Chondromalacia Patellae
Original Editors - Francky Petit
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Search Strategy[edit | edit source]
Search Engines
- Pubmed
- Web of Knowledge
- http://scholar.google.be/
- Youtube
Key Words
- Chondromalacia
- Patellae
- Therapy
- Orthoses
- Physiotherapy
- Anatomy
- Ice Application
- Chondropathie
- Patellofemoral Pain Syndrome
- Therapy
- Anatomy
- Physiotherapy
- McConnell Tape
- Ice Application
Definition/Description[edit | edit source]
Chondromalacia patellae (CMP) is referred as anterior knee pain due to physical and biomechanical changes[1]. It manifests as’ softening, swelling, fraying, and erosion of the hyaline cartilage overlying the patella and sclerosis of underlying bone[2]’.
Simplified, it means that the posterior surface of the patella is going though softening and degenerative changes[3].
CMP is one of the mail illnesses of “Patellofemoral pain syndrome" (PFP)”[1][4] and is also known as “Runner’s Knee”.[5]
Clinically Relevant Anatomy[edit | edit source]
The quadriceps femoris is devided into four different muscles with the same insertion on the patella: the rectus femoris (RF), the vastus lateralis (VL), the vastus intermedius (VI) and the vastus medialis (VM). The VM has oblique fibres , which is reffered to the vastus medialis obliques (VMO)[7]
Epidemiology /Etiology[edit | edit source]
The etiology of CMP is poorly understood, although most authorities believe that the causes of chondromalacia are injury, generalized constitutional disturbance and patellofemoral contact.[8] Sometimes, a weakness of the VM causes the patella to be pulled too far laterally. The patella will grind onto the condylus lateralis, which causes the degenerative disease.[9]
Characteristics/Clinical Presentation[edit | edit source]
The main symptom of chondromalacia patellae is anterior knee pain.[8] The pain is exacerbated by common daily activities that load the patellofemoral joint, such as running, stair climbing, squatting and kneeling.[1] The pain often causes disability which affects short term participation as daily and physical activities.[10]
PFP also causes a deficit in strength of the quadriceps muscle. Therefore, quadriceps strengthening exercises is often part of the revalidation plan.[1]
Medical Management
[edit | edit source]
Although there is no agreement of the treatment of chondromalacia, there is a general consensus that the best treatment is a non-surgical one.[11]
Physical Therapy Management
[edit | edit source]
Exercise Program:
The most common way to treat chondromalacia patellae is by strengthening the quadriceps muscle, because it has a very significant role in the movement of the patella.[1] Stretching of the vastus lateralis and strengthening of the vastus medialis is often recommended, but they are difficult to isolate because they have the same innervation and insertion.[7][9] Therefore, it’s easier to strengthen the whole quadriceps.
In this aspect of the therapy, make sure to give strength exercises, resistance exercises and coördination exercises of the quadriceps. Here’s is an example of an exercise program[12]:
Coördination Exercises
- Sit with the IL on a rolled towel under the fossa popliteum with no weight on the leg.
Extend the leg fast an relax slowly 50x - stand on one leg (IL) with the knee slightly bent. Tap the foot of the HL
in front, left, right and behind you on the floor - Jumping: from left to right, from the back to the front, in a square and in a diamond.
Strength Exercises
- Extend the IL for 10 seconds.
- Make a big step with the IL in front. You can make the exercise harder by
raising the distance, bending the knee moreand by jumping on the IL.
Resistance Exercises
- sit at the front of a chair with both legs extended just above the floor.
Push the heel of the healthy leg(HL) against the heel of the injured leg(IL).
Make sure there is no movement in both legs. Hold for 7 seconds. - Sit with the IL on a rolled towel under the fossa popliteum,
with a weight on the leg - stand with the IL, slightly bent, in front of the extended HL. Bend the IL
slowly. Make sure the knee never passes the foot. Move your
weight to the IL. When you feel pain, quit immediately. - stand with the IL on a step. Touch with the HL the floor by bending the
IL, first with the toes, then with the foot, then with the heel of the foot.
Ice & Drugs:
Ice is sure to decrease pain, but is more frequently used to treat acute injuries. The efficacy of ice is questionned and the exact effect isn’t clear too. Therefore, more studies are required to create evidence based guidelines.[9][13]
The benefit of anti-inflammatory drugs (NSAID’s) has not yet been proved. Althought a lot of treatments for CMP aren’t proved either, the potential side effects of NSAID’s may be more severe than the side effects of ice and exercise. Therefore, a judicious trail may be worthwile[9].
Taping:
Taping the patella into a certain position may be helpful, but the scientific evidence is varied. A commonly used technique is the ‘McConnell taping’. When taped properly, the McConnell tape may have a short-term pain relief[13].[9][14][15]
Foot Orthoses
Foot orthoses may be helpful in the pain relief of the knee. When made properly, the orthotics will cause biomechanical changes in the lower leg by preventing overpronation in pes planus and providing a better support for normal feet and pes cavus.[10][9]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 Lee Herrington and Abdullah Al-Sherhi, A Controlled Trial of Weight-Bearing Versus Non–Weight-Bearing Exercises for Patellofemoral Pain, journal of orthopaedic & sports physical therapy, 2007, 37(4), 155-160
- ↑ Gagliardi et al., Detection and Staging of Chondromalacia Patellae: Relative Efficacies of Conventional MR Imaging, MR Arthrography, and CT Arthrography, ARJ, 1994, 163, 629-636
- ↑ http://www.e-radiography.net/radpath/c/chondromalaciap.htm
- ↑ http://www.ubsportsmed.buffalo.edu/education/patfem.html
- ↑ http://orthopedics.about.com/cs/patelladisorders/a/chondromalacia.htm
- ↑ Vrije Universiteit Brussel
- ↑ 7.0 7.1 Florence Peterson Kendall et al., Spieren : tests en functies, Bohn Stafleu van Loghum, Nederland, 469p (383)
- ↑ 8.0 8.1 Iraj Salehi, Shabnam Khazaeli, Parta Hatami, Mahdi Malekpour, Bone density in patients with chondromalacia patella, Springer-Verlag, 2009
- ↑ 9.0 9.1 9.2 9.3 9.4 9.5 http://www.aafp.org/afp/991101ap/2012.htm
- ↑ 10.0 10.1 Bill Vicenzino, Natalie Collins, Kay Crossley, Elaine Beller, Ross Darnell and Thomas McPoil, fckLRFoot orthoses and physiotherapy in the treatment of patellofemoralfckLRpain syndrome: A randomised clinical trial, BioMed Central, 2008
- ↑ R van Linschoten et al., Supervised exercise therapy versus usual care for patellofemoral pain syndrome: an open label randomised controlled trial, BMJ, 2009
- ↑ P. van der Tas & J.M. Klomp-Jacobs; Chondropathie Patellae; Maatschap voor Sport-Fysiotherapie, Manuele Therapie en Medische Trainings Therapie
- ↑ Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251-261
- ↑ Derasari A. et al.;McConnell taping shifts the patella inferiorly in patients with patellofemoral pain: a dynamic magnetic resonance imaging study; Journal of the American Physical Therapy association; 2010 March; 90(3): 411–419
- ↑ Naoko Aminaka & Phillip A Gribble; A Systematic Review of the Effects of Therapeutic Taping on Patellofemoral Pain Syndrome; Journal of Athletic Training; 2005 Oct–Dec; 40(4): 341–351
