If you are suffering from knee joint pain, one reason could be a condition called chondromalacia patellae, or better known as runner's knee. Sometimes referred to as runner's knee or patellofemoral syndrome, it can make even the slightest movements very painful. What is chondromalacia patellae and how is it treated? Here is some information you need to know.
What is Chondromalacia Patellae?
Chondromalacia patellae is a condition in which the cartilage underneath the kneecap abnormally deteriorates or breaks down, causing the thigh bone to rub against the kneecap. This causes a “grating” of one bone against another, often leading to swelling and a great deal of pain. The rubbing of bone may also cause further deterioration of the cartilage, thereby compounding the problem.
The femur (thighbone), tibia (large bone in the lower leg), and patella make up the knee joint. The patella sits inside a special channel known as the patella groove, and along with the femur and tibia, is covered with cartilage. The quadriceps mechanism holds the patella in position and allows the knee to flex and bend when moving. When the quadriceps mechanism or any part of the knee joint fail to function properly, the kneecap may not glide smoothly as it is intended to do. It may also be incapable of absorbing shock.
Signs and Symptoms
Chondromalacia patellae are often accompanied by pain in or around the kneecap that:
- Becomes more aggravated during strenuous physical activity such as running or jumping.
- Makes going up and down stairs difficult. In fact, many patients with chondromalacia patellae experience greater discomfort when descending stairs rather than climbing them.
- Is accompanied by crackling or grinding noises when bending the knee.
- Appears to worsen after sitting or standing for a prolonged period of time, or when performing exercises that result in a great deal of pressure to your knees (for example, squats or lunges).
Pain in the knees may also be accompanied by:
- Joint stiffness
In advanced stages, patients may experience a loss of strength in the quadriceps muscle. When this happens, the knee may buckle or give out unexpectedly, leading to an increased risk of falling or another injury.
Present in One or Both Knees
With chondromalacia patellae, one or both knees may be affected. When the condition is present in both knees, one is usually affected more severely than the other. Symptoms may also be present in one knee then shift to the other, or come and go in both knees simultaneously. Even when only one knee show symptoms, it is important to exercise precautions in the opposite one to keep it from becoming afflicted as well.
Who is Susceptible?
Some people are more susceptible to developing chondromalacia patellae than others. Some high-risk factors include:
- Being female, as males have more muscle mass to stabilize and protect the knee.
- Flat-footedness, as individuals without a strong arch, may have to absorb some of the shock from everyday activities in their knees rather than the balls of their feet.
- Arthritis, which can cause inflammation in the knees and prevent the kneecap from moving properly.
- Having a previous knee injury such as a dislocated kneecap.
Affects Old and Young Alike
Age plays a role in the development of chondromalacia patellae. For example, teen and young adult athletes are at a higher-than-average risk of developing it. The reason for this is simple-growth spurts may lead to muscle imbalances that would then create weakness in the knees. Upon reaching adulthood, many are no longer affected by this condition until later in life when excessive wear and tear on joints throughout the body also becomes apparent.
Poor Alignment a Leading Factor
Those with certain misalignment issues may also be more susceptible to developing chondromalacia patellae as well. A few alignment conditions that might increase one’s odds include:
- Femoral anteversion, or a thigh bone that twists inward
- Bowed legs
- Parella alta, a condition in which one or both kneecaps are positioned higher than normal
- External tibial torsion, which occurs when the tibia turns inward
How is Chondromalacia Patellae Diagnosed?
Chondromalacia patellae may be diagnosed by reviewing symptoms and then performing a physical examination that involves pressing on the kneecap and checking for tenderness in and around it. In cases where an injury or underlying condition such as arthritis is present, certain testing may be required to achieve an accurate diagnosis. Some common tests used to diagnose this condition are:
- X-rays, which can reveal some of the common misalignment issues that contribute to chondromalacia patellae.
- Magnetic Resonance Imaging or MRI, a procedure that allows doctors to view the cartilage behind the kneecap and determine the amount of wear and tear that has taken place.
- Arthroscopy, a procedure in which a tiny camera known as an endoscope is inserted into the knee to check for damage.
Early Treatment Options
Moderate instances are often treated using the RICE method, which involves:
More Aggressive Treatment Options
An anti-inflammatory medication such as ibuprofen can prove very effective at eliminating symptoms. Many people fully recover after conservative treatment such as this, but some will require more aggressive measures such as:
- Physical therapy to strengthen the hamstrings, quadriceps, abductors, and adductors. Improving muscle strength in these areas counteracts knee alignment and reduces friction.
- Bracing or taping the knee to prevent excessive movement.
- Wearing orthopedic shoes with the right biomechanical fit to support the arches so that further stress on the knees may be avoided.
- Corticosteroid injections to reduce inflammation and swelling.
- Viscosupplementation, which involves injecting a lubricating fluid directly into the knee joint. This type of treatment is often recommended whenever osteoarthritis is a contributing factor.
Although certain people are more predisposed to chondromalacia patellae than others, the condition can actually strike anyone at any time. As such, it is important to take precautionary measures such as:
- Avoiding too much strain on the knee joints-for example, limiting the number of squats you perform or doing low-impact cardio such as swimming or bicycling rather than running or jumping.
- Maintaining a normal weight. Each pound of excess weight creates four additional pounds of stress on your knee joints.
- Performing more exercises to strengthen your quadriceps and thigh muscles.
- Ensuring you wear the proper athletic shoes when working out, particularly if you are flat-footed.
- Limiting the amount of time you spend sitting, standing, or kneeling.
- Wearing kneepads or using a cushion when kneeling for any extended amount of time such as when gardening.
When treated in its early stages, the odds of recovering from chondromalacia patella are very high. However, when symptoms persist or the underlying cause is not addressed, one of the following surgical procedures could become necessary:
- Lateral release to eliminate tension in the ligaments and provide a greater range of motion.
- Smoothing or “sanding” the back of the kneecap.
- Cartilage grafts.
- Kneecap replacement, which is typically performed only in the most extreme cases where it is little or no cartilage remaining and excruciating pain greatly detracts from one’s quality of life.
Diagnosed with Chondromalacia Patellae? Take Action Now
Chondromalacia patellae is potentially serious, even when conditions improve with adequate rest. If you are at risk of developing it, we suggest one of our knee braces and sleeves to alleviate pressure and eliminate excessive grinding.