24/12/2021, 21:02 Chondromalacia Patella: Causes & Treatment - Knee Pain Explained

Chondromalacia Patella
Written By:  Chloe Wilson, BSc(Hons) Physiotherapy
Reviewed by:  KPE Medical Review Board

Chondromalacia patella is a common knee

condition where there is softening and damage
to the cartilage on the back of the patella
(kneecap). 

Chondromalacia causes  front knee

pain,  swelling  and clicking/grinding noises
when moving the knee.

It tends to affect young, healthy and often

sporty people, most commonly affecting
adolescents and young adults. Chondromalacia
is more common in women than men.

Chondromalacia patella is frequently

misdiagnosed as  Runners Knee, which is
actually a problem with how the kneecap moves rather than the cartilage
itself.

Here we will look at the most common causes and symptoms of

chondromalacia as well as the best ways to treat it and the recovery process.

Why Do We Have Kneecaps?

The patella is a small, triangular shaped bone that sits inside the quads
muscles at the front of the thigh.

It rests in a special dip know as the patella

groove on the front of the thigh bone, the
femur, where it moves up and down as you
move your leg.

The patella is lined with the thickest cartilage in

the whole body which:

Ensures the patella glides smoothly over

the knee bones
Works as a shock absorber

Not only does the patella help to protect the

knee joint, it also helps the quads muscles work more effectively, by reducing
the amount of force needed to move the knee.

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What Causes Chondromalacia

Patella?
Chondromalacia patella is caused by a problem with how the knee cap move.
Instead of gliding smoothly up and down in the patella groove, it shifts over
slightly, rubbing against the edge of the groove, causing friction. This causes
small tears in the cartilage which get inflamed and cause pain.

Common causes of chondromalacia patella are:

1. Muscle Imbalance:  In chondromalacia

patella, a combination of  muscle tightness  on
the outer knee and  muscle weakness  on the
inner knee affects the position of the kneecap in
the patella groove.

This pulls the kneecap slightly to the side so it

rubs on the edge of the patella groove,
resulting in a lot of friction which ends up
damaging the cartilage. This is also known as patella maltracking. 

2. Poor Alignment of the Kneecap:  For some people, their patella

doesn’t sit in the right position, but rests either too high or too low. Some
people are born this way, but it doesn’t become apparent until
adolescence.

3. Overuse of the Leg:  Any activities that place strong, repetitive forces
through the kneecaps, e.g. running, jumping, twisting, can damage the
back of the cartilage leading to chondromalacia.

4. Flat Feet:  Having flat feet is another common cause of chondromalacia

patella. When the foot arches drop, as with flat feet, it changes the way
the forces are distributed through the knee as we walk and run which
makes the cartilage more prone to damage.

Chondromalacia Patellae
Symptoms
The most common symptoms associated with Chondromalacia Patella are:

Front Knee Pain: tends to be achy rather than sharp 

Grinding/Grating Sensation: when moving the leg, known as crepitus
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Minor Swelling: usually around the patella

Tenderness: with any pressure through the kneecap
Pain On Stairs:  tends to worse going downstairs rather than upstairs
Pain After Prolonged Rest:  when you first get up after sitting down for
a while

How is Chondromalacia
Diagnosed?
Your doctor will normally diagnose patella chondromalacia from your
description of symptoms and by carrying out some simple tests. 

These may include looking at the movement of

the knee, and putting pressure through the knee
cap

Standard x-rays don’t usually show up the

problem, although a “skyline view x-ray” taken
from the side of the leg can be used to see the
back of the kneecap.

MRI scans are occasionally used to confirm the diagnosis.

Treating Chondromalacia
Chondromalacia patella treatment typically includes:

1. Knee Straps:  They might not look like

much but wearing a strap directly under the
kneecap helps take pressure off the joint,
which can dramatically reduce knee pain.
They are simple to use and very
effective.  LEARN MORE >

2. Knee Exercises:  Strengthening and

stretching exercises  can really help with
chondromalacia. They help to combat any
muscle imbalance and improve how the
kneecap moves, which takes the pressure off the kneecap. I have never
known anyone with chondromalacia patella who has not had muscle
imbalance.  LEARN MORE >

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3. P.R.I.C.E:  Protect, Rest, Ice, Compress, Elevate is one of the simplest

and underused treatments for chondromalacia. When done properly it
helps reduce pain and swelling and can speed up recovery.  LEARN MORE >

4. Ice:  Using  ice  regularly and before and after activity can help reduce
swelling and pain associated with chondromalacia.  LEARN MORE >

5. Shoe Inserts:  If are suffering from chondromalacia and you have flat
feet, then wearing insoles known as orthotics can really help. They simply
slip into your shoe and help to correct alignment by supporting the foot
arches which helps to reduce the force through the kneecap.

If you are going to use shoe inserts, make sure you wear them in both
shoes otherwise you end up with one leg slightly longer than the other
which can lead to back and hip problems. You should also start by only
wearing them for short periods and gradually build up to allow your body
to adjust.

6. Medication:  Non-steroidal anti-inflammatories (NSAID’s) such as

ibuprofen will help to relieve the inflammation and pain associated with
chondromalacia. Always check with your doctor before taking any
medication.

7. Taping:  Taping can help to realign the patella and take the pressure off
the kneecap - particularly useful for sports. Initially, I would recommend a
physical therapist applies the tape, but once they have found the best
taping technique for you, they can teach you how to do it yourself. 

8. Modify your Activity:  An important part of Chondromalacia Patella

treatment is to try and avoid the activities that placing pressure through
the kneecap.

Limit running and instead try swimming or cycling. If you want to run,
ensure you are wearing good shoes with cushioned shoes, and stay off
hard surfaces e.g. concrete.

9. Use Knee Pads:  Gel Pads  are an excellent way to reduce kneecap pain
and irritation when you are kneeling. They take the pressure off the back
of the kneecap and provide cushioning. There are loads of different
options out there, some more effective than others.  LEARN MORE >

10. Knee Surgery:  Surgery for chondromalacia patella is only considered if

nothing else works and the pain is really affecting your daily life.

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Most commonly it will be a knee arthroscopy, keyhole surgery where they

make 2-3 small holes around the knee and insert a camera. The surgeon
cuts any tight ligaments to allow the patella to sit in the right place in the
groove and/or shave off any damaged bits of cartilage so the kneecap can
move correctly.

Recovery Process
Chondromalacia Patellae usually settles down with medication and exercises
but it is likely to take a few months.

The sooner you get going with exercises, the sooner it will get better. Check
out the  strengthening exercises  and  stretches  sections for exercises you can
do at home to help. Surgery is rarely necessary.

Common Misdiagnosis
Front knee pain  is commonly misdiagnosed as chondromalacia patellae when it
isn’t. Another common cause of similar pain is  Runners Knee  aka Anterior
Knee Pain or Patellofemoral Pain.

While the symptoms can be similar, there is not the softening and damage to
the cartilage that is characteristic of chondromalacia. Treatment is however
similar for both conditions. 

If chondromalacia patella doesn't sound quite like your problem, visit the  knee
pain diagnosis  section for help working out what your problem is and what
you can do about it.   

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