Treating Bad Knees, Chondromalacia Patellae

Chondromalacia Patellae, or Runner’s Knee, occurs when the cartilage present on the undersurface of the kneecap (patella) starts softening and disappearing, resulting in severe pain that hinders proper knee movement.

The condition generally results from overuse, and therefore, requires only rest, home treatment, and physiotherapy for a full recovery. For a thorough treatment, consult an orthopedic specialist.

Surgery is usually only needed if the cartilage has partially or fully worn off, or if misaligned joints are the cause.

Treatment:

Chondromalacia patellae is a self-repairing condition, so the goal of treatment is to reduce knee joint pressure to allow the cartilage to repair itself:

1-Preliminary Measures:

The following measures are taken for stabilizing the knee joint and reducing any swelling:

• Take OTC or prescription-grade non-steroidal anti-inflammatory medications (NSAIDS) like ibuprofen for pain management.
• Place ice or a cold pack over the painful and/or swollen area for 15-20 minutes 4 time a day and after exercise. Always wrap the ice or cold pack in a towel before using to avoid extreme exposure.
• Start an exercise program to strengthen the surrounding knee muscles. However, avoid high-impact, kneeling, and squatting exercises.
• Wear a knee brace, tape, or special patellar-tracking sleeve to retain kneecap alignment when walking.
• Athletes can stay in proper shape during the recovery period by switching to low-impact activities like swimming instead of their usual exercise regime; at least until the inflammation subsides, after which targeted physiotherapy can help strengthen the thigh muscles.

2-Physical Therapy:

After several weeks, when pain and inflammation are considerably reduced, patients are commonly recommended physiotherapy sessions to help improve knee joint, thigh and hip muscle strength, balance, and flexibility, and avoid future recurrences.

Therapy generally focuses on the quadriceps (front thigh), hamstrings (back thigh), adductors (outer thigh), and abductors (inner thigh) to prevent knee misalignment.

Physiotherapy usually consists of non-weight-bearing and isometric exercises (holding a position instead of full body movement). Some isometric exercises that can be performed at home include:

• Straight Leg Lift: Bend one leg at a 90^o angle and keep the foot flat on the floor while lying on your back. Straighten the other leg, tighten the quadriceps, and raise it at a 45^o Hold for 1-2 seconds, lower down slowly, switch legs, and repeat alternately in 2-3 sets of 20 repetitions for each leg.
• External Hip Rotation: Lie on your side with one knee over the other and bent at 90^o. Flex your hips at an angle of approximately 60^o. While keeping your heels pressed over each other and your pelvis flat and perpendicular to the ground, lift the upper knee as high as possible, hold for 1-2 seconds, and lower slowly. Continue for 10-15 times (1 set), switch sides, and repeat. Aim for 2-3 sets daily.
• Quadricep Contraction: lie on your back with both legs extended in front, and a rolled-up towel or blanket under one knee so that it is slightly bent upward. Now lift the foot of the bent knee up to fully straighten the knee. Hold for 5 seconds, relax the quadriceps, and lower slowly. Continue for 10 repetitions, switch legs, and repeat. Perform the exercise 3-5 times daily.

Note:All exercises should be performed after a physiotherapist consultation.

3-Arthroscopic Surgery:

If swelling, tenderness, and pain persist after a few months of continuous preventative care, Arthroscopic surgery may be recommended. The surgery involves inserting a camera into the affected joint via a tiny incision to identify the cause. In case of shredded cartilage, the damaged layers are removed while leaving health cartilage in place. Kneecap displacement can also be corrected to reduce cartilage wear and tear.

Other procedures include smoothing the back of the kneecap, cutting some knee ligaments to relieve tension and increase knee movement, and implanting a cartilage graft.

Prevention:

• Lose weight through exercise and a healthy diet, if needed, as excess weight increases knee pressure.
• Warm up and stretch before exercising, and increase exercise intensity gradually.
• Wear protective knee pads if you regularly kneel over hard surfaces during work.
• Strengthen thigh muscle balance through exercise.
• Wear arch-elevating shoe inserts for flat feet to reduce knee pressure, and possibly realign the kneecap.
• Ask your doctor or trainer about supportive knee equipment if you ski or play football or rugby.

Since knee cartilage tends to heal poorly, chondromalacia patella is usually permanent. However, with regular muscle-building exercise and minor preventative care, the pain can be eliminated, and most people with the condition can lead active, healthy lifestyles.

Consult with your doctor on the appropriate treatment measures if you have chondromalacia. You can also book an appointment with a top Orthopedic Specialist in Karachi, Lahore and Islamabad through oladoc.com, or call our helpline at 042-3890-0939 for assistance to find the RIGHT Doctor for your health concerns.