How Chondromalacia Is Treated

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Chondromalacia patellae affects the cartilage on the undersurface of the kneecap (patella), causing it to deteriorate or soften. Symptoms of this common condition include knee pain and grinding when the knee is flexed. It is also referred to as anterior knee pain syndrome or runner's knee.

Chondromalacia may be seen as an overuse injury in sports, especially running and cycling, but can also occur in people who have had a kneecap injury. It more often affects women and adolescent females.

Treating chondromalacia starts with nonsurgical options, such as rest from training. If nonsurgical options fail or your symptoms become severe, your doctor may suggest surgery to address your knee pain, function, or mobility issues. Learn how chondromalacia is treated and your options to get relief.

Runner's Knee
praetorianphoto / Getty Images.

Home Remedies and Lifestyle Changes

Home remedies and lifestyle changes can generally be enough to relieve pain and stiffness for runner’s knee. 

Home Remedies

Resting and recovering after any exercise can help you reduce your risk for a new knee injury or worsening symptoms from a current one. If you are often working out in a way that puts pressure on your knees and you start experiencing specific injury symptoms, it is time to give your knees time to recover.

Symptoms of chondromalacia to look out for include:

  • Pain, stiffness, swelling, knee locking, etc. that starts during or after physical activity, i.e., running
  • Symptoms that start when you start exercising and decrease after you stop
  • Pain that forces you to stop exercising—if you ever experience pain to this extreme, seek out medical attention

To reduce symptoms of chondromalacia and to help you recover more quickly, try:

  • Elevating the affected knee: Elevate your leg while sitting; place your affected leg up with a pillow under it.
  • Cold therapy: Ice your knee for up to 15 to 20 minutes every 3 to 4 hours for several days.
  • Elastic bandage: Wrapping the injured knee with an elastic bandage can keep the knee in place and ease the pain.
  • Patella-stabilizing knee brace: This type of brace maintains the patella in the socket but does not apply any direct pressure over the joint.
  • Arch supports or orthotics for your shoes: Both can help position your feet, which reduces pressure on the knees. You can buy arch supports or orthotics in the store, online, or have them custom made.

Lifestyle Changes

When you are diagnosed with chondromalacia, some aspects of your life might have to change so you can manage symptoms and keep the condition from getting worse. Fortunately, these lifestyle changes won’t just help you manage pain and stiffness, but they will also improve your health overall.

Change the Way You Exercise

Chondromalacia requires you to be more cautious about your knee health, which includes how you exercise. Your doctor may want you to give up running and focus on exercises that are less aggressive on your knees, like walking, swimming, biking, tai chi, or yoga.

These types of exercises will not only be easier on your knees, but they can reduce your pain and improve your strength and mobility. Talk to your doctor or physical therapist about an exercise plan that might best work for your unique situation.

A program that helps strengthen the muscles around your knees can help manage chondromalacia. Focus on isometric quad strengthening. This means strengthening the quadriceps muscle (the large group of muscles along the front of the thigh) with exercises that keep the muscle at the same length (i.e., not bending the knee joint).

You can do this by placing a light weight on the ankle. Then, in a sitting position, lift the foot off the ground while the knee is straight. Hamstring strengthening will also be beneficial.

Maintain a Healthy Weight

If you have a body mass index over 30 (clinically classified as obese), losing 10% of your body weight can significantly improve pain, stiffness, and physical function in the knees, according to a study reported in 2014 in the journal Obesity Reviews. Any small amount of weight loss can reduce pressure on your knees.

Talk to your doctor about how weight loss might improve chondromalacia symptoms and ways to bring down your weight.

Avoid Strain on Your Affected Knee

As long as you reduce strain on your knees, symptoms of chondromalacia generally improve. Avoid activities like standing for long periods, squatting, or work tasks that require you to bend your knees repeatedly (such as lifting), stair climbing, and exercise machines that mimic stair climbing.

Over-the-Counter Therapies

Over-the-counter medications that can treat pain and swelling associated with chondromalacia include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).

Acetaminophen

Acetaminophen is available under many brand names, the most common being Tylenol. It is an analgesic drug used to relieve minor aches and pain temporarily.

While you don’t need a prescription for acetaminophen, you should still check with your doctor about how much to take and how often to take it for managing your chondromalacia pain. If taken in high doses for long periods, acetaminophen can cause liver damage.

NSAIDs

NSAIDs, such as Advil (ibuprofen) and Aleve (naproxen), can help decrease swelling and pain associated with chondromalacia. NSAIDs are available with or without a prescription.

Before taking NSAIDs to treat chondromalacia, ask your doctor if NSAIDs are safe for you to take, along with the dosage information and how often to take them. Chronic use of NSAIDs can lead to stomach bleeding and kidney problems. Always read bottle labels and follow the directions.

NSAID topical creams can be an option for managing knee pain, although it is always wise to check with your doctor to see what OTC NSAIDs are safe for you to use. Topical NSAID medicines are to be applied directly to the skin.

Diclofenac gel, under the brand name Voltaren gel, is a topical NSAID available without a prescription to treat knee and other joint pain. It can be applied up to four times a day.

According to the Cleveland Clinic, topical NSAIDs, like diclofenac gel, are generally well-tolerated, but they do come with mild side effects, including rash, redness, dryness, and itchiness.

