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Chondromalacia (Runner's Knee) (Chondroplasia, Chondrocytes) Print E-mail
by Ron Kennedy, M.D., Santa Rosa, CA

Dr. Kennedy The term chondromalacia means softening of cartilage, denoting a degneration of the quality of cartilage structure. Chondromalacia usually refers to chondromalacia patellae or Runner's Knee. "Patella" refers to the knee cap. It is a common cause of kneecap pain or anterior knee pain, usually found in young people who run for conditioning and sport. This condition often affects otherwise healthy athletes. Women are more commonly affected with chondromalacia. Why this is the case is unknown, but it is thought to be related to anatomical differences between men and women, in which women experience increased lateral forces on the patella. Chondromalacia is caused by irritation of the undersurface of the kneecap. The undersurface of the kneecap (the patella) is covered with a layer of smooth cartilage. This cartilage normally glides effortlessly across the knee during bending of the joint. However, in Runner's Knee the kneecap rubs against one side of the knee joint, and the cartilage surface become irritated. Knee pain is the result. Chondromalacia is due to changes of the deepest layers of cartilage with blistering of the surface cartilage. The pattern of cartilage damage is distinct from the degeneration seen in arthritis, and the damage from chondromalacia is capable of repair, unlike that seen with arthritis. Chondrocytes are cells which regenerate cartilage, a aprocess chondroplasia.

Most individuals can recover 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. Patients are instructed to avoid painful activities that irritate the knee for several weeks, followed by a gradual return to activity. Cross-training activities, such as swimming, can allow an athlete to maintain their fitness while resting the knee. The next step in treatment is physical therapy emphasizing strengthening and flexibility of the quadriceps and hamstring muscle groups. Use of nonsteroidal anti-inflammatory medication can also be helpful to minimize the pain associated with chondromalacia. Treatment with surgery is declining in popularity due to good outcomes without surgery, and the fact that only a small number of patients actually benefit from surgical treatment. However, sometimes chondromalacia is not cured by conservative therapy, and surgery may be needed for definitive treatment. By looking into the knee with an arthroscope, the surgeon can assess the damage done to the cartilage and can also assess the mechanics of the joint to ascertain if there is an anatomic misalignment that could be corrected. A common misalignment is due to abnormal movement of the patella in relationship to the movement of the knee caused by tight tissue on the outside of the kneecap. For this problem a procedure known as a lateral release is performed which involves cutting the lateral ligaments to allow for normal position and tracking of the patella. If this is not sufficient to correct the misalignment, more extensive surgery that can be performed.

The information in this article is not meant to be medical advice.�Treatment for a medical condition should come at the recommendation of your personal physician.

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