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What is Chondromalacia?

by Jaydee Vykoukal, PT, DPT August 19, 2020 0 Comments

Chondromalacia Knee pain

What is chondromalacia? If you suffer from aches and pains in your kneecap or have the strange sensation that the bones around your knee are grating against one another, you may have chondromalacia patella. It is characterized by the knee cartilage softening and potentially wearing away and can severely affect knee function if left untreated. Keep reading to learn common chondromalacia patella causes and symptoms, as well as available treatment options and tips for prevention.

What is Chondromalacia Patella?

Chondromalacia, by definition, is abnormal softness of cartilage. Therefore, the term chondromalacia patella refers to the wearing down or thinning of the cartilage in the patella, or the kneecap. It is often the underlying cause of knee pain related to common diagnosed conditions like patellofemoral pain or runner’s knee.

Chondromalacia of the patella is commonly seen in athletes, but it also affects adolescents and older adults. When patellar chondromalacia occurs, the kneecap rubs against the thigh or shin bone, rather than gliding smoothly over it as it should. This constant friction damages the cartilage around the patella. If left untreated, the thinning cartilage will eventually expose bone, which causes significant pain, inflammation, and immobility.

Chondromalacia Grades

Chondromalacia ranges from mild to severe, with damage to the knee being classified as:

  • Grade 1 chondromalacia:

    A softening of the knee cartilage, also known as mild chondromalacia patella

  • Grade 2 chondromalacia:

    A moderate chondromalacia characterized by the presence of soft cartilage with some abnormal surface features that suggest early tissue erosion

  • Grade 3 chondromalacia:

    Thinning cartilage and active tissue deterioration

  • Grade 4 chondromalacia:

    Severe chondromalacia patella characterized by significant deterioration of tissue and some exposed bone, which significantly affects normal knee function

Chondromalacia Causes

The main cause of chondromalacia patella is abnormal movement of the patella over the thigh bone. Common chondromalacia causes include:

  • Overuse of the knee
  • Misalignment of the knee due to developmental issues
  • Muscle imbalance—when certain muscles lack strength or coordination, other muscles and soft tissues pick up the slack, which leads to excess strain and can eventually cause injury or damage. Common imbalances are between the quadriceps and hamstrings and the hip adductors and abductors.
  • Injury to the knee- particularly a direct blow to the patella
  • Wear and tear of cartilage in the entire knee joint due to overuse or regular high impact activities

Chondromalacia Risk Factors

Although chondromalacia can happen to anyone, certain people are at increased risk of developing the condition. Risk factors include:

  • Age

    Adolescents, young adults, and older adults are at an increased risk of developing chondromalacia patella.

  • Sex

    Females are more likely than males to develop this condition, due to greater risk of muscle imbalance and joint hypermobility.

  • Lifestyle

    Those who regularly participate in high impact sports or perform weight-bearing activities are at an increased risk of developing chondromalacia such as running, jumping, skiing or many team sports. These types of activities cause repetitive stress to the joints and increase the risk of accumulative or sudden injury to the knee.

  • Flat Feet

    If you have flat feet, you may be at higher risk for chondromalacia patella. Flat feet cause increased stress on the knee joints.

  • Injury or Illness

    People who have previously injured their kneecap, or who have joint conditions such as arthritis, are more likely to experience thinning cartilage and inflammation.

Chondromalacia Patella Symptoms

The most common chondromalacia symptoms include:

  • Pain in the knee
  • Non-specific discomfort in the patella
  • Mild swelling
  • Pain or discomfort that gets worse after sitting
  • Increased pain or discomfort after standing for long periods
  • Pain or discomfort that gets worse during workouts
  • A feeling of grating or grinding when bending or extending the leg
  • A sensation of tightness or fullness in the knee
  • Loss of thigh muscle strength (if initial symptoms are left untreated)

Diagnosing Chondromalacia

Your doctor will diagnose chondromalacia patella by taking a full medical history and carrying out a physical examination. Imaging tests may be required to confirm the diagnosis, to rule out alternative knee conditions, and to grade the severity of the chondromalacia.

  • Medical History and Physical Examination

    The first step is to discuss your chondromalacia symptoms with your doctor. He or she will ask about your medical and family history, your physical activities, and when you first noticed symptoms.

    They will carry out a physical examination to look for other chondromalacia signs and symptoms such as swelling, tenderness, and pain. They will also check your knee structure and alignment, as misalignment can suggest chondromalacia patella.

  • Chondromalacia Patella Test

    A simple test, also called Clarke’s Test, may be used to help confirm a diagnosis. The doctor may ask you to contract your quad muscles while they exert pressure on a certain part of your knee. Pain or discomfort suggests chondromalacia patella.

  • Chondromalacia Pictures

    Chondromalacia patella radiology, or medical imaging tests, include X-rays and MRI scans and are used to diagnose disease and damage within the body.

    If your doctor suspects chondromalacia patella, MRI scans may be used to check for damage to the cartilage and other soft tissues in the knee. X-rays may be taken to look for misalignment, cartilage changes, or damaged bones.

  • Arthroscopy

    This minimally invasive surgical procedure involves the insertion of a small camera into the knee joint. It is typically used to explore knee tissue damage and complete any necessary “clean up” of damaged tissues. Although common and considered low risk, it is still a surgical procedure that can affect the integrity of the knee joint.

Chondromalacia Patella Recovery Time

The time required for a full recovery from chondromalacia patella varies based on a number of factors, including the grade of the condition, your lifestyle, and treatments used. However, most cases heal within weeks or months with the use of minimally invasive treatments. The top treatment option is physical therapy for restoring better knee alignment. Other options for managing pain include acupuncture, chiropractic care, and massage therapy. 

Similarly, arthroscopic knee surgery recovery time varies depending on circumstances. After chondromalacia surgery, you may need to use a brace and ice pack to alleviate pain, and physical therapy should begin within days.

For the best chance of a quick recovery, address your symptoms immediately and always focus on good form with daily activities. Consult your doctor and use the RICE protocol without delay to help manage pain and swelling effectively.

Preventing Chondromalacia

Chondromalacia patella is a painful and debilitating condition that can be slow to heal and may result in complications with proper knee function. Therefore, it’s best to take steps to prevent it from happening in the first place. Prevention tips include:

  • Achieving Muscle Balance

    Stretch and strengthen the muscles in the knee, leg, and whole body to avoid putting too much stress on one muscle or group of muscles. In particular, work on your hamstrings, quads, abductors, and adductors.

  • Correcting Flat Feet

    Take steps to address flat feet, including exercise, wearing supportive footwear, and shoe inserts.

  • Avoiding Repeated Stress to the Knees

    Engage in low-impact activities, wear knee braces for added support if needed, and consider using knee pads when decorating or gardening to protect your kneecaps. If you do participate in high impact sports, always do so with attention to the utmost best form possible.

  • Maintaining a Healthy Weight

    Carrying too much body-weight puts added stress on all your joints, increasing your risk of illness and injury. Eat a balanced diet and engage in daily physical activity to stay fit and slim.

Don’t Leave Chondromalacia Patella Untreated

The road to recovery from issues like runner’s knee caused by chondromalacia patella can be frustrating, long, and bumpy if not properly addressed from the start of symptoms. The first step is to visit your doctor or physical therapist for an accurate diagnosis. Then you should consider using some, or all, of the treatment options listed above.

If you’re lucky enough to have never experienced chondromalacia patella, make sure you never do by being aware of your knee alignment with activity and following our other preventative tips.


SHOP Chondromalacia PAIN


Jaydee Vykoukal, PT, DPT
Jaydee Vykoukal, PT, DPT

JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.

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