the groove and/or shave off any damaged bits of cartilage.

Recovery Process

Chondromalacia Patellae usually settles down with medication and exercises but it is likely to take a few months. The sooner you get going with exercises, the sooner it will get better. Check out the strengthening exercises and stretches sections for exercises you can do at home to help. Surgery is rarely necessary.

Common Misdiagnosis

Front knee pain is commonly misdiagnosed as chondromalacia patellae when it isn’t. Another common cause of similar pain is Runners Knee (aka Anterior Knee Pain or Patellofemoral Pain). While the symptoms can be similar, there is not the softening and damage to the cartilage that is characteristic of chondromalacia patella. Treatment is however similar for both conditions.  You can find out more in the Runners Knee section.