- See:
Patella and Patellofemoral Function:
- Discussion:
- chondromalacia describes softening & fissuring of
articular hyaline cartilage;
- chondromalacia may result from an excessive load on patellofemoral joint, but disuse may be a contributing factor;
- most common in yound women;
- relationship between chondrosis & subsequent arthrosis is unclear;
-
contributing factors:
- weakness and tightness of
quadriceps muscle;
- genu valgum;
- increased
Q angle
-
patella alta
- Clinical Features and Exam:
- pts may report anterior knee pain, esp. while climbing stairs;
- compression of patella may cause pain along medial & lateral retinacula & patellar ligament;
- compression of the patella during flexion & extension of knee may elicits crepitation and discomfort;
-
patellar tracking
- best seen when examiner is seated in front of pt & takes knee through full passive and active ROM.
-
crepitus:
- may be a normal finding in young people;
- misc signs:
- excessive tibial rotation
- foot pronation
- Radiograpic Features:
- is best seen on a slightly over exposed lateral x-ray;
- axillary radiograph will determine which facet is involved;
- usually it will involve the medial facet;
- Agliettis et. al. Clin. Ortho 1983
- 53 patients w/ chondromalacia:
-
Q angle was 20 deg (versus 15 deg;)
-
LT/LP differed only in the males = 1.08 versus 1.01
-
congruence angle = - 2 deg (sig diff. for males and fem)
- Stages:
- I: swelling and softening of the cartilage;
- II: fissuring w/in the softened areas
- III: fasciclations of articular cartilage almost to level of subchondral bone;
- IV: destruction of cartilage w/ subchondral bone exposed;
- histologically, stage IV is virtually indistinguishable from DJD;
- there is no unequivical progression from stage I to IV;
- Non Operative Treatment:
- reduced strenuous activities;
- exercises to stretch & strengthen quadriceps muscle are started;
- avoid stressing the painful arc of motion;
- immobilization is a contributing cause of chondromalacia and its contributing cause of chondromalacia & its subsequent symptoms;
- reference:
Physical Therapy for Patellofemoral Pain
- Operative:
-
debridement: little proven benefit;
-
lateral retinacular release:
- little proven benefit if chondromalacia is 2nd to
patella alta;
-
distal realignment procedures:
- as noted by Morshuis et al, distal realignment procedures result in satisfactory results in about 2/3 patients who have patellofemoral pain and x-ray
evidence of arthrosis but nearly all patients w/ patellofemoral pain w/o x-ray evidence of arthrosis had good or excellent results;
Miyakawa patellectomy
An electron microscopic study of early pathology in chondromalacia of the patella;
Resurfacing of the knee with fresh osteochondral allograft.
Treatment of chondromalacia patellae by lateral retinacular release of the patella.
Insall proximal realignment for disorders of the patella.
Chondromalacia Patellae. A prospective study.
Long-term results for the McKeever patellar resurfacing prosthesis used as a salvage procedure for severe chondromalacia patellae.
Chondralmalaciapatella in athletes: Clinical preservation and conservative management. DeHaven KE, Dolan WA, Mayer PJ: Am J Sports Med 1989;7:5.
Physical Therapy for Patellofemoral Pain. A Randomized, Double-Blinded, Placebo-Controlled Trial.
Alternatives to Total Knee Replacement: Autologous Hamstring Resurfacing Arthroplasty
