Knee Chondromalacia

person with Knee ChondromalaciaWhat Is Knee Chondromalacia?

If you’ve been experiencing dull, achy pain around or under your kneecap, you may be suffering from a condition called knee chondromalacia or chondromalacia patella. Previously, any pain over the kneecap or patella (the anterior aspect of the knee) was often referred to as patellofemoral chondromalacia, but it actually describes a specific condition. 

Articular cartilage is a type of tissue that protects most joints in your body. This tissue covers the ends of bones inside a joint, helping cushion the bones and allowing them to glide smoothly against one another. When the cartilage inside a joint softens and breaks down, it’s called chondromalacia (or knee chondromalacia). The cartilage provides a smooth surface for the knee to bend and straighten, so deterioration can result in pain, swelling, and decreased mobility.

How Does Knee Chondromalacia Feel? 

Your knee may feel painful after activity due to cartilage thinning, early arthritis, or chronic tendonitis. Often, these conditions have caused you pain for years, but a change in weight or activity level makes it feel much worse.

Knee chondromalacia affects patients in all age groups and is especially common in women. If your job requires you to spend a lot of time kneeling – for example, laying carpet, setting tile, or laying floors – you are also more likely to develop knee chondromalacia. It’s also common in older adults who have arthritis in their knees.

What Causes Knee Chondromalacia?

Chondromalacia can affect any joint, but it is most common on the underside of the kneecap. Frequently, it starts as a small, painful area of softened cartilage behind the kneecap. When more cartilage softens,  it may crack, shred, or even wear away altogether. If this happens, your kneecap may grind painfully against the end of your thigh bone or femur.  Knee chondromalacia sometimes happens without any trauma, and can become symptomatic when you are ramping up activity quickly in an effort to get back in shape.

In the knee, chondromalacia may be related to injury, overuse of the knee, and poorly aligned muscles and bones around the knee joint. There are a few potential causes of knee chondromalacia:

  • Trauma, especially if you fracture (break) or dislocate your kneecap
  • Overuse such as high load deep squats or jumping sports such as basketball
  • Poorly aligned bones of the knee joint
  • Injury to a meniscus (C-shaped cartilage inside the knee joint)
  • Rheumatoid arthritis or osteoarthritis
  • An infection in the knee joint
  • Repeated episodes of bleeding inside the knee joint

Symptoms of Knee Chondromalacia

The primary symptoms of chondromalacia patella include:

  • A dull, aching pain around or under your kneecap that worsens with activity
  • Swelling and stiffness of your knee
  • A grinding, catching, or popping sensation when you bend your knee
  • Knee pain when you climb stairs or hills
  • Pain increases if you sit for extended periods of time with your knees bent

These symptoms usually start gradually and may come and go, but as the cartilage deteriorates further over time, your pain may become more constant.

Diagnosing Knee Chondromalacia

If you experience these symptoms, visit your doctor for a physical exam to check for tenderness, swelling, and knee alignment issues. Your doctor may order imaging tests, such as x-rays or MRI scans, to better assess the degree of cartilage damage.

During your appointment, be prepared to discuss your symptoms in detail, including when your pain started, what activities aggravate it, and any injuries you’ve had that might have contributed to it. Let your doctor know about your typical exercise routine as well.

Treatment for Chondromalacia

While knee chondromalacia can’t be cured (unfortunately, cartilage damage cannot heal on its own), you can manage the condition by reducing pain and preventing further damage. 

If you have ongoing knee pain, discuss your symptoms with your doctor. Identifying knee chondromalacia early can help you slow down the progression of chondromalacia patella primarily by making simple lifestyle and exercise modifications, including changing your exercise program or avoiding activities that are high load to the front of the knee. You can also go to physical therapy or use injection treatments, such as cortisone, hyaluronic acid, and platelet rich plasma (PRP). In some cases, orthopedic surgeons use stem cell injections to decrease symptoms.

