Chondromalacia patellae, also referred to as runner’s knee, is a health issue in which the cartilage beneath the patella, or kneecap, becomes soft and ultimately degenerates. This problem is prevalent among young athletes, however, it may also develop in older adults who suffer from arthritis of the knee.

Sports injuries like chondromalacia patellae are frequently regarded as an overuse injury. Taking some time off from participating in physical activities and exercise may produce superior outcomes. In the instance that the individual’s health issues are due to improper knee alignment, rest may not offer pain relief. Symptoms of runner’s knee include knee pain and grinding sensations.

What Causes Chondromalacia Patellae?

The kneecap, or the patella, is generally found through the front of the knee joint. If you bend your knee, the rear end of your kneecap slips over the cartilage of your femur, or thigh bone, at the knee. Complex soft tissues, such as tendons and ligaments, connect the kneecap to the shinbone and thigh muscle. Chondromalacia patellae can commonly occur when any of these structures fail to move accordingly, causing the kneecap to rub against the thigh bone. Poor kneecap motion may result from:

• Misalignment due to a congenital health issue
• Weakened hamstrings and quadriceps, or the muscles of the thighs
• Muscle imbalance between the adductors and abductors, the muscles on the inside and outside of the thighs
• Continuous pressure to the knee joints from certain physical activities and exercise like running, skiing, or jumping
• a direct blow or injury for a kneecap

Who is at Risk for Chondromalacia Patellae?

Below is an assortment of factors which may increase an individual’s chance for developing chondromalacia patellae.

Age

Adolescents and young adults have the highest risk for this health issue. During growth spurts, bones and muscles can often grow too rapidly, causing short-term muscle and bone imbalances in the human body.

Gender

Females are more likely than males to develop runner’s knee, because women generally possess less muscle mass than men. This may result in abnormal knee placement, and more lateral pressure on the kneecap.

Flat Feet

Individuals who have flat feet can add more strain to the knee joints as compared to individuals who have higher arches.

Past Injury

Previous injuries to the kneecap, including a dislocation, can raise the chance of developing chondromalacia patellae.

Increased Physical Activity

Increased levels of physical activities and exercise can place pressure on the knee joints, which may raise the risk for knee issues.

Arthritis

Runner’s knee may also be an indication of arthritis, a well-known problem causing pain and inflammation to the tissue and joint. Swelling can prevent the proper function of the knee and its complex structures.

What are the Symptoms of Chondromalacia Patellae?

Chondromalacia patellae will generally present as pain in the knee, called patellofemoral pain, accompanied by sensations of cracking or grinding when extending or bending the knee. Pain may worsen after sitting for an extended period of time or through physical activities and exercises that apply intense pressure for your knees, like standing. It’s essential for the individual to seek immediate medical attention if the symptoms of chondromalacia patellae, or runner’s knee, do not resolve on their own.

Diagnosis and Chondromalacia Patellae Grading

A healthcare professional will search for areas of pain and inflammation on the knee. They might also look at the way the kneecap aligns with the thigh bone. A misalignment may indicate the presence of chondromalacia patellae. The doctor may also perform a series of evaluations to ascertain the presence of this health issue.

The healthcare professional may also ask for any of the following tests to help diagnose chondromalacia patellae, including: x-rays to show bone damage or misalignments or arthritis; magnetic resonance imaging, or MRI, to see cartilage wear and tear; and arthroscopic examination, a minimally invasive procedure which involves inserting an endoscope and camera inside the knee joint.

Grading

There are four levels of chondromalacia patellae, ranging from grade 1 to 4, which characterize the level of the patient’s runner’s knee. Grade 1 is considered mild while grade 4 is considered severe.

• Grade 1 indicates the softening of the cartilage in the knee region.
• Grade 2 suggests a softening of the cartilage followed by abnormal surface features, the start of degeneration.
• Grade 3 reveals the thinning of the cartilage together with active degeneration of the complex soft tissues of the knee.
• Grade 4, or the most severe grade, demonstrates exposure of the bone through a substantial part of the cartilage Bone exposure means that bone-to-bone rubbing is most likely happening in the knee.

