Chondromalacia

Chondromalacia
Chondromalacia (KON-dro-mah-LAY-she-ah), also called
chondromalacia patellae, refers to softening of the articular
cartilage of the kneecap. This disorder occurs most often in
young adults and can be caused by injury, overuse, misalignment
of the patella, or muscle weakness. Instead of gliding
smoothly across the lower end of the thigh bone, the knee
cap rubs against it, thereby roughening the cartilage underneath
the knee cap. The damage may range from a slightly
abnormal surface of the cartilage to a surface that has been
worn away to the bone. Chondromalacia related to injury
occurs when a blow to the knee cap tears off either a small
piece of cartilage or a large fragment containing a piece of
bone (osteochondral fracture).
Symptoms
The most frequent symptom is a dull pain around or under
the knee cap that worsens when walking down stairs or hills.
A person may also feel pain when climbing stairs or when
the knee bears weight as it straightens. The disorder is common
in runners and is also seen in skiers, cyclists, and
soccer players.
Diagnosis
Your description of symptoms and an x ray usually help the
doctor make a diagnosis. Although arthroscopy can confirm
the diagnosis, it’s not performed unless conservative treatment
has failed.
Treatment
Many doctors recommend that people with chondromalacia
perform low-impact exercises that strengthen muscles, particularly
muscles of the the inner part of the quadriceps,
without injuring joints. Swimming, riding a stationary bicycle,
and using a cross-country ski machine are examples of
good exercises for this condition. Electrical stimulation may
also be used to strengthen the muscles.
Increasingly, doctors are using osteochondral grafting, in
which a plug of bone and healthy cartilage is harvested from
one area and transplanted to the injury site. Another relatively
new technique is known as autologous chondrocyte implantation,
or ACI. It involves harvesting healthy cartilage cells,
cultivating them in a lab and implanting them over the lesion.
If these treatments don’t improve the condition, the doctor
may perform arthroscopic surgery to smooth the surface of
the cartilage and “wash out” the cartilage fragments that
cause the joint to catch during bending and straightening.
In more severe cases, surgery may be necessary to correct the
angle of the knee cap and relieve friction between it and the
cartilage, or to reposition parts that are out of alignment.