Description of Patellofemoral Chondromalacia
In the past, any type of pain over the anterior aspect of the knee was commonly called patellofemoral chondromalacia. However, patellofemoral chondromalacia is a specific term describing a particular pathology/injury that should only be used in cases with this problem.
Chondromalacia, or damage to the cartilage, is the formation of early arthritis. Any type of damage to the cartilage surface itself results in an early onset of arthritis. Thus, any grinding with translation of the patella in the trochlea groove, or evidence of pain or swelling with activities, could be indicative of some underlying patellofemoral chondromalacia. This chondromalacia can occur both on the patella (the kneecap) or the trochlea groove (the end of the femur where the kneecap articulates).
Treatment for Patellofemoral Chondromalacia
The treatment of patellofemoral chondromalacia depends upon its location, the symptoms, and whether it is localized or more diffuse. A good physical exam with radiographs and an MRI may be necessary to best differentiate this.
In the vast majority of cases, we commonly recommend starting out with a patellofemoral-strengthening program. In addition, it has been well demonstrated that strengthening the hip muscles is very important to help to alleviate some of the pain associated with patellofemoral chondromalacia. The use of a stabilizing knee brace, such as a neoprene sleeve, and injections may also be indicated in some patients.
In those patients who have a localized area of arthritis or who have flaps of the patella or trochlea groove that are catching when the knee bends and extends, there may be an indication for surgery. The most common surgical procedure is to smooth down the unstable articular cartilage flaps. While this does not cure the arthritis, it may prevent further rapid progression of the arthritis by preventing these articular cartilage flaps from peeling back and becoming deeper lesions. In patients who may have a patellar dislocation or other causes of a small, localized area of arthritis, patellar articular cartilage resurfacing procedures may be indicated. These are much more rare and the results are not as good as cartilage resurfacing procedures for the rest of the knee. Thus, a complete evaluation must be performed on those patients to determine what necessary steps may be indicated.
Patients who have a trimming of the rough cartilage areas of the patella or trochlea (a chondroplasty) initiate physical therapy the day after surgery. It is important to work on reactivation of the quadriceps muscles, to minimize knee swelling after surgery, and to work on full knee motion. In addition, it is essential that patients work on patellar mobility after surgery to minimize the chance of scar tissue adhesions of the patellofemoral joint. This is especially important because the formation or reformation of these scar tissue adhesions increase the stress on the patellofemoral joint cartilage, which in the presence of arthritis increases the chance of recurrent pain. In many instances, patients should avoid lunges and deep squatting because of the extra stress this places on the patellofemoral joint cartilage. Low impact activities are stressed, such as the use of a stationary bike, an elliptical machine, swimming and walking. Activities which cause recurrent or postoperative knee swelling should be avoided because this swelling can lead to atrophy of the quadriceps muscles and recurrent pain.