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Chondromalacia Patella

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Chondromalacia Patella

WHAT IS IT?

Chondromalacia can be defined as the softening of cartilage, which is an anatomo-pathological definition, since the alteration of the cartilage can occur with or without painful surgery. In chondropathy, anatomo-pathological injury in itself is what gives rise to painful surgery. Chondromalacia is understood as patellar pain in the anterior side of the knee which worsens on sitting for prolonged periods, or going down stairs/slopes, with joint clicking and episodes of pseudo-locking and failure. It is more frequently found bilaterally, in young women, and among other causes we find degenerative, inflammatory post-traumatic mechanics (delineation) after immobilisation. This disease is classified on four levels:

  • Grade I chondromalacia: softening of the cartilage is observed.
  • Grade II chondromalacia: minor fissures.
  • Grade III chondromalacia: fissures affecting half the thickness of the cartilage.
  • Grade IV chondromalacia: erosion all the way to the bone.

CAUSES

Chondromalacia patellae arises when kneecap movement is displaced, causing it to rub against the distal part of the femur. Among other causes, we find kneecap malalignment, weakness of the surrounding muscle, and an excess in any activity that puts a strain on the kneecap, such as jumping and running.

SYMPTOMS

Intermittent swelling: this is often the only symptom. It is caused by loose fragments that have come away from the cartilage and which irritate the synovial membrane within the joint, which responds by producing more synovial liquid (leakage).

Pain: pain may be experienced during long walks, climbing up or down stairs or on sitting for extended periods (claudication).

Occasional loss of stability

Locking: the free-floating fragments can prevent the knee from bending.

Noise: The knee may emit noise (crepitus) during movement, especially if the cartilage at the back of the kneecap is damaged.

TREATMENT

Initially, conservative treatment is preferred, involving weight-loss, non-steroid anti-inflammatory medication, orthoses (knee, foot) and, on occasion, the modification of physical activity, quadricep-strengthening exercises, quadricep stretches, chondroprotectives and intra-articular injections of Hyaluronic acid.

Intra-articular PRGF® Endoret® injections are also recommended, administered weekly, on an outpatient basis, for three consecutive weeks and with maximum asepsis. These injections are performed on the lateral side of the medial compartment of the patellofemoral joint.

If there is no improvement with said conservative treatment, surgery will be considered, depending on the extent of injury, as with cases of patellofemoral syndrome. (link to patellofemoral syndrome)


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