Chondromalacia Patella

Overview

 

The loss of the smooth cartilage lining the undersurface of the patella is described as chondromalacia patella. It may involve one side of the patella (medial or lateral facet) or both sides. Occasionally kissing lesions of cartilage loss are seen on patellar side and also on the femur (thigh bone) trochlear area. The depth and extent of the cartilage tear or loss matters in terms of symptoms and also the response to specific treatment modalities. 

Causes

Localized areas of cartilage loss can happen due to various conditions

  • Repetitve strain

  • Patellar maltracking

  • Trauma

  • Iatrogenic (previous surgeries)

 

Generalised loss of cartilage occurs with wear and tear over the longer period of time.

  • Osteoarthritis

 

How does chondromalacia affect?

The common symptoms of patellar chondromalacia are pain in the front of the knee particularly with activities such as climbing the stairs and squats. Pain is often less on playing when you have warmed up. Along side with pain, clicks, instability are often experiences. Occasionally swelling is noted. 

Classification

 

International Cartilage Repair Society (ICRS) Grading system

  • Grade 1. Nearly normal (superficial lesions)

  • Grade 2. Abnormal (lesions with < 50% of cartilage depth)

  • Grade 3. Severely abnormal (loss of >50% of cartilage depth)

  • Grade 4 Severely abnormal (Exposure of the subchondral bone)

 

What happens if patellar chondromalacia is not treated?

 

Cartilage has poor blood supply and has got very limited capacity to regenerate and repair itself. Without treatment, at best it can remain the same, and at worse the cartilage loss can gradually increase in depth and also become widespread in the whole joint.

 

Management

Early grades (Grade 1 and 2) of cartilage can often be managed either with physiotherapy, activity modification, collagen supplements or PRP (Platelet Rich plasma) injection. Advanced grades (Grade 3 and 4) of cartilage damage needs chondroplasty (cartilage regeneration technology).