A common source of knee pain is chondromalacia patella. (Chondro means cartilage, malacia means breakdown, and patella means kneecap.) Thus, chondromalacia patella refers to cartilage breakdown underneath the kneecap. This condition is also called patellofemoral dysfunction or patellar-tracking dysfunction, and is common among runners and also athletes where the sport involves a lot of running (soccer, tennis, etc.) A more accurate description is that chondromalacia patella begins as a patellar-tracking problem. This means that the kneecap scrapes the bones underneath when the knee is moved. Typical conventional treatments for this condition include taping the knee, exercising to strengthen the thigh muscles, and stretching exercises. These treatments may be effective but are usually not curative. Prolotherapy, on the other hand, can help patellar tracking and relieve chondromalacia pain.
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Chondromalacia is difficult for doctors and patients to understand.
In 2012 Doctors at the Finish Institute of Military Medicine found that MRI was ineffective in helping doctors determine the extent of injury in instances of Chondromalacia Patellae. The problem of understanding Chondromalacia Patellae by way of MRI continued until an April 2017 study to figure out how to read an MRI in Chondromalacia Patella patients was published.
Doctors announced that they have created a system to accurately read MRIs in patients with Chondromalacia patellae. Writing in the medical journal Acta radiologica researchers say that although magnetic resonance imaging (MRI) is widely used to investigate patellar cartilage lesions, there is no descriptive MRI-based grading system for chondromalacia patellae. To that end the researchers proposed a new MRI grading system for chondromalacia patellae with corresponding high resolution images which might be useful in precisely reporting and comparing knee examinations in routine daily practice and used in predicting natural course and clinical outcome of the patellar cartilage lesions.1
Even so, the problems of understand Chondromalacia Patellae will continue.
In 2014, our staff at Caring Medical published research findings in a paper entitled: Outcomes of Prolotherapy in Chondromalacia Patella Patients: Improvements in Pain Level and Function in the medical journal Clinical Medicine Insights Arthritis and Musculoskeletal Disorders.
Here are the highlights of that paper with explanations:
- Chondromalacia patella is the softening, thinning, and breakdown of cartilage underneath the patella (knee cap). It is also defined as patellofemoral pain syndrome or PFPS, often called Runner’s Knee in adolescents and young adults, the condition is primarily due to injury leading to the breakdown of intraarticular cartilage and resultant osteoarthritis.
- In older adults, chondromalacia patella is primarily the result of age-related osteoarthritis of the knee.
- Conservative, first line therapy for chondromalacia patella includes exercise, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections.
- While temporary pain relief is associated with chondromalacia patella, both treatments also lead to cartilage degeneration and knee replacement is ultimately required.
Chondromalacia patella causes and symptoms
In adolescents and active adults, chondromalacia patella can be due to sports injury with participation in athletics, such as running, soccer, cycling, skiing, and gymnastics, which are high-impact sports, involve abrupt stopping, and apply repetitive torsion, stress, and force to the joint.
Other sources that can lead to patellofemoral pain syndrome in teens and young adults include injury due to car accidents (dislocation and fracture) and congenital flat feet.
- In addition to acute or chronic pain, symptoms of chondromalacia patella may include popping and cracking sounds. These symptoms are worse upon climbing stairs, running, kneeling, squatting, or other physical activity involving the knee. Typically, the symptoms of chondromalacia patella worsen over time.
Chrondromalacia Patella Treatments
Doctors at Queen Mary University of London wrote in the medical journal Sports Medicine that doctors “with appropriate caution,” should consider taping for those patients with greater pain, orthoses (knee braces) for older individuals and exercise for younger individuals, and orthoses intervention for patients with greater forefoot and rearfoot abnormalities.
Why the caution? Because there is not good evidence that these treatments work. 1
This is in agreement with another study from Denmark that suggests that only one in three patients diagnosed with chondromalacia patellae were seen as “cured.” The study also showed that chondromalacia patellae will also cause one in four athletes to stop participating in sports because of knee pain. 2
As mentioned above supportive knee braces, arch supports and taping may also be recommended to improve the alignment of the kneecap. The problem with this approach is that they do not repair the deteriorated cartilage in the patellae.
- Physical therapy includes leg extensions and stretching exercises to help strengthen the thigh muscle, so the patellae or kneecap, tracks better on the femur – it doesn’t scrape the thigh bone.
- Muscle strengthening exercises may improve the relative location of the patella upon movement, but do not improve the tendons, ligaments, or cartilage.
In cases of unresponsiveness to medications or steroid injections, a surgeon may recommend an arthroscopic surgical procedure to “determine the level of damage” to the cartilage and attempt correction to the knee cap misalignment.
Another procedure known as a lateral release involves cutting the lateral ligaments to allow for normal position and tracking of the patella. If this does not correct the misalignment, more extensive surgical remedies may be recommended.
Chondromalacia Patella and Prolotherapy
In our 2014 paper our team evaluated the effectiveness of Prolotherapy in resolving pain, stiffness, and crepitus, and improving physical activity in chondromalacia patients. We examined and treated Sixty-nine knees with Prolotherapy in 61 patients (33 female and 36 male) who were 18–82 years old (average, 47.2 years).
Following Prolotherapy treatments:
- Patients experienced statistically significant decreases in pain
- Stiffness and crepitus decreased after Prolotherapy,
- Range of Motion increased.
- Patients reported improved walking ability and exercise ability after prolotherapy.
- No side effects of prolotherapy were noted.
- Only 3 of 69 knees were still recommended for surgery after Prolotherapy.
- Prolotherapy decreased chondromalacia patella symptoms and improved physical ability.
- Patients experience long-term improvement without requiring pain medications.5
If you would like to discuss non-surgical options for your Chondromalacia Patella problems – talk to our specialists.
- Ross Hauser, MD | Danielle Steilen-Matias, PA-C | Katherine Worsnick, PA-C | David Woznica, MD
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1 Mattila VM, Weckström M, Leppänen V, Kiuru M, Pihlajamäki H. Sensitivity of MRI for articular cartilage lesions of the patellae.Scand J Surg. 2012;101(1):56-61. [Sage Publications]
2. Özgen A, Taşdelen N, Fırat Z. A new MRI grading system for chondromalacia patellae. Acta Radiol. 2017 Apr;58(4):456-463. doi: 10.1177/0284185116654332. [Pubmed]
3. Lack S, Barton C, Vicenzino B, Morrissey D. Outcome predictors for conservative patellofemoral pain management: a systematic review and meta-analysis. Sports Med. 2014 Dec;44(12):1703-16. [Pubmed]
4. Rathleff MS, Rasmussen S, Olesen JL. Unsatisfactory long-term prognosis of conservative treatment of patellofemoral pain syndrome. Ugeskr Laeger. 2012 Apr 9;174(15):1008-13. [Pubmed]
5. Hauser RA. Outcomes of Prolotherapy in Chondromalacia Patella Patients: Improvements in Pain Level and Function. Clin Med Insights Arthritis Musculoskelet Disord. 2014; 7: 13–20.