Chondromalacia Patellae

 CHONDROMALACIA PATELLAE

 

Patellofemoral syndrome:

Def- It is the term used to describe pain on and around the patella or kneecap.  Chondromalacia patella results from degeneration of cartilage due to poor alignment of the kneecap as it slides over the lower end of the thigh bone (femur).. 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 It can be started by an impact or it gradually comes on from rubbing on the bone underneath. The injury is often referred to as Chondromalacia patellae, patella pain syndrome or runner’s knee.

Who are at risk?

It is common in young adults, especially soccer players, cyclists, rowers, tennis players, ballet dancers and runners. Snowboarders are particularly prone to this injury, especially those specializing in jumps where the knees are under great stress.

Note:-

Patellofemoral Pain Syndrome is the term used to describe pain in or around the kneecap (patella). It is also known as PFJ (Patellofemoral joint) syndrome and anterior knee pain. Pain results from the abnormal movement of the patella on the femur (thigh bone) during bending of the knee joint.

Chondromalacia is sometimes used to describe this injury. However this is a common misconception as Chondromalacia refers specifically to the softening of the articular cartilage on the underside of the patella.

When the knee is bent from being outstretched, a number of muscles and ligaments that are attached to the patella function to move it medially (towards the inside surface of the knee) to sit in the intercondylar notch of the femur (bit in the middle where the patella sits).

In general, Patellofemoral pain syndrome occurs when the patella does not move or ‘track’ in a correct fashion when the knee is being bent. This movement can lead to damage of the surrounding tissues, such as the cartilage on the underside of the patella itself, which can lead to pain in the region. This injury is quite common in people who do a lot of sport, in particular women of an adolescent age. Correct and immediate rehabilitation is vital for this injury as, if ignored it becomes very difficult to treat

 Causes:

Overloading – Bending the knee increases the pressure between the patella and the femur. Thus sports such as running, where repeated weight-bearing occurs, may result in PFJ syndrome.

Pronating Feet – Pronating or ‘flat’ feet lead to an increased biomechanical stress on the knee joint. This may affect the alignment of the patella particularly during movement.

Muscle imbalance – The quadriceps muscle group are responsible for the movement of the patella itself. If the lateral (outer) fibres are stronger or tighter than the medial fibres, or if the iliotibial band (ITB) is very tight this can lead to problematic patella tracking.

Knock kneed individuals

Q-angle – Some people have a larger than normal femoral angle (known as the Q-angle)and may have ‘knock-kneed’ appearance (genu valgum). When the person straightens their leg, the patella will be forced to the outside of the knee. With repeated bending and loading, this motion may lead to damage of the underlying structures and cause pain.

Individuals with unusually shaped patella

Symptoms of Patellofemoral syndrome

  • Aching pain occurs in the knee joint, particularly at the front, around and under the patella.
  • Pain under the patella when bending and straightening the knee.
  • Tenderness along the inside border of the kneecap
  • Usually swelling is present
  • Is often worse when walking up or down hills or stairs.
  • A clicking or cracking sound may be present on bending the knee.
  • Sitting for long periods may be uncomfortable. This is known as the theatre sign.

Occasionally, if chronic symptoms are ignored, the associated loss of quadriceps (thigh) muscle strength may cause the leg to “give out.”  Reduction in quadriceps becomes obvious.

What other signs may be present with Patellofemoral syndrome?

Temporary loss of function.

Wasting (atrophy) of the quadriceps muscles.

A Q-angle greater than 18 to 20 degrees.

Tight muscles including calf muscles, hamstrings, quadriceps (especially vastus lateralis on the outside) and iliotibial band.

Who is most at risk from patellofemoral syndrome?

You are more prone to this if you have a small kneecap or one that sticks out

If your feet roll in or pronate.

If you have weak quadriceps muscles.

Athletes who do a lot of long distance running or hill running.

Those who have had a previous knee dislocation

What can the athlete do to prevent patellofemoral syndrome:

 Apply RICE (Rest, ice compression and elevation) to the injured knee. This will help reduce swelling.

Rest until there is no pain (this is very important).

Use a knee support or heat retainer (with a hole).

 Visit Physioline for treatment and rehabilitation

Physioline treatment:

  • Electrotherapy for pain and swelling reduction
  • A comprehensive rehabilitation programme in conjunction with taping -techniques.
  • Vastus Medialis Obliquus (VMO) strengthening exercises combined with iliotibial band (ITB) stretches.
  • Selective strengthening of the inner portion of the quadriceps muscle will help normalize the tracking of the patella.
  •  Cardiovascular conditioning  by stationary bicycling (low resistance but high rpms), pool running, or swimming (flutter kick). Reviewing any changes in training prior to chondromalacia patella pain, as well as examining running shoes for proper biomechanical fit are critical to avoid repeating the painful cycle. Generally, full squat exercises with weights are avoided. Occasionally, bracing with patellar centering devices are required.
  • Stretching and strengthening the quadriceps and hamstring muscle groups is critical for an effective and lasting rehabilitation of chondromalacia patella.
  • Provide orthotic foot supp,
  • Ambience conducive for treatment