Chondromalacia (Patellofemoral Syndrome) – Runner’s Knee

Chondromalacia Patella is the degeneration of the cartilage in the knee caused by mal-tracking of the patella as it slides over the femur.

It can also be an over-use syndrome caused by sports.

 

Improper knee cap movement may result from:

• Poor alignment due to a congenital condition.
• Weak hamstrings and quadriceps.
• Muscle imbalance between the adductors and abductors (inside of thigh)
• Repeated stress to knee joints from running, ski-ing or jumping.

Adolescents and young adults are at high risk for this condition. During growth spurts the muscles develop rapidly which may contribute to short-term muscle imbalance.

Females are more likely to develop Runner’s Knee as they typically have less muscle mass than males. This causes more lateral pressure on the knee cap.

Flat feet will place more stress on the knee joints than people with higher arches.

Runner’s Knee can also be a symptom of arthritis.

Symptoms:

Chondromalacia Patellae will typically present itself with pain in the knee region. You may feel sensations of cracking or grinding when sitting or extending the knee. Pain is usually worse after sitting for a prolonged time or during activities which apply pressure to the knee.

Chondromalacia

Diagnosis:

There will be an area of swelling or tenderness around the knee.

• X-rays can show bone damage or signs of mal-alignment and arthritis.
• MRI show cartilage wear and tear.
• Arthroscopic exam is a minimally invasive procedure involving an endoscope and camera.

Grading:

Grade: 1 Softening of the cartilage.

Grade: 2 Softening of the cartilage with abnormal surface
characteristics. This shows the beginning of tissue erosion.

Grade: 3 Thinning of cartilage with active deterioration of the tissue.

Grade: 4 Most severe. Exposure of the bone with a significant portion of cartilage deterioration. Bone-to-bone rubbing.

Treatment options for Chondromalacia:

The goal is to reduce the pressure on the knee cap. Resting, stabilizing and icing the joint. Cartilage damage can sometimes repair with rest.

Anti-inflammatories can reduce inflammation around the joint.

Physical therapy:

Focuses on strengthening the quadriceps, hamstrings, adductors and abductors which can help improve muscle strength and balance.

Muscle balance can help prevent knee misalignment.

Non-weight bearing exercises are recommended (swimming, riding and stationary bike exercises).

Isometric exercises which tighten and release muscles helps maintain muscle mass.

Surgery:

Arthroscopic surgery – a common procedure. It is a lateral release (cutting some of the ligaments to release tension) allowing more movement. Other options are smoothing the back of the knee cap, a cartilage graft or relocating insertion of thigh muscle.
Preventing Chondromalacia Patellae:
Avoid repeated stress to knee caps. Wear knee pads if you spend a lot of time kneeling.

Create muscle balance by strengthening quadriceps, hamstrings, abductors and adductors.

Wear orthotics that correct flat feet. This will decrease the amount of pressure placed on the knee and may re-align the knee cap.

Maintaining a healthy body weight can reduce pressure on the knee and other joints.

Merriefield Podiatry stock a range of off-the-shelf orthotics as well as offering a bespoke service – your feet are cast in Plaster-of-Paris and orthotics are crafted to the contours of your feet and manufactured from a range of materials. Additional components can be added to correct any mal-alignments and therefore improve your walking.

Please enquire for further details:
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