Dr. Carlos Rebollón
Patellar Chondromalacia
Diagnosis and Treatments
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Patellar Chondromalacia
Patellar Chondromalacia
Although age is a factor that favors the occurrence of patellar chondromalacia in older adults, young individuals can also experience the condition with even more intense symptoms. Confirming the definitive diagnosis and ruling out other common knee pathologies is essential to effectively treat the wear and tear of the articular cartilage.
At Panama Clinic Orthopedic Center (COPAC), we provide top-notch orthopedic and traumatology services, and our specialists are ready to conduct a thorough evaluation to identify the cause of the problem and find the exact way to correct it and accelerate your recovery process.
WHAT IS PATELLAR CHONDROMALACIA?
It is a degenerative condition in which damage occurs to the cartilage of the patella (knee cap). Patellar chondromalacia leads to the wear, erosion, or softening of this crucial hyaline cartilage, with the extent of damage varying from mild to severe depending on the cartilage’s level of suffering.
Generally, patellar chondromalacia is accompanied by patellofemoral syndrome, causing pain in the front part of the knee (the joint area between the femur and the patella). However, the symptoms of both problems do not indicate the presence of a more serious disease or pathology such as arthritis.
In adolescents and young individuals, patellar chondromalacia is caused by overload or excessive pressure on the knee during daily activities, while in older individuals, it is often due to underlying degenerative diseases such as osteoarthritis.
GRADES OF PATELLAR CHONDROMALACIA
Patellar chondromalacia is classified into 4 grades as follows:
Grade 1
Initial stage (mildest of all), where the cartilage begins to show slight signs of softening.
Grade 2
The cartilage surface appears “frayed,” with changes visible on magnetic resonance imaging.
Grade 3
Fissures or cracks have penetrated the deeper layers of the cartilage, causing pain and inflammation in the joint.
Grade 4
The injury has advanced significantly, with the cartilage completely worn away and the underlying bone fully exposed.
SYMPTOMS OF PATELLAR CHONDROMALACIA
Symptoms of patellar chondromalacia include:
Pain in the patella (front part of the knee) that intensifies when flexing the knee.
Clicking or crunching sounds during flexion and extension movements of the affected knee.
Swelling.
Weakness of the quadriceps.
Instability.
Stiffness.
Limited mobility.
Diagnosis
A medical history and physical examination confirming the presence of the aforementioned symptoms are often sufficient to suspect chondropathy.
However, the definitive diagnosis of patellar chondromalacia is usually made after evaluating the current state of the cartilage through magnetic resonance imaging. The images taken will show the extent of cartilage erosion and the level of bone exposure.
CAUSES OF PATELLAR CHONDROMALACIA
The causes of patellar chondromalacia can be attributed to multiple factors, with a higher incidence observed in women than in men. Among the activities that can contribute to accelerated wear of the knee’s articular cartilage are:
Excessive joint use.
Individuals with knee alignment problems.
Overloading due to participation in certain sports.
Previous or recurrent knee injuries (fractures, chondral bruises, etc.).
Cartilage degeneration due to natural aging of the body.
TREATMENTS FOR PATELLAR CHONDROMALACIA
Commonly employed methods for treating patellar chondromalacia include:
Relative rest
The patient can lead a normal life but should avoid activities that generate impact and knee pain. Many of the symptoms improve progressively when excessive joint use is stopped.
Medications
Over-the-counter analgesics and anti-inflammatory drugs such as acetaminophen and ibuprofen are widely recommended to temporarily alleviate the discomfort of patellar chondromalacia.
Oral supplements
Although compounds containing substances like glucosamine, collagen, chondroitin, magnesium, and vitamin C may not have a significant effect on their own, they can work well as a complement to conservative treatment.
PHYSIOTHERAPY
In addition to helping improve muscle tone, strengthen and balance the knee structures, the physiotherapist may also offer the application of patellar taping (patellar strap) to reduce pain and correct knee alignment.
INJECTIONS
The use of hyaluronic acid and injections of growth factors or platelet-rich plasma are two techniques that have gained relevance in recent years. Both procedures have shown very good results in treating patellar chondromalacia by effectively blocking joint wear and preventing hyaline cartilage degeneration.
SURGERY
Surgery is usually the last treatment option for patellar chondromalacia and is considered only when conservative treatments have not helped after several weeks or when a clear anatomical anomaly has been identified.
Arthroscopic surgery is the typical surgical procedure for these cases.
During knee arthroscopy, the surgeon makes very small incisions through which they insert an arthroscope (visualization device) to expand the internal visual field. Subsequently, with the help of specialized instruments, they can correct any joint problems they encounter.
Rehabilitation
Patellar chondromalacia has a relatively slow recovery process. Patients treated conservatively may notice progress between the first 2 and 6 months of treatment.
On the other hand, those who have undergone surgical intervention will need to undergo a prolonged rehabilitation period (around 6 to 12 months). This period includes weeks of immobilization after surgery, subsequent use of crutches, progressive recovery of mobility and muscle strength, and finally, the necessary exercise plan to restore muscle strength.
