The patella, also called the ‘knee cap’ is a small bone present on the front of your knee joint. The underside of the patella is covered by cartilage that allows smooth gliding of the knee with movement. Overuse or malalignment of the patella can cause wear and tear of the cartilage.
Chondromalacia patella describes a condition characterized by softening, weakening and damage of the cartilage. The condition is most often seen among young athletes and older adults who have arthritis of the knee. It is more commonly seen in females.
There is no explicit reason why the cartilage damage occurs. However, it is associated with poor knee alignment or imbalance in the tightness of the muscles holding it in place. Overuse of the knee in certain sports activities may cause wear and tear of the cartilage. This may cause rubbing or grinding of the kneecap instead of it smoothly gliding over the knee joint.
Chondromalacia patella may also be caused due to injuries such as fractures or dislocations, or may develop as a part of your ageing process.
Chondromalacia patella is the most common cause of knee pain. Sometimes referred to as patellofemoral pain syndrome, it is characterized by the following:
- Pain in front, around or behind your knee
- Pain that gets worse when climbing up or down the stairs, sitting or standing for long periods, or when extreme pressure is applied on the knee
Other symptoms may include:
- Crunching, grinding or cracking sensation or noise whenever you move your knee
- Rarely, swelling or fluid effusion in your knee joint
Your surgeon will conduct a physical examination by applying pressure on different areas of your knee and moving your leg in different positions. You may be asked to undergo imaging tests including plain X-rays, a skyline/sunrise X-ray,and possibly CT scan or MRI scan to obtain detailed images of the bones and soft tissues of the knee joint.
The treatment of chondromalacia patella initially involves simple conservative procedures. You may be asked to rest your knee and avoid any activity that may aggravate the knee joint. Your doctor may prescribe painkillers and anti-inflammatory drugs to relieve pain and reduce swelling. Physiotherapy may help you to improve the muscle strength, decrease stress on your knee and aid in correcting the malalignment. Wearing support braces and specialist taping around the knee by your physiotherapist may help you protect your joint, reduce pain and improve alignment/tracking. Application of ice on the knee may be recommended after exercise.
When non-surgical treatment does not relieve pain, your surgeon may recommend surgical treatment. Surgery may involve:
- Arthroscopy: your doctor inserts a device called an arthroscope (thin tube with a camera and light attached) through a small incision. This helps to clearly view the surgical site while other instruments are inserted to remove fragments of the damaged cartilage.
- Reconstruction of the stabilising Patellofemoral ligaments (MPFL) if instability is an underlying cause.
- Realignment: your surgeon may operate on your knee to realign the position of your knee cap and release the pressure over the cartilage.
Your surgeon will examine your condition and provide you with best treatment option.