Chondromalacia Patella Treatment: Relief for Knee Pain

How self-care, medication, and surgery can help with runner's knee

Chondromalacia patella affects the cartilage on the undersurface of the kneecap (patella), causing it to deteriorate or soften. It 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.

Chondromalacia symptoms include knee pain and grinding when the knee is flexed. It more often affects biological females.

This article discusses chondromalacia treatment surgery, as well as nonsurgical options such as rest from training, lifestyle changes, over-the-counter medication, and chondromalacia exercises.

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 the chondromalacia symptoms associated with this condition, also known as a type of patellofemoral pain syndrome (PFPS), anterior knee pain syndrome, or runner's knee.

Home Remedies

Resting and recovering after any exercise can help you to 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, your knees need time to recover.

Chondromalacia symptoms include:

  • Pain, stiffness, swelling, and/or knee locking that starts during or after physical activity like 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.

Chondromalacia Exercises

Chondromalacia requires you to be more cautious about your knee health, which includes how you exercise. A healthcare provider may want you to give up running and focus on exercises that are less aggressive on your knees. Walking is good for chondromalacia patella, as are 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 a healthcare provider or physical therapist about an exercise plan that might best work for your unique situation.

A program that helps to 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

Any small amount of weight loss can reduce pressure on your knees.

Talk to a healthcare provider 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 a healthcare provider 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 a healthcare provider 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 a healthcare provider 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.

Prescriptions

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.

Hyaluronic acid can help to lubricate joints, assist the growth of bone and cartilage, and reduce inflammation while restoring the natural properties of hyaluronic acid.

Can You Fix Chondromalacia?

There are a number of treatment options for chondromalacia, including hyaluronan injections. A 2019 study looked at people with anterior knee and patellar cartilage injury (grades II or III). One group went to physical therapy for three months. The other group did too, but also had hyaluronan injections. Those receiving injections had less pain, better mobility, and reduced symptoms after six months.

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 a healthcare provider 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 a healthcare provider 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

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 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.

Chondromalacia and Laser Treatment

Researchers are looking into how high-powered laser therapy (HPLT) can help people with chondromalacia. One study of 44 people, divided into groups that received HPLT or a placebo, found laser treatment with exercise was safe and relieved pain but did not improve mobility. More studies are needed to see how HPLT might help.

Outcomes

Most people with chondromalacia make a full recovery. That recovery might occur quickly, as early as one month, or it could take years, depending on the severity of the condition. 

Some cases will respond well to ice, elevation, and rest, features of what's often called the RICE method of treatment. Nonsurgical treatment, including physical therapy and even shoe inserts, can work to relieve symptoms and restore function quickly.

Surgery is rare, and it's done only in cases that fail to respond to other interventions. In most cases, people are expected to make a full recovery.

Summary

Chondromalacia rarely requires long-term treatment. In mild to moderate cases, you can manage chondromalacia with rest, ice, and stretching.

Over-the-counter medication can help, along with home remedies. Your healthcare provider can provide prescription medication and, if necessary, refer you to a specialist for further evaluation or possible surgical interventions.

A Word From Verywell

If your symptoms continue for longer than a couple of weeks or become severely worse, make an appointment to see a healthcare provider. Keep in mind that chronic knee pain might be caused by another condition, like osteoarthritis, or require more advanced treatments.

Frequently Asked Questions

  • Is it OK to walk on a knee with chondromalacia?

    The answer will depend on the severity of your knee pain and the stage of any treatment or recovery. It's a better strategy to rest a knee when chondromalacia is causing pain. Yet walking is a type of exercise that can strengthen your knee. Talk to your healthcare provider about the activities and exercises you can do.

  • What kind of exercises are good for chondromalacia?

    Exercises to treat your knee pain may include quad sets, straight leg raises, hip strengthening and balance exercises, and leg stretches. Talk to your healthcare provider or physical therapist about how exercises can help to relieve chondromalacia pain and symptoms.

  • Will chondromalacia go away on its own?

    Not exactly, but damage caused by chondromalacia can heal. Rest and physical therapy can help to improve or prevent episodes. It's important to first reduce the inflammation and avoid stressor activities. Your healthcare provider can help to ensure you have the right diagnosis and treatment for moving forward.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Lana Barhum
Lana Barhum has been a freelance medical writer since 2009. She shares advice on living well with chronic disease.