Prescriptions

If you experience significant pain and swelling, your doctor might prescribe stronger versions of acetaminophen and NSAID pain relievers. They can also prescribe strong NSAID topical pain relievers.

Corticosteroid injections are another helpful option for managing pain and swelling from chondromalacia. These injections can deliver a quick pain relief option. They are often used with other pain relievers that aren’t helping to manage pain in your knee.

Hyaluronan injections—also called viscosupplementation—may be a longer-term solution. As a chondromalacia treatment, hyaluronan injections are given directly in the knee joint. Hyaluronic acid is found naturally in the synovial fluid. Synovial fluid is found in many of your joints and keeps them healthy and moving.

Hyaluronic acid can help to lubricate joints, assist the growth of bone and cartilage, and reduce inflammation. One hyaluronan treatment might include one to three injections and can offer symptom relief for five or more months.

Hyaluronic injections might help to restore the natural properties of hyaluronic acid. According to physiatrist Dr. Michael Schaefer of Cleveland Clinic, “HA is a cushion or a buffer against inflammatory cells in the joint,” Dr. Schaefer says. “In some cases, it can stimulate the knee to start producing more natural HA.”

A study reported in 2019 evaluated the benefits of hyaluronan injections for runner’s knee. The study participants had anterior knee and patellar cartilage injury (grades II or III) with no major bone abnormalities.

The researchers randomized the participants into two groups—those who went to physical therapy for three months and those who went to physical therapy and also had hyaluronan injections.

Study results showed that the people treated with both physical therapy and hyaluronic injections had less pain and better function after three months and six months. In addition, this group also showed reduced symptoms upon physical examination of the knee after six months of treatment.

Complementary and Alternative Medicines

Complementary therapies are those used along with standard medical treatments. Alternative therapies, on the other hand, are used instead of standard medical treatments. Together, these approaches are called complementary and alternative medicine (CAM).

CAM therapies for chondromalacia include physical therapy, acupuncture, and prolotherapy. They might be considered complementary or alternative therapies, depending on the treatment plan your doctor has prescribed.

Physical Therapy

Physical therapy is often included in a chondromalacia treatment plan. A physical therapist (PT) can put together an exercise plan that focuses on your patella and the muscles around it.

The PT will evaluate your mobility, strength, and flexibility and recommend activities that you can safely continue and ones you should avoid. The therapist can also teach you exercises that reduce stress on your knee. This will include strengthening exercises to improve strength in your knee and stretching exercises for tight muscles.

Acupuncture

Acupuncture might relieve some of the pain and swelling associated with chondromalacia. It involves the insertion of very thin needles through the skin at specific acupuncture points on the body. Acupuncture is a key part of traditional Chinese medicine that has been commonly used to treat pain.

Research shows acupuncture can reduce pain and swelling and alleviate tension off the muscles causing misalignment of the kneecap and underlying cartilage. In some cases, it might be more effective than NSAID therapy.

Before considering acupuncture to manage chondromalacia, talk to your doctor to see if it is a safe option to manage the condition's symptoms.

Prolotherapy

Prolotherapy, also known as proliferation or regenerative injection therapy, is an injection-based CAM therapy used to treat musculoskeletal pain. The goal of these injections is to stimulate a natural healing response in soft tissues or joints affected by pain.

These injections contain irritants like dextrose, glycerine, lidocaine, or phenol to increase inflammation temporarily. That inflammatory response should increase blood flow to stimulate new growth and healing of the damaged tissues.

According to a study reported in 2014 in the journal Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders, prolotherapy can improve chondromalacia symptoms and physical function.

The researchers felt prolotherapy could provide long-term improvement that reduces the need for pain medications. They added that prolotherapy should be considered a first-line conservative (least invasive) therapy for chondromalacia.

Surgeries and Procedures

Your doctor may order additional tests to further investigate the problem, such as magnetic resonance imaging (MRI) or X-ray. If the MRI shows you have a focal (small) area of cartilage damage beneath the patella, surgery may be recommended.

If the lesion has certain characteristics on the MRI, surgery can be used to clean out the affected area so there are no loose flaps of cartilage that may cause pain. If the lesion is in a particular location, doctors can sometimes replace it with a healthy piece of cartilage, either from another part of the knee or from a donor.

Arthroscopic surgery starts with examining the joint to look for the misalignment of the knee and then correct it. This surgery involves using a small camera inserted into the joint with a small incision so that the surgeon can see inside the knee. 

Some people have chondromalacia because their patella is misaligned. This means the patella does not sit in its groove correctly. One common procedure to address this is a lateral release.

A lateral release is usually done with a combination of arthroscopic and open techniques. This involves cutting some of the tight ligaments pulling the patella to release tension and allow for proper movement and position.

A Word From Verywell

Most people with chondromalacia make a full recovery. That recovery might occur as early as one month, or it could take years, depending on the severity of the condition. In mild to moderate cases, you can manage chondromalacia with rest, ice, and stretching.

If home remedies don’t help you manage symptoms and pain from chondromalacia, symptoms continue for longer than a couple of weeks or become severely worse, make an appointment to see your doctor.

Chondromalacia rarely requires long-term treatment, but chronic knee pain might be caused by another condition, like osteoarthritis. You might need further or more advanced treatments to manage the knee joint's pain, swelling, and stiffness. 

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