Chondromalacia Patella
“Coming in on pace for a personal best is Banghao Li and he comes in through the final straight” is probably something closer to what athlete Banghao Li, a cross-country runner at Arcadia High School, had expected to hear this past season. Instead, he found himself sidelined and rehabbing after experiencing chondromalacia patella earlier in the season. To understand Li’s pain, we need to dive deeper into what chondromalacia patella is.
Knee Anatomy
The patella, otherwise known as the kneecap, is the main bony structure on the anterior side of the knee. It is classified as a sesamoid bone meaning that it “floats” on top of the patellofemoral joint surface (In reality it is attached via the quadriceps and patella tendons). The surface of the joint itself is covered by something known as the articular cartilage, which provides a smooth surface for the patella to slide across. However, in patients with chondromalacia patella, the cartilage begins to deteriorate creating tissue degeneration, making it a case of osteoarthritis.
Etiology and Symptoms
Chondromalacia patella is typically caused by overuse or repetitive trauma, such as those caused during running; this garners it the name “runner’s knee”. Specifically, chondromalacia begins with the irritation of the articular cartilage which causes it to soften, and eventually crack or shred if proper precautions are not taken. In a small percentage of cases, the condition progresses to the point where complete joint degeneration takes place, exposing the bony surface of the femur which causes the patella to painfully grind against the patellofemoral surface. Alternate causes of chondromalacia patella include muscle imbalances (specifically in the quadriceps), poor bone or muscle alignment, previous history/family history of arthritis, and in rare cases infections within the knee joint. As a result, chondromalacia patella is more prevalent in more active groups, specifically young adults who participate in running, skiing, playing soccer, and other sports that place repetitive stress on the knee.
In its very nature, chondromalacia patella is a form of osteoarthritis. As such, athletes experiencing this condition will often experience a grinding or clicking sensation, especially when running or after repeatedly bending the afflicted knee. This includes activities such as squatting, or something simple such as walking up a flight of stairs.
Furthermore, athletes will often experience pain in the anterior knee just behind their kneecap that gets worse after being in a seated position for an extended period of time. The loss of articular cartilage causes the patella, which usually easily translates across the joint surface, to “catch” during certain movements. In addition, because of the joint effusion caused by this condition, it is possible that there is an element of swelling present in the knee. It is important to note that although a person’s knee may creak during flexion, it is not indicative of chondromalacia or that the cartilage is damaged.
Diagnosis
For a preliminary/on-field diagnosis, athletes can see an athletic trainer or someone similar who can perform a test to help determine what the condition may be. The test itself is called the patellar grind test with the positive sign being known as Clarke’s sign. If the patient has chondromalacia patella, they will experience a painful, grinding sensation when the test is performed.
For a more conclusive diagnosis, athletes should see their primary care provider who can help by further investigating the history of the patient (Previous knee injuries, knee surgeries, knee infections, family history of arthritis etc). They can also use bilateral comparison to compare the uninjured knee to the affected knee and order an MRI if necessary. In some cases, the doctor may also order an arthroscopy to investigate the knee joint itself and confirm whether the condition is chondromalacia patella.
Treatment
Typically, treatment for chondromalacia will depend on the severity of the injury. Some athletes who have less severe cases may be allowed to continue their typical activities with reduced workloads/mileage to help minimize the impact on the knee. For others, they may be completely sidelined to ensure that their condition does not progress further and to reduce the inflammation that is present.
Some helpful methods to relieve the pain are to…
Apply ice to the area after exercise to reduce pain/swelling (No longer than 15 minutes at a time)
Take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
Avoid all high-impact exercises such as jump squats etc
A knee brace or sleeve to support the knee (Or knee tape)
Visit a physical therapist and partake in physical therapy
Something to note is that because the articular cartilage does not regenerate over time, this condition can be permanent. However, the pain in the knee can be resolved via physical therapy and monitoring inflammation.
Athlete Interview
Chondromalacia patella can be an unpleasant and frustrating situation for any athlete. As mentioned earlier, Banghao Li, a cross-country runner at Arcadia High School is no stranger to this. This past season, due to an initial spike in activity, Banghao experienced this condition which left him sidelined for a substantial portion of his season. To read more about his experience, check out the link to the article below.
Conclusion
For all athletes, it is crucial to listen to your body and take all pain seriously. Conditions such as chondromalacia patella are created because of overuse. But with proper support and guidance, athletes can return to peak performance sooner than ever. This article serves as something to help give you a better idea about what chondromalacia patella is and what the treatment process looks like. As always, consult a medical professional before making any decisions about treatment.
Sources
“Chondromalacia Patella.” Arthritis Foundation,
www.arthritis.org/diseases/chondromalacia-patella. Accessed 25 Nov. 2023.
“Chondromalacia.” Harvard Health, 15 Mar. 2023,
www.health.harvard.edu/a_to_z/chondromalacia-patella.
