Knee Pain And Chondromalacia Patellae

What is chondromalacia patellae?

Chondromalacia patellae is a condition that affects the knee, causing pain. In particular, it affects the joint with your kneecap.
Because it causes pain, we also call it patellofemoral pain syndrome.
It happens when there is softening and degeneration of the kneecap cartilage, which results in pain and discomfort.
Chondromalacia patellae is a common cause of anterior knee pain, especially in young adults, athletes, and individuals who engage in activities with repetitive knee movements.

What are the causes?

• Excessive use: repetitive activities that put pressure on your kneecap, like long-distance running or CrossFit.
• Deep squats: even though bodybuilders insist on going deep down with each squat, that’s not the best option for your knees. Your cartilage suffers when your knee flexes over 90 degrees. It’s too much tension to endure.
• Anatomic factors: some people have knee variations, like a high patella. These are not strictly harmful, but they can overstress your knee and lead to knee pain and chondromalacia.

Symptoms of chondromalacia patellae

Pain. It happens in the front of your knee, and it begins gradually. It’s usually related to physical activity and can occur in one or both knees.
It gets worse with activities with knee flexion, such as squats, jumping (beware Crossfitters doing the box jump), or running.
You can feel clicking or crackling sounds when climbing stairs, but that does not necessarily indicate a serious issue.
In some cases, your knee may swell. This is most common if you have a loose cartilage fragment moving around your knee. If the fragment gets trapped, your knee may get locked and you can’t bend it.

How do you diagnose it?

The most important part is physical exploration. A doctor, usually an orthopedic surgeon, needs to examine you. They will also ask questions about your pain.
That will give them a good idea about what’s going on in your knee.
Then, they will need some tests. The most common are:

• x-ray of your knee
• MRI: it’s great at showing any damage to your cartilage.
• CT: great for finding anatomic variations, like trochlea deformity, patella alta…

The role of MRI in knee pain

MRI is the most helpful test you can have if you have knee pain.
First, it will show many of the different lesions that cause knee pain. For example, it will show if you broke your ACL or your meniscus. It also shows chronic conditions such as impingement syndromes or chondromalacia patellae.
If you do have chondromalacia, MRI is great because it allows us to know the grade of the lesion (how bad it is from 1 to 4).
Finally, some cases are due to scars inside your knee, which we call plicae. MRI can find those scars so that your surgeon can remove them accurately.

How to treat it

Most of the time, you won’t require any surgery or special treatment.
Only really severe cases end up needing surgery.
For the rest of you, you need to focus on building strength around your knee and correcting some causes.

· Improve your knee mechanics

• Reduce high-impact activities, at least until the pain goes away. Meanwhile you can try biking, swimming, or the elliptical machine.
• If you are overweight, try to lose some weight. Your knees will feel the difference.
• Try to build muscle on the inner side of your quadriceps and your adductors. You can do this through ‘sumo’ squats or lunges. These two exercises may worsen the pain in the first few days, but they yield excellent results in the medium term.

· Supplements and injections

• Oral supplements. They contain compounds such as glucosamine, chondroitin, and collagen. They won’t heal you on their own. However, they can help complement the treatment if you do all the other things right.
• Hyaluronic acid injection. Hyaluronic has 2 effects: it acts as lubrication and helps repair the cartilage.  In the short term, it’s like using WD-40 lubricant inside the joint; however, it acts as a growth factor at high concentrations.
• Other treatments, such as platelet-rich plasma (PRP) or stem cells, are showing promising results; however, they are not as effective inside the joints as they are on tendons.

Surgery

Most cases don’t require surgery. However, you may need it if pain persists despite the above measures.
In many cases, an arthroscopic procedure will be the most adequate.
An arthroscopy involves two small openings with direct camera visualization. Then, there are several therapies we can perform:

• Remove damaged cartilage. If there is loose or unstable cartilage, we can remove it from the surface of the patella. This technique is called Chondroplasty, and it improves pain significantly.
  If there are large or deep lesions, we may also perform micro-perforations. That way, stem cells can reach the “holes” and turn into cartilage, regenerating it.
• Release the Lateral Retinaculum. If the lateral retinaculum is too tense, your patella will be tight, too. By cutting it, we will reduce tension and correct patellar misalignment.
• Remove joint adhesions and plicae. Some cases of knee pain are caused by articular scars between the patella and the femur. If that’s the cause of your pain, a minor intervention will provide you great relief. The way to find these adhesions is through a knee MRI.
• Surgery to the Anterior Tibial Tuberosity (ATT). Some people have knee pain because their patella is not “in the middle” but rather “lateral.” Through this surgery, we’ll realign your patella in the middle, in a more natural place.

Sources

· Arthroscopic treatment of lateral retinaculum: video.
· Arthroscopic chondroplasty of the patella: link.