Chondromalacia Patellae

What is chondromalacia patellae?

Chondromalacia patella refers to damage to the cartilage on the undersurface of the patella (kneecap). This damage can occur if the patella is not tracking normally within the V-shaped groove of the femur bone (trochlea). Issues with patella tracking can be caused by muscle weakness, abnormal alignment or rotation of the femur or tibia, pronated feet, or a tight iliotibial band.

What are the symptoms of chondromalacia patellae?

Pain at the front of the knee, which is worse with activities that load the patellofemoral joint such as walking up stairs, running, lunging, or squatting. 

How do you treat chondromalacia patellae?

Treatment of this condition is usually non-operative and involves correcting the tracking of the patella so that it sits centrally in the groove of the femur with knee joint motion. Usually a combination of the below treatments can alleviate pain caused by chondromalacia patellae.

Treatment can involve the following:

Activity modification

Avoid activities that cause significant loading of the patellofemoral joint.

Physiotherapy

Strengthening the hip abductors and inner thigh (quadriceps) muscle as well as stretching the iliotibial band.

Joint injection

Injecting a lubricant (hyaluronic acid) into the knee joint to make patellofemoral gliding smoother.

Botox injection

Injecting a paralysing agent into the tensor fascia lata muscles. This relaxes the tightness within the iliotibial band and can help with patella tracking.

Braces

Patellofemoral brace that encourages central patella tracking.

Taping of the patella

Foot orthotics

To correct the pronation in the feet.

What does surgery for chondromalacia patellae involve?

Surgery for chondromalacia patellae is only considered after non-operative measures have been exhausted and if there is an anatomical abnormality that can be corrected.

Keyhole surgery will be performed to assess the state of the cartilage across the patellofemoral joint. Any loose cartilage lesions will then debrided until they become stable. If there are significant issues with the alignment of the patella, this can be corrected by realignment surgery. Tight tissues on the outside of the knee may need to be released in order to let the patella sit in the groove normally.