Here are some of the key treatment options for knee chondromalacia, including non-surgical and surgical approaches:

Non-Surgical Treatments

  • Rest and activity modification – Avoid activities that aggravate your symptoms, such as running, jumping, and squatting. Low-impact exercises, including swimming or cycling, may be better options for you.
  • Ice and over-the-counter medications – Apply ice packs to your knee to reduce pain and swelling. You can also take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to help manage your symptoms.
  • Knee bracing or taping – Some patients find that a knee sleeve, brace, or taping technique can improve kneecap tracking and support their knee.
  • Physical therapy – Stretching and strengthening exercises to address muscle imbalances around the knee and hip. PT can also help with gait/movement retraining.
  • Weight loss (if overweight) – Reducing stress on the knee joint.
  • Orthotics – Shoe inserts to correct biomechanical issues affecting knee alignment.

Lifestyle Changes

  • Consider low-impact exercises, including swimming, cycling, and yoga
  • Avoid excessive deep knee bending activities
  • Use knee pads or cushions when kneeling

If non-surgical treatments don’t improve your symptoms after 3-6 months and you have significant, persistent pain, your kneecap is catching or locking, or imaging shows that you have loose pieces of cartilage in the joint, you should consult an orthopedic surgeon.

Surgical Options

  • Arthroscopy – Your surgeon inserts a camera into your knee joint and then removes loose pieces of cartilage or smoothes roughened areas.
  • Cartilage repair or regeneration techniques – Cartilage restoration procedures can reduce pain and restore function. Treatment options include mosaicplasty, cell based cartilage transplant (MACI and Denovo), osteochondral autograft transplant, and osteochondral allograft
  • Ligament reconstruction procedures – A medial patellofemoral ligament reconstruction creates a new stabilizing ligament for the patella and protects the joint from additional damage due to instability.
  • Tibial Tubercle Osteotomy or Knee Realignment Surgery – In this surgery, the bony attachment of the patellar tendon to the shin is moved medially or distally or both to improve the patellar tracking.

Your surgeon may recommend the least invasive surgical option first (arthroscopy). In more severe cases, you may need complex realignment or cartilage repair/regeneration. Physical therapy will also help you restore strength and mobility after surgery.

Recovery and Rehabilitation

After surgery, proper post-operative care and rehabilitation is critical for managing pain and restoring function. Here’s what to expect:

Immediate Post-Op 

  • Rest and apply ice to reduce your swelling and pain in the first few days

  • Use the pain medication prescribed by your surgeon (your surgeon may prescribe opioids initially for the first few days after surgery)

  • Use crutches and/or a knee brace to limit weight bearing and protect the surgical repair

  • Follow instructions for gentle knee exercises to start your range-of-motion recovery

Rehabilitation Process

  • Your physical therapy usually starts a week after surgery

  • The initial focus is on reducing swelling and restoring knee range-of-motion through exercises

  • You’ll progress to strengthening exercises for your quadriceps, hamstrings, and core muscles

  • Next, you may begin low-impact cardio exercises, such as stationary cycling, based on your healing progress

  • Typically, complete recovery requires six to twelve weeks for arthroscopy, six to nine months for cartilage restoration surgery, tibial tubercle osteotomy, and  MPFL reconstruction

Knee Chondromalacia, Arthritis, & Tendonitis

Before you get surgery for knee chondromalacia, consider your overall health. In some cases, you may be able to manage your symptoms without surgery, either through rest and activity modification, ice and over-the-counter medications, knee bracing or taping, injection therapy, physical therapy, weight loss (only if overweight), or orthotics. Make sure you consider the recovery time and your commitment to following physical therapy recommendations to regain full function. Find a trusted orthopedic surgeon who has the knowledge and expertise to provide guidance based on your specific situation about the best way to manage your knee chondromalacia.

Contact me if you want to discuss your knee chondromalacia options or get a second opinion.