What is the Treatment for Chondromalacia Patellae?

The goal of treatment for chondromalacia patellae is to first decrease the strain being placed on the kneecap, or patella, and the femur, or thigh bone. Rest and the use of ice and heat agains the affected knee joint is generally the first line of treatment. The cartilage damage associated with runner’s knee may often repair itself with these remedies along.

Moreover, the healthcare professional may prescribe anti-inflammatory drugs and/or medications, such as ibuprofen, to decrease pain and inflammation around the knee joint. When tenderness, swelling, and pain persist, the following treatment options could be explored. As mentioned above, individuals should seek immediate medical attention if symptoms persist. 

Chiropractic Care

Chiropractic care is a safe and effective, alternative treatment option which focuses on the diagnosis, treatment, and prevention of a variety of injuries and/or conditions associated with the musculoskeletal and nervous system, including chondromalacia patellae. Occasionally, knee pain may originate due to spinal misalignments or subluxations. A doctor of chiropractic, or chiropractor, will use spinal adjustments and manual manipulations to carefully restore the natural integrity of the spine. 

Furthermore, a chiropractor may also recommend a series of lifestyle modifications, including nutritional advice and a physical activity or exercise guide to help ease symptoms associated with chondromalacia patellae. Rehabilitation may also focus on strengthening the quadriceps, hamstrings, adductors, and abductors to improve muscular strength, flexibility, and mobility. The purpos of muscle balance is also to assist in preventing knee misalignment, among other complications.

Surgery

Arthroscopic surgery might be required to inspect the joint and ascertain whether there is a misalignment of the knee. This operation involves inserting a camera in the knee joint through a very small incision. A surgical procedure can repair the issue. One common process is a lateral release. This surgery involves cutting a number of the ligaments to release tension and permit for more movement. Additional surgery may entail implanting the back of the kneecap, inserting a cartilage graft, or transferring the thigh muscle.

Chondromalacia patellae is characterized as the inflammation of the underside of the patella, or kneecap, caused by the softening of the cartilage surrounding the soft tissues of the knee joint. This well-known health issue is generally caused due to sports injuries in young athletes, although chondromalacia patellae may also occur in older adults with arthritis in the knee. Chiropractic care can help restore strength and balance to the knee joint and its surrounding soft tissues.

Dr. Alex Jimenez D.C., C.C.S.T. Insight

How to Prevent Chondromalacia Patellae

A patient can ultimately lower their chance of developing runner’s knee, or chondromalacia patellae, by: 

• Avoiding repeated stress on the knees. In case the individual needs to spend time on their knees, they could wear kneepads.
• Produce muscle balance by strengthening the quadriceps, hamstrings, abductors, and adductors.
• Wear shoe inserts that correct flat feet. This may reduce the amount of pressure being placed on the knees to realign the kneecap, or patella.
  

Keeping a healthy body weight can also help prevent chondromalacia patellae. Following the nutritional advice and guidance from a healthcare profesional can help promote a healthy body weight. The scope of our information is limited to chiropractic and spinal health issues. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

Curated by Dr. Alex Jimenez

Additional Topic Discussion: Relieving Knee Pain without Surgery

Knee pain is a well-known symptom which can occur due to a variety of knee injuries and/or conditions, including sports injuries. The knee is one of the most complex joints in the human body as it is made-up of the intersection of four bones, four ligaments, various tendons, two menisci, and cartilage. According to the American Academy of Family Physicians, the most common causes of knee pain include patellar subluxation, patellar tendinitis or jumper’s knee, and Osgood-Schlatter disease. Although knee pain is most likely to occur in people over 60 years old, knee pain can also occur in children and adolescents. Knee pain can be treated at home following the RICE methods, however, severe knee injuries may require immediate medical attention, including chiropractic care.

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