Chondromalacia Patellae is a knee condition in which the cartilage that connects the undersurface of the knee bone starts softening and deteriorating, resulting in grinding sounds and moderate-to-severe knee pain.
It is often considered a sports overuse injury; hence the alternative name ‘Runner’s Knee’. However, Chondromalacia patellae can also affect older arthritic individuals, among others.
How It Happens?
When bending, the backside of the kneecap or patella glides over the knee joint, but due to the presence of a smooth layer of cartilage, the bones move smoothly without any friction. However, due to continued overuse or misaligned joints, this cartilage starts softening and deteriorating overtime; leaving little protection between the bone ends and causing them to rub against one another in a painful manner.
Issues with kneecap movement may be due to one or more of the following reasons:
- Congenital (at birth) misalignment of bones or joints.
- Weak thigh muscles, i.e. the hamstrings (back thigh) and quadriceps (front thigh).
- Imbalanced thigh muscles, i.e. the adductors (outer thigh) and abductors (inner thigh).
- Repeated stress on knee joints from running, jumping, and other activities.
- A direct kneecap or cartilage injury or infection
- Osteoarthritis or rheumatoid arthritis
- Intermittent bleeding inside the knee joint
- Repeated steroid injections into the knee
A constant, dull, aching pain in the front of the knee is the most common symptom of chondromalacia. This pain worsens when:
- Ascending or descending stairs
- Standing up after sitting for prolonged time periods
- Standing still for too long, like in the bus
Grinding and cracking, or creaky, sounds and sensations when bending, extending, or moving the knee in general are also common; although the creaky sounds may not always be a result of chondromalacia.
Another sign is trouble moving the knee joint past a certain point, along with unexpected ‘buckling’ of the knee joint, especially when bent repeatedly.
The affected knee may also appear puffy or swollen.
Chondromalacia Patellae is more common in sports which require placing frequent and excess pressure on the knee joints, such as running, football, cycling, tennis, volleyball, skiing, weightlifting, snowboarding, gymnastics, and ballet. However, the following factors can also predispose someone to developing the condition:
- Flat Feet: The arches are low and the foot rolls inward while walking, which places excess pressure on the feet and knee joints.
- Previous Injury: A direct blow to the knee resulting in a dislocation in the past increases the risk of developing chondromalacia.
- Occupation: Carpet layers, tile setters, floor layers, housemaids, and other workers who are required to kneel for prolonged time periods are more likely to experience cartilage deterioration.
- Arthritis: Chondromalacia can also be a sign of overall arthritis, i.e. joint and tissue inflammation and stiffness, which makes movement difficult.
- Age: Rapid bone and muscle development during growth spurts can cause short-term muscle imbalances in adolescents and young adults.
- Sex: Women naturally have less muscle mass than males, which increases side pressure on the kneecap and abnormal knee positioning, particularly during high-impact sports. Regularly wearing high heels also increases the risk of chondromalacia.
The gradual progression of chondromalacia patellae is organized into 4 stages according to severity:
- Grade 1: A small area of the cartilage behind the kneecap starts softening with mild, dull pain.
- Grade 2: The softened area increases and the knee may start appearing slightly swollen.
- Grade 3: The entire back-knee cartilage softens and thins, even cracking and shredding into a mass of fibers in most cases.
- Grade 4: A large portion of the cartilage deteriorates or disappears, resulting in increased bone-to-bone friction and extreme pain. In the most severe cases, cartilage will wear off completely and pieces of cartilage may even float inside the joint and cause irritation. This irritation causes fluid buildup, or ‘Joint Effusion’, inside the joint.
Chondromalacia patella is largely a self-healing condition, and the pain can be easily relieved through non-surgical means. So contact your doctor if knee pain develops suddenly and lasts longer than a few days.
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