| Chondromalacia patella | |
|---|---|
| Classification and external resources | |
| ICD-10 | M22.4 |
| ICD-9 | 717.7 |
| DiseasesDB | 2595 |
| MedlinePlus | 000452 |
| MeSH | D046789 |
Chondromalacia patellae (also known as CMP) is a term that goes back eighty years. It originally meant "soft cartilage under the knee cap," a presumed cause of pain at the front and especially inner side of the knee. This condition often affects young, otherwise healthy individuals.[1][2]
Chondromalacia is due to an irritation of the undersurface of the kneecap. The undersurface of the kneecap, or patella, is covered with a layer of smooth cartilage. This cartilage normally glides effortlessly across the knee during bending of the joint. However, in some individuals, the kneecap tends to rub against one side of the knee joint, and the cartilage surface become irritated, and knee pain is the result.[3]
The term "chondromalacia" sometimes is used to describe abnormal-appearing cartilage anywhere in the body.[4] For example, a radiologist might note chondromalacia on an MRI of an ankle.
Pain at the front / inner side of the knee is common in young adults, especially soccer players, gymnasts, cyclists, rowers, tennis players, ballet dancers, basketball players, horseback riders, volleyball players, and runners. The pain of chondromalacia patellae is typically felt after prolonged sitting, like for a movie, and so is also called "movie sign" or "theater sign". [5] Snowboarders and skateboarders are prone to this injury, particularly those specializing in jumps where the knees are under great stress. Skateboarders most commonly receive this injury in their non-dominant foot due to the constant kicking and twisting that is required of it during skateboarding.[6]
The condition may result from acute injury to the patella or from chronic friction between the patella and the groove in the femur through which it passes during motion of the knee.[7] Possible causes include a tight iliotibial band, neuromas, bursitis, overuse, malalignment, core instability, and patellar maltracking.
Pain at the front of the knee due to overuse can be managed with a basic program consisting of RICE (rest, ice, compression, elevation), anti-inflammatory medications, and physiotherapy[6][8], however; if there is cartilage damage this is not easily repairable.
Usually chondromalacia develops with no swelling or bruising. The treatment of chondromalacia remains controversial, but most individuals can undergo effective treatment by resting the knee and adhering to a proper physical therapy program. Allowing the inflammation of chondromalacia to settle is the first step of treatment. Avoiding painful activities that irritate the knee for several weeks, followed by a gradual return to activity is important. In this time, cross-training activities, such as swimming, can allow an athlete to maintain their fitness while resting the knee. The next step in treatment is a physical therapy program that should emphasize strengthening and flexibility of the muscles of the hips and thighs. Use of nonsteroidal anti-inflammatory medication is also helpful to minimize the pain associated with chondromalacia. Treatment with surgery is declining in popularity for two reasons: good outcomes without surgery, and the small number of patients who actually benefit from surgical treatment. [9]
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