Patellar chondromalacia – what is it, causes, symptoms, diagnosis, treatment

Proven content

Patellar chondromalacia is a disease of the cartilage that destroys it. Patellar pathology most often affects the knee and is the cause of injuries, disturbances of the limb axis or high stature. The result of chondromalacia of the patella is its softening or cracking.

What is patella chondromalacia?

Patellar chondromalacia is a condition characterized by the softening of the articular cartilage, it is a progressive process leading to its destruction. As a result of softening, the cartilage loses its properties, it ceases to be resilient and hard, and becomes soft, which is why it is not able to protect the bone and subchondral tissue that are on it. The cause of chondromalacia of the kneecap may be mechanical trauma to the knee joint or other indirect causes, such as overweight or tall stature. This ailment is considered to be one of the most common diseases of the kneecap, accompanied by pain in the knee and a feeling of “crunching” in the knee when bending or straightening the joint.

Features of the kneecap

The patellofemoral joint is responsible for the correct straightening of the knee joint, and the kneecap itself performs the following functions:

1. protective – protects the front knee compartment during bending and straightening;
2. shock-absorbing – transfers dynamic loads;
3. increasing the strength of the quadriceps shoulder.

Although the kneecap is covered with a thick layer of articular cartilage, it still suffers from numerous damages due to its load. It is related to the lack of own innervation and vascularization. For this reason, cartilage feeds primarily on synovial fluid, and it does not have regenerative capacity itself, so the destruction process is irreversible. Lack of innervation causes pain symptoms to occur only with severe damage to the cartilage, as a result of which patients see a doctor at an advanced stage of the disease.

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Patellar chondromalacia – causes

Patellar chondromalacia is one of the most common causes of the so-called painful kneeespecially in adolescents. The causes of this condition may lie precisely in the abnormal structure of the knees (valgus knees), weakness or excessive muscle tension around it, or the wrong position of the kneecap.

Other factors that increase the risk of chondromalacia of the patella:

1. mechanical injuries of the knee joint,
2. strain on the knee joints as a result of being overweight or poorly performed training.

Degenerative changes that form around the knee joint can be:

1. primary – without a clearly defined cause,
2. secondary – resulting from past injuries or related to a specific disease and treatment.

Patellar chondromalacia – classification

The most common disease classification is the Outerbridge classification, which distinguishes between lesions:

1. Grade 1 – lesions are superficial; you can feel a softening in the cartilage area.
2. 2nd degree – lesions extend to half the thickness of the articular cartilage; in addition, cracks and fissures in the cartilage are diagnosed.
3. 3rd degree – changes spread over half the thickness of the cartilage; the fractures are full thickness and extend to the subchondral bone.
4. 4th degree – defects in articular cartilage reveal the subchondral bone.

Patellar chondromalacia – symptoms

A typical and primary symptom of patellar chondromalacia is pain, located in the anterior compartment of the knee. It can occur at rest, when sitting with bent knees, when going down stairs, when going downhill. The disease may begin with an exudate in the knee joint, which occurs, for example, after a long trip or skiing.

In addition to pain, there may be:

1. swelling, especially when we overload the joint,
2. a feeling of joint stiffness,
3. “Crunch” and “crackle” in the pond,
4. instability in the pond.

Patellar chondromalacia – diagnosis

The basis for the diagnosis of patellar chondromalacia is a medical history, clinical tests and additional tests. The most frequently reported complaint is pain, which is especially aggravated when climbing stairs and sleeping. The history of trauma occurs most often, although the pain does not always follow it. The reason for visiting the doctor’s office is frequent exudation into the pond.

Clinical examinations are aimed at a comprehensive assessment of the patient, including his gait and possible disturbances of the limb axis. For this purpose, various types of tests are performed, e.g. ligamentous and meniscal tests. In addition, it will be checked if there is fluid in the joint. Both limbs should be examined. This is important because it is then possible to see differences between them in terms of muscle strength, soreness, mobility and friction when moving the kneecap.

On the other hand, among the additional tests performed in the diagnosis of chondromalacia of the patella, X-ray examinations (anteroposterior, axial and lateral sections) are the most frequently performed. Another examination is ultrasound, aimed at assessing superficial tissues, and magnetic resonance imaging, which is the most accurate non-invasive imaging examination. MRI allows you to diagnose cartilage pathologies and assess the degree of lesions. Sometimes arthroscopy is also used, which consists in inserting special tools into the joint that allow examination of changes located within the patella.

Patellar chondromalacia treatment

In the early stages of the disease, conservative treatment is used – warming up physiotherapy, quadriceps exercises, aspirin, possibly intra-articular administration of hyalgan. If the disease is advanced, surgery is indicated. The aim of the treatment of patellar chondromalacia is: regaining the full range of motion in the joint, reducing pain and inflammation, regenerating the articular cartilage, restoring muscle balance.

1. Conservative treatment. This type of treatment uses:

1. physical therapy – treatments aimed at reducing pain, e.g. cryotherapy, laser therapy, ultrasounds, electrotherapy, short-wave diathermy;
2. kinesitherapy – exercises that improve mobility and lead to muscle balance, e.g. stretching, muscle strengthening and stabilization exercises; in addition, weight reduction is important (in overweight people);
3. pharmacological treatment – the following are implemented: anti-inflammatory agents that reduce inflammation and pain; steroid preparations with a strong analgesic effect and administered directly into the joint; preparations improving the metabolism of articular cartilage, regenerating the cartilage by supplying it with components that build it. The preparations used can be administered orally or directly into the joint.

2. Surgical treatment. It may include correcting biomechanical disorders and treatments on articular surfaces. The most common procedure is arthroscopy, which is a less invasive procedure that allows the patient to recover quickly. Chondroplasty is also performed, during which the damaged layer of cleaning water is removed and the articular surface is cleaned and leveled.

In people with more advanced chondromalacia of the patella, the following procedures are performed:

1. to stimulate the regeneration of cartilage, e.g. abrasion. Thanks to its deep penetration from the bone marrow fat cells and blood cells flow out, which in turn fill the cavities in cartilage with mesanchymal cells;
2. filling defects in articular cartilage – using biomaterials, which are a scaffold for cells filling the defects; during the procedure, a small hole is drilled in the place of the defect, and then the biomaterial is inserted into it, which will be rebuilt with your own cells;
3. in the form of endoprosthesis of the patellofemoral joints and plasty with periosteal flaps,
4. in the form of cartilage and bone grafts using allogeneic (external) or autogenous (own) grafts.