Chondromalica: Causes, Risk Factors, and Prevention

Chondromalacia patella, also known as runner's knee, is a knee condition that can cause pain and grinding when the knee is flexed. It's due to the breakdown in the cartilage on the undersurface of the kneecap (patella) that causes bones to rub against each other. Overuse (especially from running or cycling), trauma, such as a fracture, or a misalignment of the kneecap and femur can all cause chondromalacia.

Most of the time you can treat chondromalacia with rest and over-the-counter pain medication such as nonsteroidal anti-inflammatory drugs (NSAIDs). Sometimes physical therapy, and more rarely, surgery, is recommended.

This article discusses more about what causes chondromalacia, the range of treatment options, and how to prevent it from occurring.

Symptoms

Chondromalacia symptoms can include swelling or grinding feeling in the knee, but the hallmark symptom is knee pain. It may feel worse:

• After being seated for a while
• When getting out of a chair
• When going up and down stairs
• When kneeling or squatting

Causes

Many different types of conditions and injuries can put stress on the knee, causing chondromalacia.

Flat Feet

Having flat feet is something you're born with, and it means that the entire soles of the feet touch the floor. If you have flat feet, this can cause the shin and thigh bones to twist inwards, putting stress on the knee. Over time, the cartilage can wear down and lead to pain.

Arthritis

This degenerative disease can cause inflammation in the knee, causing it to become stiff and have a limited range of motion. This can put further stress on the knee, softening to the cartilage over time.

Age

While chondromalacia can affect people of all ages, it typically affects teenagers and young adults. Younger people are still growing, so at times there may be muscle imbalances that can put stress on the knee. This age group is also more likely to be active.

Injury

A dislocation, fracture, or other injury to the kneecap can cause chondromalacia.

Activity Level

People who frequently engage in activities that require constant movement of the knee, such as running and cycling, are more likely to develop a softening of the cartilage under the kneecap.

Risk Factors

Some people have a higher chance of developing chondromalacia. They include:

• Females
• Younger people
• People who are active
• People who spend a lot of time kneeling for their job, such as carpet or floor layers
• People with arthritis
• People with flat feet
• People who are overweight

Treatment

Home remedies and lifestyle changes can generally be enough to relieve pain and stiffness for the chondromalacia symptoms associated with this condition, but sometimes surgery may be recommended.

Home Remedies

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 three to four 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. Some strategies to treat chondromalacia include:

• Switching to exercises that are less aggressive on the knees, such as walking, swimming, tai chi, or yoga
• Engaging in exercises that strengthen the muscles around your knees
• Losing weight through a plan that includes exercise and eating a diet full of fruits and vegetables
• Reduce strain on your knee by avoiding standing for a long period of time, squatting, or working on tasks that require you to bend your knees repeatedly

Medication

Over-the-counter medications that can treat pain and swelling associated with chondromalacia include:

• Acetaminophen, such as Tylenol
• NSAIDs like Advil (ibuprofen) and Aleve (naproxen)
• NSAID topical creams such as Diclofenac gel, under the brand name Voltaren gel

If you experience significant pain and swelling, a healthcare provider 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.

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 that may focus on exercises that reduce stress on the knee and strengthen it
• Acupuncture, which involves the insertion of very thin needles through the skin at specific acupuncture points on the body
• Prolotherapy, which is an injection-based CAM therapy that aims to stimulate a natural healing response in soft tissues or joints affected by pain

Surgeries and Procedures

A healthcare provider 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, healthcare providers 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 correcting 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.

Prevention

Fortunately, you can take steps to avoid placing stress on your knee that can lead to chondromalacia. Steps for preventing the condition from developing include:

• Warming up: Stretching before physical activity can prevent the knee from becoming overly stressed during more strenuous exercise.
• Strengthening leg muscles: Performing leg exercises that strengthen the muscles around the knee, particularly the quadriceps, can keep your muscles balanced. 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.
• Wearing supportive gear: Wear comfortable, well-fitting shoes and use shoe inserts if misalignment is an issue. If you spend a lot of time kneeling, wear protective knee pads to prevent extra strain on your knees.
• Resting between activities: Make sure to spend ample time resting in between activities.
  

Summary

Chondromalacia patella is a condition in which the cartilage on the underside of the kneecap softens, leading to pain. It occurs as a result of repeated physical activity, trauma, or misalignment that places stress on the kneecap.

Chondromalacia rarely requires long-term treatment. In mild to moderate cases, you can manage chondromalacia with rest, ice, and stretching. In more extreme cases, surgery may be recommended.

To prevent chondromalacia, remember to stretch your knee and do exercises to strengthen the muscles around it. Rest in between activities and wear supportive shoes.