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 condition where there is softening of the articular cartilage of the patella.
The patella (kneecap) and the femur (upper leg bone) articulate at the beginning of knee flexion and the space between the medial part of the patella and the femur diminshes greatly beyond 90 degrees of flexion. This area of contact, between the medial facet of the patella and the medial femoral condyle, is the area where chondromalacia typically starts. The earliest sign is softening and fissuring (small cracks) in the cartilage. Over time, there is further cartilage deterioration with the development of full blown osteoarthritis.
Patellofemoral osteoarthritis limits activities such as stair climbing, walking, running, and even getting out of a chair.
As the condition progresses, there is increased pain, lim ited range of motion, fluid accumulation, stiffness with rest, and crepitus (crunchiness) in the joint.
Conservative care includes rest, ice, anti-inflammatory medicines (either oral or topical), braces, non-prescription topical ointments, physical therapy, and quadriceps strengthening exercises.
Activities that aggravate knee pain such as stair climbing, squatting, running, and so on should be avoided.
While not as effective as it is for osteoarthritis involving the femoral-tibial compartment, viscosupplementation (injecting lubricants such as Supartz or Hyalgan) occasionally is beneficial.
Recent work with autologous mesenchymal stem cells for cartilage regeneration looks promising.
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