Chondromalacia patellae

Chondromalacia patellae (also known as CMP) is a term that goes back eighty years. It originally meant "soft cartilage under the knee cap," a presumed cause of pain at the front of the knee. It has gradually come to mean pain at the front of the knee from just about any cause. It is therefore no longer a diagnosis (see below).^[1][2] Pain at the front of the knee is common in young adults, especially soccer players, cyclists, rowers, tennis players, ballet dancers, horseback riders, volleyball players, and runners. Snowboarders and skateboarders are especially prone to this injury, particularly those specializing in jumps where the knees are under great stress (skateboarders most commonly receive this injury in their non-dominant foot due to the constant kicking and twisting that is required of it during skateboarding).^[3] The condition may result from acute injury to the patella or from chronic friction between the patella and the groove in the femur through which it passes during motion of the knee.^[4] When pain at the front of the knee is due to overuse it can be addressed with a basic program consisting of RICE method (an acronym for rest, ice, compression, elevation), anti-inflammatory medications, physiotherapy. ^[3][5]

Causes

The term "chondromalacia" is a term left over from the 20th century. In the early 1900s investigators in Europe developed the theory that soft cartilage (the literal translation of chondro-malacia) is the cause of pain at the front of the knee. By the end of the 20th century, that theory had been discredited,^{[citation needed]} but health professionals continued to use the term to describe patients with pain at the front of the knee. The term is still used today, but with diminishing frequency. It is gradually being replaced by the term "patellofemoral syndrome", a term used by clinicians when they do not have a specific explanation for a patient's pain^[3].

Possible causes include a tight iliotibial band, neuromas, bursitis, overuse, malalignment, core instability, patellar maltracking, to name but a few. The term chondromalacia can also be used to describe abnormal appearing cartilage (anywhere in the body)^[6]. A radiologist might, for example, note chondromalacia on an MRI of an ankle. There is no one "cause" of chondromalacia. There are as many causes as there are conditions lumped under the term "chondromalacia".

Treatment

The treatment will depend on the specific source of a person's pain. Most sportspersons will use variations on the RICE method and anti-inflammatories, to rule out a simple overuse injury. If the pain is very severe or does not pass, they may consult a doctor. As noted above, "chondromalacia" and "patello femoral syndrome" are not diagnoses, as they do not help explain the source of pain. If pain is due to a tight iliotibial band, treatment will be focused on stretching of that band. If a person suffers from irritation of the infrapatellar branch of the saphenous nerve, treatment might consist of a small injection. If core stability is the issue, treatment might consist of physical therapy focused on the abdomen, pelvis and hips. If the condition is exacerbated by flat feet, these can be treated by orthotics^[3].

See also

• Iliotibial Band Syndrome
• Osgood-Schlatter disease

References