Chondromalacia
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Chondromalacia patellae (also known as CMP) is an
inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...
of the underside of the
patella The patella (: patellae or patellas), also known as the kneecap, is a flat, rounded triangular bone which articulates with the femur (thigh bone) and covers and protects the anterior articular surface of the knee joint. The patella is found in m ...
and softening of the
cartilage Cartilage is a resilient and smooth type of connective tissue. Semi-transparent and non-porous, it is usually covered by a tough and fibrous membrane called perichondrium. In tetrapods, it covers and protects the ends of long bones at the joints ...
. The cartilage under the kneecap is a natural shock absorber, and overuse, injury, and many other factors can cause increased deterioration and breakdown of the cartilage. The cartilage is no longer smooth and therefore movement and use is very painful. While it often affects young individuals engaged in active sports, it also afflicts older adults who overwork their knees. ''Chondromalacia patellae'' is sometimes used synonymously with patellofemoral pain syndrome. However, there is general consensus that ''patellofemoral pain syndrome'' applies only to individuals without cartilage damage. This condition is also known as Chondrosis. The term literally translates to softening (malakia) of cartilage (chondros) behind patella in Greek.


Cause

The condition may result from acute injury to the patella or chronic friction between the patella and a groove in the femur through which it passes during knee flexion. Possible causes include a tight
iliotibial band The iliotibial tract or iliotibial band (ITB; also known as Maissiat's band or the IT band) is a longitudinal fibrous reinforcement of the fascia lata. The action of the muscles associated with the ITB ( tensor fasciae latae and some fibers of gl ...
, neuromas,
bursitis Bursitis is the inflammation of one or more bursae (synovial sacs) of synovial fluid in the body. They are lined with a synovial membrane that secretes a lubricating synovial fluid. There are more than 150 bursae in the human body. The bursae (bu ...
, overuse, malalignment, core instability, and patellar maltracking. Pain at the front or inner side of the knee is common in adults of all ages especially when engaging in soccer, gymnastics, cycling, rowing, tennis, ballet, basketball, horseback riding, volleyball, running, combat sports, figure skating, snowboarding, skateboarding and even swimming. The pain is typically felt after prolonged sitting. Skateboarders most commonly experience this injury in their non-dominant foot due to the constant kicking and twisting required of it. Swimmers acquire it doing the breaststroke, which demands an unusual motion of the knee. People who are involved in an active lifestyle with high impact on the knees are at greatest risk. 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. Tests are not necessarily needed for diagnosis, but in some situations they may confirm diagnosis or rule out other causes for pain. Commonly used tests are blood tests, MRI scans, and arthroscopy. While the term ''chondromalacia'' sometimes refers to abnormal-appearing cartilage anywhere in the body, it most commonly denotes irritation of the underside of the kneecap (or "patella"). The patella's posterior surface is covered with a layer of smooth cartilage, which the base of the
femur The femur (; : femurs or femora ), or thigh bone is the only long bone, bone in the thigh — the region of the lower limb between the hip and the knee. In many quadrupeds, four-legged animals the femur is the upper bone of the hindleg. The Femo ...
normally glides smoothly against when the knee is bent. However, in some individuals the kneecap tends to rub against one side of the knee joint, irritating the cartilage and causing knee pain.


Diagnosis

When investigating a possible diagnosis of chondromalacia, a physician will carry out a complete examination of the affected knee. The physician will palpate the patella and surrounding tissue, feel the joint to observe when and how the distress manifests and obtains a list of symptoms and clinical history. The following tests or procedures may be used to refine the diagnosis: * A knee X-ray and/or blood test – this can assist to exclude certain types of arthritis or inflammation. * Magnetic Resonance Imaging (
MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and rad ...
) – to observe cartilage condition and assess deterioration *
Arthroscopy Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the j ...
– a low invasive approach to image the inside of the knee joint by inserting an endoscope into the knee joint.


Treatment

In the absence of cartilage damage, pain at the front of the knee due to overuse can be managed with a combination of
RICE Rice is a cereal grain and in its Domestication, domesticated form is the staple food of over half of the world's population, particularly in Asia and Africa. Rice is the seed of the grass species ''Oryza sativa'' (Asian rice)—or, much l ...
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rest REST (Representational State Transfer) is a software architectural style that was created to describe the design and guide the development of the architecture for the World Wide Web. REST defines a set of constraints for how the architecture of ...
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ice Ice is water that is frozen into a solid state, typically forming at or below temperatures of 0 ° C, 32 ° F, or 273.15 K. It occurs naturally on Earth, on other planets, in Oort cloud objects, and as interstellar ice. As a naturally oc ...
,
compression Compression may refer to: Physical science *Compression (physics), size reduction due to forces *Compression member, a structural element such as a column *Compressibility, susceptibility to compression * Gas compression *Compression ratio, of a ...
,
elevation The elevation of a geographic location (geography), ''location'' is its height above or below a fixed reference point, most commonly a reference geoid, a mathematical model of the Earth's sea level as an equipotential gravitational equipotenti ...
), anti-inflammatory medications, and
physiotherapy Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...
. Usually chondromalacia develops without swelling or bruising and most individuals benefit from rest and adherence to an appropriate physical therapy program. Allowing inflammation to subside while avoiding irritating activities for several weeks is followed by a gradual resumption. Cross-training activities such as swimming – using strokes other than the
breaststroke Breaststroke is a human swimming, swimming style in which the swimmer is on their chest and the torso does not rotate. It is the most popular recreational style due to the swimmer's head being out of the water a large portion of the time, and ...
– can help to maintain general fitness and body composition. This is beneficial until a physical therapy program emphasizing strengthening and flexibility of the hip and thigh muscles can be undertaken. Use of nonsteroidal anti-inflammatory medication is also helpful to minimize the swelling amplifying patellar pain. Treatment with surgery is declining in popularity due to positive non-surgical outcomes and the relative ineffectiveness of surgical intervention.


See also

*
Knee In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest joint in the hu ...
*
Knee pain Knee pain is pain in or around the knee. The knee joint consists of an articulation between four bones: the femur, tibia, fibula and patella. There are four compartments to the knee. These are the medial and lateral tibiofemoral compartments, the ...
* Patellofemoral pain syndrome * Knee osteoarthritis * Plica syndrome *
Iliotibial band syndrome Iliotibial band syndrome (ITBS) is the second most common knee injury, and is caused by inflammation located on the lateral aspect of the knee due to friction between the iliotibial band and the lateral epicondyle of the femur. Pain is felt most ...


References


External links

* {{DEFAULTSORT:Chondromalacia Patellae Overuse injuries Arthropathies Knee injuries and disorders