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  • Patella Chondromalacia

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Patella Chondromalacia
Posted on: Jul 19
Filed under Knee Pain, Patella Chondromalacia

Patella Chondromalacia

Authored by Orthopedic Surgeon, Edward G. Loniewski, DO and posted here with his permission.

This disease is also known as softening of the cartilage of your knee cap or "anterior knee pain". This is a big medical word for a condition where the shiny cartilage surface of your patella (knee cap) is softened due to many factors including abnormal pressure across the joint surface or hormonal changes in your body.
This pain is usually located over the front of your knee and is described as a deep aching pain. It is sometimes associated with swelling and is usually worse when your knee is bent for long periods of time such sitting in a car or bus. The pain is also worse with such activities as squatting, kneeling or stair climbing (either up or down stairs). The pain is sometimes improved with rest and the use of pain medication.
It is sometimes associated with mild or moderate swelling of the knee and some people report a grinding feeling in their kneecap. It is more common in younger females especially after a growth spurt where the knee must carry more weight.
Many times this problem can be due to "excess lateral pressure syndrome"; that is, the kneecap tends to sit too far out to the side of the knee. Usually, this problem is related to how one's bones are shaped and determined by genetics. In this case, the kneecap is most tender when pushing on its outside ("lateral") surface.
It is usually pretty simple to diagnose chondromalacia. Mostly it is diagnosed based on your complaints. On physical examination, your doctor may push back on your kneecap. That often causes pain in people with this problem. The physician may also move your kneecap from side-to-side. If the patella does not move easily inwards (toward the other knee), the knee is described as having "lateral tightness", which is indicative of excess lateral pressure syndrome.
Chondromalacia patella is the most common cause of pain in the front of the knee.
Most orthopedic surgeons agree that chondromalacia, as with any knee injury treatment, should first be treated conservatively. This means treatment for your knee injury without surgery. However, each person is different and your doctor may feel you need acute knee injury treatment immediately by way of surgery. If you are told that you will require conservative care you can remember the plan easily by remembering the words: Control, Avoid, and Rehabilitate.

Control: Get your pain under control

Cryotherapy (ice, cold therapy) is an excellent way to control your pain. Do not apply ice directly to your skin for more than 5 minutes as it can cause burns. A device specially designed to cool your joint (see our Iceman Clear) can be used for longer periods, as long as you carefully follow the directions for knee injury treatment and discontinue its use if you have pain or a burning sensation.

Over-the-counter pain medications can be of use. These include anti-inflammatories such as Ibuprofen and Mediproxen (naproxen), and pain medications, such as APAP (acetaminophen).

Occasionally heat can be of benefit after the initial pain has resolved. Heat is sometimes useful to combat stiffness. You can apply a heating pad on a low setting for approximately 10-20 minutes at a time. If you do not have a heating pad, you can use a soft terry cloth hand towel placed under warm (not hot) tap water.

Bracing. In addition to providing stability, braces provides pain relief by stimulating some of your nerve fibers which make you feel that your joint is more stable and secure. These are the same nerve fibers you compress when you grab your finger after you hit it with a hammer. Even though your finger was just smashed, you squeeze it with your other hand as hard as you can and it makes it feel better. If support helps, sometimes a simple elastic bandage is all you need; however, some people will feel better with a knee brace. Our DonJoy Comfort Knee Brace will give you the gentle support that you need.

In addition, with chondromalacia, bracing may help to better centralize your patella in its groove so that it "tracks" more centrally, thereby decreasing your pain. The DonJoy Lateral "J" Brace and the DonJoy Tru-Pull Advanced Patellar Knee Brace are specifically designed to help your patella tracking. Both are far superior to the simple "neoprene sleeves" one can obtain in the supermarket or drugstore. Both are exceptionally useful for ACL knee injury treatment and people with excessive lateral pressure syndrome that causes pain on the outer (lateral) undersurface of the kneecap. The DonJoy Lateral "J" Brace is perhaps one of the most popular patella stabilizing braces in the world. We also really like both the DonJoy Tru-Pull Advanced Patellar Knee Brace, and its more supportive cousin, the DonJoy Tru-Pull Advanced Hinged Patellar Knee Brace

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Avoid activities that cause your pain

Just like the old bad joke about the patient that told the doctor: "Doc, everytime I do this, my knee hurts" and the doctor replies: "Well, don't do that!" Although this may seem humorous, there is some truth to the joke. Your body has developed a very complex mechanism to inform you that something is wrong. Humans that ignored these warning signs are no longer living with us today. When our great, great ancestors did not listen to this mechanism, they were killed off by disease or by predators. Thus, pain acts as a warning signal to stop, rest and do something else. Avoid such activities as squatting, kneeling, heavy lifting, climbing, and even running. Listen to your body and make a list of activities or movements that increase your pain and DON'T DO THESE THINGS. Also, make a list of activities and movements that reduce your pain and DO THESE THINGS. For example, many doctors recommend the following for knee injury treatment (be sure to check with yours to make sure he/she agrees).
DON'T DO these if you have chondromalacia:
  • Keep your knee bent for long durations.
  • Kneel on your knees
  • Walk up and down stairs/hills unnecessarily
DO these:
  • Try to sleep with your legs out straight at night instead of curling up into a ball.

Rehabilitate your knee

The key to this step is to remember controlled motions. This means you have complete control of these motions through a structured rehabilitation program. Most treatment/knee injury rehabilitation programs can be done in the convenience and privacy of your own home. The basic philosophy of knee injury treatment is to strengthen the large muscle on the front of your knee called the quadriceps as well as stretching the tendons in the back of your knee called the hamstrings. In specific cases, your doctor may prescribe formalized physical therapy, with a therapist or trainer.
The keys to knee injury treatment include
  • Motivation to actually do the exercises.
  • Deluxe Knee Therapy Kit
  • The correct exercises for your knee injury treatment. See your doctor or physical therapist if you need advice in this regard.
  • Proper equipment. This equipment can either be at your therapists office, at your health club, or items that you purchase for use at home. We have found that people who do their knee injury treatment exercises at home are much more likely to benefit from the program as they more frequently perform the exercises. 

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