Chondromalacia and etiology

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Chondromalacia is a softening of the articular cartilage. Most often, chondromalacia is discussed in reference to the knee.There appear to be three types:

•a temporary kind, described as a primary idiopathic form, affecting adolescents as well as young adults with chronic persistent pain. This type usually resolves with minimal residual problems.

•another adolescent form which is due to patellar trauma Osteoarthruitis may develop with repetitive trauma.

•an adult form beginning in the second decade and presenting with osteoarthritic symptoms. This form tends to become even more symptomatic with age.

The patella (kneecap) and the femur (upper leg bone) are adjacent to each other at the beginning of knee flexion. This proximity becomes more of an issue when loading transfers to the medial facet of the patella with knee flexion exceeding 90 degrees. This area of contact between the medial facet and medial femoral condyle is the site of earliest osteoarthritis. The first sign is softening and fissuring (small cracks) in the cartilage. This is the beginning of chondromalacia. Further cartilage breakdown occurs and osteoarthritis develops.

The development of patellofemoral arthritis presents clinically with difficulty in stair climbing and getting up from a chair, both of which lead to pain. Joint stiffness relieved by activity, limitation of range of motion, pain at rest, effusion (fluid in the knee), and crepitus (crunchiness) occurs.

With severe disease, walking, even on a level surface becomes difficult and may require the use of a cane or even a walker.

Conservative treatment includes rest, ice, braces, topical preparations, physical therapy, and quadriceps strengthening exercise. Ice packs may be helpful.

A knee brace sometimes helps with pain relief.

Activities that impose painful loads on the knee such as stair climbing, squatting, etc., should be avoided.

In patients with progressive chondromalacia, autologous stem cell procedures may be useful for restoring cartilage integrity.

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