A condition affecting the hyaline cartilage covering the articular surfaces of the bone is commonly referred to as chondromalacia (sick cartilage). When the hyaline cartilage of the patella tears, fissures, and erodes, the posterior articular surface of the patella becomes softer and loses density, a condition known as chondromalacia patella (CMP). It is frequently referred to as runner’s knee, patellofemoral syndrome, or chondromalacia of the patella since it is widely acknowledged to involve the knee’s extensor mechanism. Hyaline cartilage covers the underside of the patella, and this cartilage articulates with the femoral groove (also known as the trochlear groove). Chondromalacia can occur as a result of post-traumatic injuries, microtrauma wear and tear, and injections of iatrogenic medications. Any joint can develop chondromalacia, however it is more prevalent in joints that have had stress or abnormalities1. According to H zhang et al; The higher Q angles in women are thought to be the reason why more women than males are impacted. The variance does not seem to have a hormonal explanation. Also a greater incidence of chondromalacia is seen in active young adults who play running sports or in workers who put more stress on their patellofemoral joint by often stair climbing and/or kneeling2.
If you are suffering from chondromalacia patellae you may experience
- Pain on anterior side of the knee.
- Pain progresses with activities.
- Difficulty in stair ascending, descending, squatting, kneeling & running.
- Presence of swelling.
- Wasting of quadriceps muscle.
- Retropatellar crepitus sound3.
Physical therapists use a thorough and methodical approach for assessing chondromalacia patellae. This process starts with a comprehensive patient history and continues with a physical examination and functional evaluations. Assessments of discomfort, effusion, quadriceps strength, patella mobility, and crepitus should all be part of a comprehensive evaluation of the patellofemoral joint1. Lower limb malalignment & patellar maltracking also leads to the chondromalacia patellae. This can be identified by physical therapist with Q angle measurement. The pull of the quadriceps muscle in relation to the bring in of the patella tendon on the patella is measured as the Q angle. For men, a typical angle is 14 degrees; for women, it is 17 degrees. This difference results from the fact that girls typically have a broader pelvis than males do. A lateral pull of the patella in the femur’s trochlear groove and a mechanism of articular cartilage wear and tear are indicated by an unusually high Q angle > 20 to 25 degrees. Narrow contact pressure zones with elevated stresses and higher discomfort are the outcome of patellar maltracking1. Clark’s test is a physical examination that particularly assesses the knee for chondromalacia patellae. By squeezing the patella into the femoral trochlea and having the patient use their quadriceps muscle to pull the patella into the groove, this test assesses patellofemoral grinding and discomfort. The goals of physical therapist for chondromalacia patellae are pain relief, better patellar tracking, and knee function restoration. A personalized workout regimen aimed at strengthening the quadriceps—especially the vastus medialis obliquus (VMO), which is critical for stabilizing the patella—is the sequential step in the treatment process. A successful recovery depends on the quadriceps’ strength and function being restored to a sufficient level. According to clark d er al; In the inner range, isometric and isotonic activities of quadriceps are the most beneficial4. In addition to strengthening, the regimen will include stretching the hamstring muscles. As research indicates that hamstrings in persons with patellofemoral pain syndrome are shorter and less flexible than those without the condition. While stretching can help with knee function and flexibility5. Also static and dynamic strengthening exercises for gluteal muscles are very helpful in this condition as weakness of these muscles are associated with hip adductors which lead to assymetry in patellar alignment5. Also if required physical therapist will use a kinesiotaping, as per derasari et al; Kinesiotaping is likely to be beneficial for all individuals with abnormal patellofemoral kinematics6. As per Harvie D et aln studies show that when exercises are done every day for six weeks or longer, the best outcomes are obtained & the physical therapy approaches have been most successful for treatment. Ultimately pain can be greatly reduced and knee function can be restored with the appropriate physical therapy approach. Physical therapy treats the underlying causes of the condition, facilitating recovery and averting recurrence, via focused exercises, stretching, and close attention to biomechanics.
References:
1. Habusta, S. F., Coffey, R., Ponnarasu, S., Mabrouk, A., & Griffin, E. E. (2017). Chondromalacia patella.
2. Zhang, H., Kong, X. Q., Cheng, C., & Liang, M. H. (2003). A correlative study between prevalence of chondromalacia patellae and sports injury in 4068 students. Chinese Journal of Traumatology= Zhonghua Chuang Shang za zhi, 6(6), 370-374.
3. Leslie, I. J., & Bentley, G. E. O. R. G. E. (1978). Arthroscopy in the diagnosis of chondromalacia patellae. Annals of the Rheumatic Diseases, 37(6), 540-547.
4. Clark, D. I., Downing, N., Mitchell, J., Coulson, L., Syzpryt, E. P., & Doherty, M. (2000). Physiotherapy for anterior knee pain: a randomised controlled trial. Annals of the rheumatic diseases, 59(9), 700-704.
5. Harvie, D., O’Leary, T., & Kumar, S. (2011). A systematic review of randomized controlled trials on exercise parameters in the treatment of patellofemoral pain: what works?. Journal of multidisciplinary healthcare, 383-392.
6. Derasari, A., Brindle, T. J., Alter, K. E., & Sheehan, F. T. (2010). McConnell taping shifts the patella inferiorly in patients with patellofemoral pain: a dynamic magnetic resonance imaging study. Physical therapy, 90(3), 411-419.
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