Chondromalacia Patella
Chondromalacia patella is an abnormal condition of the patella's cartilage surface, a circumferential bone located in front of the knee. Due to anatomical variations, it affects women proportionally more than men and it is caused by a mechanical overload of the patellofemoral joint, which occurs both due to a muscular imbalance, characterized mainly by a decrease in strength of the quadriceps femoris muscle and the hip abductor muscles, and due to routine activities, such as squatting, going up and down stairs, and sitting for long periods with the knee bent.
What the Patient Feels
Patients with chondromalacia patella often complain of pain in the front of the knee. This pain usually worsens when the knee is bent too much, going up and down stairs, squatting, and when sitting for long periods. There may be a noise inside the knee when moving and a sensation that there is sand inside the joint.
Imaging Exams
The diagnosis of chondromalacia patella can be made clinically, without any imaging exams. However, we often request nuclear magnetic resonance to assess the condition of the cartilage.
With MRI, it is possible to classify chondromalacia patella. There are several classifications described in the literature, but in general we divide it into four grades:
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Grade I: Softening of the cartilage;
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Grade II: Superficial fissures, affecting up to 50% of the cartilage thickness;
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Grade III: Deep fissures, affecting more than 50% of the cartilage thickness;
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Grade IV: Erosion of the cartilage, with exposure of the subchondral bone
Tratamento
Treatment
In most cases, the treatment for chondromalacia patella is non-surgical and is based on:
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Medication to relieve pain and inflammation;
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Body weight control;
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Changing habits, avoiding sitting for long periods, going up and down stairs, wearing high heels, etc.;
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Physical therapy to rebalance the muscles;
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Muscular strengthening.
In some specific cases, treatment with infiltration of the knee with hyaluronic acid, also known as knee viscosupplementation, may be indicated. This procedure is performed in the doctor's office and does not require hospitalization. It can provide a significant improvement in pain and, therefore, allow for optimization of motor physiotherapy.
Surgical treatment may be indicated in some situations or when non-operative treatment fails.
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