Presentation
Chondromalacia, sometimes a precursor of osteoarthritis, is present in the articular cartilage of the patella of most people by the age of thirty; it causes symptoms in only a few, and it gives rise to osteoarthritis in fewer still. [online.boneandjoint.org.uk]
Hyaluronic acid (HA) which is present in our synovial fluid is also found in most body tissues. In a healthy adult, synovial fluid HA has a molecular weight of 4-5 million. [sutterhealth.org]
Entire Body System
- Pain
[…] used synonymously with patellofemoral pain syndrome. [4] However, there is general consensus that patellofemoral pain syndrome applies only to individuals without cartilage damage. [4] [5] Cause [ edit ] The condition may result from acute injury to [en.wikipedia.org]
Available at: http://www.dynamed.com/topics/dmp~AN~T116002/Patellofemoral-pain-syndrome. Updated February 28, 2017. Accessed March 26, 2018. Patellofemoral pain syndrome (runner's knee). Johns Hopkins Medicine website. [winchesterhospital.org]
Effectiveness of Manual Therapy for Pain and Self-reported Function in Individuals With Patellofemoral Pain: Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2018 May; 48 (5):358-371. [ PubMed : 29308698 ] 6. [ncbi.nlm.nih.gov]
[…] and may attempt to heal by the formation of fibro-cartilage Patient is usually female and reports diffuse pain in the front (anterior knee pain) of the knee, especially after bent knee activities (stairs, sitting, etc.) [orthopaedicsone.com]
Activities that cause pain should be modified or abandoned temporarily until the pain resolves. [sutterhealth.org]
- Surgical Procedure
Surgical procedures include the following: Moving the quadriceps muscle insertion on the lower leg to improve alignment Releasing the lateral thigh muscles and tightening the medial muscles Smoothing over the undersurface of the patella Implanting cartilage [winchesterhospital.org]
Chondromalacia is also seen as a complication of injuries, immobilization, and surgical procedures that lead to quadriceps atrophy. The cause is the micro-trauma created by the decreased pull of the quadriceps muscle on the patella. [ncbi.nlm.nih.gov]
- Weakness
[…] the quadriceps mechanism Patellectomised knees have a decreased torque compared to normal side of 50% Leads to difficulties in stair climbing and rising from chairs Excellent or good in 75% of patients (50% in patello-femoral OA) Poorer results with weakness [orthopaedicsone.com]
This can occur due to: Birth defect in knee alignment Weak quadriceps Muscle strength imbalance between the inside and outside of the thigh Direct trauma Risk Factors Chondromalacia patella is more common in adolescents and young adults. [winchesterhospital.org]
- Inflammation
This article is about certain forms of inflammation under the patella. For other uses, see Runner's knee. Chondromalacia patellae (also known as CMP ) is an inflammation of the underside of the patella and softening of the cartilage. [en.wikipedia.org]
This creates a vicious cycle, where more destruction and inflammation ensue. 50% idiopathic 20% secondary to maltracking; lateral patellar compression syndrome 15% post traumatic 15% due to unstable patella (recurrent dislocation) Wiberg described 3 types [orthopaedicsone.com]
Musculoskeletal
- Fracture
Endo Y...Babb JS 2007 39 Arthroscopic debridement for grade III and IV chondromalacia of the knee in patients older than 60 years. ( 17993066 ) van den Bekerom MP...Albers GH 2007 40 Chondromalacia of trochlear notch after healing of olecranon stress fracture [malacards.org]
Treatment
But surgery may be needed if other treatments are not helpful. [winchesterhospital.org]
The symptoms, signs and treatment are discussed. Operation, which has been performed only when there are disabling symptoms, may consist in removing part or the whole of the articular cartilage, or in excision of the patella. [online.boneandjoint.org.uk]
[…] ki HK...Mattila VM 2010 30 Capsulolabral advancement for the treatment of glenoid chondromalacia. ( 20608600 ) Arrigoni P...Harwin SF 2010 31 Ulnohumeral chondral and ligamentous overload: biomechanical correlation for posteromedial chondromalacia of [malacards.org]
However, in some individuals the kneecap tends to rub against one side of the knee joint, irritating the cartilage and causing knee pain. [10] Treatment [ edit ] In the absence of cartilage damage, pain at the front of the knee due to overuse can be managed [en.wikipedia.org]
[…] there is no one specific form of treatment that is universally accepted as a standard of care. [ncbi.nlm.nih.gov]
Prognosis
It may progress slowly or quickly but there is no clinical method of assessing the prognosis at an early stage. 2. The earliest change is swelling of the cartilage associated with a decrease in the chondroitin sulphuric acid content of the matrix. [online.boneandjoint.org.uk]
Etiology
The process is described and the etiology discussed. 3. The symptoms, signs and treatment are discussed. [online.boneandjoint.org.uk]
The varied etiological factors of chondromalacia mandate a thorough history and physical evaluation to correctly diagnose this condition and avoid mismanagement due to misdiagnosis. [ncbi.nlm.nih.gov]
Epidemiology
Epidemiology More women than men are affected, and this is attributed to increased Q angles in women. There does not appear to a be a hormonal cause of variation. [ncbi.nlm.nih.gov]
Pathophysiology
Pathophysiology Hyaline cartilage is composed of chondrocytes that are dispersed throughout an extracellular matrix. This matrix consists of type 2 collagen, proteoglycans, and water. [ncbi.nlm.nih.gov]
Prevention
Elevation—Keeping the affected area elevated can help fluids drain out or prevent fluids from building up. Prescription or over-the-counter medications may be advised to reduce pain. Physical Therapy A physical therapist will assess the knee. [winchesterhospital.org]
Proper management of physical activity may help prevent worsening of the condition. Athletes are advised to talk to a physician for further medical diagnosis as symptoms may be similar to more serious problems within the knee. [en.wikipedia.org]