Chondromalacia patellae

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This article is about certain forms of inflammation under the patella. For other uses, see Runner's knee.
Chondromalacia patella
Classification and external resources
ICD-10 M22.4
ICD-9 717.7
DiseasesDB 2595
MedlinePlus 000452
Patient UK Chondromalacia patellae
MeSH D046789

Chondromalacia patellae (also known as CMP) is inflammation of the underside of the patella and softening of the cartilage.

Chondromalacia patellae is a term sometimes treated synonymously with patellofemoral pain syndrome.[1] However, there is general consensus that patellofemoral pain syndrome is a term that applies only to individuals without cartilage damage,[1] thereby distinguishing it from chondromalacia patellae, a condition characterized by softening of the patellar articular cartilage.[2]

The cartilage under the kneecap is a natural shock absorber, and overuse, injury, and many other factors can cause increased deterioration and breakdown of the cartilage. The cartilage is no longer smooth and therefore movement and use is painful.[3] While it often affects young individuals engaged in active sports, it also afflicts older adults who overwork their knees.[4][5]

Description[edit]

While the term chondromalacia sometimes refers to abnormal-appearing cartilage anywhere in the body,[6] it most commonly denotes irritation of the underside of the kneecap (or "patella"). The patella's posterior surface is covered with a layer of smooth cartilage, which the base of the femur normally glides effortlessly against when the knee is bent. However, in some individuals the kneecap tends to rub against one side of the knee joint, irritating the cartilage and causing knee pain.[7] Chondromalacia can be classified into four levels. Grade 1 is when there is softening and swelling of the cartilage. Grade 2 is when there is breaking up and fissuring of cartilage in an area that is half an inch or smaller in diameter. Grade 3 is disintegration and fissuring of cartilage in an area larger than half an inch. Grade 4 is when cartilage erodes down to the bone. [8] The condition may result from acute injury to the patella or chronic friction between the patella and a groove in the femur through which it passes during knee flexion.[9] Possible causes include a tight iliotibial band, neuromas, bursitis, overuse, malalignment, core instability, and patellar maltracking.

The border of the medial condyle differs from the lateral condyle in that the articular cartilage is separated from the femoral shaft by a distinct rim. When flexion occurs at the knee, instead of sliding smoothly, hugs the femoral shaft closely, then lifts up over the rim. The patella is dragged across the rim and then tilts down to the surface of the condyle. The part of the medial facet involve in this process is usually the same area where chondromalacia occurs. [8]Pain at the front or inner side of the knee is common in both young adults and those of more advanced years, especially when engaging in soccer, gymnastics, cycling, rowing, tennis, ballet, basketball, horseback riding, volleyball, running, combat sports, figure skating, snowboarding, skateboarding and even swimming. The pain is typically felt after prolonged sitting.[10] Skateboarders most commonly experience this injury in their non-dominant foot due to the constant kicking and twisting required of it.[citation needed] Swimmers acquire it doing the breaststroke, which demands an unusual motion of the knee. People who are involved in an active life style with high impact on the knees are at greatest risk. Proper management of physical activity may help prevent worsening of the condition. Athletes are advised to talk to a physician for further medical diagnosis as symptoms may be similar to more serious problems within the knee. Tests are not necessarily needed for diagnosis, but in some situations it may confirm diagnosis or rule out other causes for pain. Commonly used tests are blood tests, MRI scans, and arthroscopy.[8]

Treatment[edit]

In the absence of cartilage damage, pain at the front of the knee due to overuse can be managed with a combination of RICE (rest, ice, compression, elevation), anti-inflammatory medications, and physiotherapy.[11]

Usually chondromalacia develops without swelling or bruising. While treatment remains controversial,[citation needed] most individuals benefit from rest and adherence to an appropriate physical therapy program. Allowing inflammation to subside while avoiding irritating activities for several weeks is followed by a gradual resumption. Cross-training activities such as swimming[citation needed] can help to maintain general fitness until a physical therapy program emphasizing strengthening and flexibility of the hip and thigh muscles can be undertaken. Training specific muscles is important to improving pain caused by chondromalacia. The quadriceps are most important because they can be trained to prevent lateral tracking of the patella, which causes the cartilage to tear. [8]Use of nonsteroidal anti-inflammatory medication is also helpful to minimize the swelling amplifying patellar pain. The patella can be taped in order to decrease pain caused by chondromalacia. However, three components must be assessed to determine how it should be taped. First, the glide component must be tested, which is the amount of glide of the patella. The next test is the tilt component, which is the amount of tilt detected by a therapist using their thumb and index finger on the lateral and medial borders of the patella. Third is the rotation component, which is the alignment of the patella. [8]Treatment with surgery is declining in popularity due to positive non-surgical outcomes and the relative ineffectiveness of surgical intervention.[7]

See also[edit]

References[edit]

  1. ^ a b Heintjes, E; Berger, MY; Bierma-Zeinstra, SM; Bernsen, RM; Verhaar, JA; Koes, BW (2004). "Pharmacotherapy for patellofemoral pain syndrome.". The Cochrane database of systematic reviews (3): CD003470. doi:10.1002/14651858.CD003470.pub2. PMID 15266488. 
  2. ^ Dixit, S; DiFiori, JP; Burton, M; Mines, B (Jan 15, 2007). "Management of patellofemoral pain syndrome.". American family physician 75 (2): 194–202. PMID 17263214. 
  3. ^ "Chondromalicia patella". Mayo Clinic. Mayo Foundation for Medial Education and Research (MFMER). Retrieved 9 December 2013. 
  4. ^ Grelsamer, Ronald P (2005). "Patellar Nomenclature". Clinical Orthopaedics and Related Research (436): 60–5. doi:10.1097/01.blo.0000171545.38095.3e. PMID 15995421. 
  5. ^ "Isolated patellofemoral arthritis often overlooked". Academy News. The American Academy of Orthopaedic Surgeons. February 6, 1999. 
  6. ^ Schindler, Oliver S. (2004). "Synovial plicae of the knee". Current Orthopaedics 18 (3): 210–9. doi:10.1016/j.cuor.2004.03.005. 
  7. ^ a b Cluett, Jonathan (June 14, 2011). "Chondromalacia". About.com. 
  8. ^ a b c d e "Chondromalacia patellae". Health Information Patient.co.uk. Egton Medical Information Systems Ltd. Retrieved 9 December 2013. 
  9. ^ Shiel, William C.; Cunha, John P. (June 27, 2012). "Chondromalacia Patella". MedicineNet. Retrieved May 19, 2013. 
  10. ^ Gauresh. "Knee Cap Pain". [unreliable medical source?]
  11. ^ Jenkins, Mark A.; Caryn Honig (2005-06-02). "Patello-Femoral Syndrome". Retrieved 2008-10-06. [unreliable medical source?]

External links[edit]