What is the best treatment for chondromalacia (cartilage softening) of the patella (kneecap)?

From the Guidelines

The best treatment for chondromalacia patellae involves delivering knee-targeted exercise therapy, with a focus on hip and knee strengthening, as well as education to challenge inaccurate beliefs and promote autonomy. This approach is supported by the most recent and highest quality study 1, which emphasizes the importance of objective evaluation of physical impairments, including muscle strength, movement patterns, and tissue tolerance to load.

Key Components of Treatment

• Deliver knee-targeted exercise therapy, with a greater focus on hip exercises in people with poor tolerance to loaded knee flexion 1
• Prescribe exercise therapy relative to specific severity and irritability, with task/load/intensity/frequency modified as required 1
• Education should underpin all interventions, adjusted to reflect the needs of the person, to challenge inaccurate beliefs, build confidence, and promote autonomy 1
• Consider supporting approaches, such as prefabricated foot orthoses, movement/running retraining, and taping, based on subjective and objective findings 1

Rationale for Treatment

The treatment approach is based on the understanding that chondromalacia patellae is a complex condition that requires a multifaceted approach. By delivering knee-targeted exercise therapy, with a focus on hip and knee strengthening, patients can improve their muscle strength, movement patterns, and tissue tolerance to load, ultimately reducing their symptoms. Education is also a crucial component of treatment, as it helps patients understand their condition, challenges inaccurate beliefs, and promotes autonomy.

Clinical Decision-Making

When making clinical decisions, it is essential to consider the individual patient's needs and circumstances. The treatment approach should be tailored to the patient's specific severity and irritability, with modifications made as required. By taking a patient-centered approach, clinicians can help patients achieve the best possible outcomes and improve their quality of life. As noted in the study 1, "Goal setting completely influences everything here … all these individual factors, are you able to address (or) account for these?" This emphasizes the importance of considering the patient's unique needs and circumstances when developing a treatment plan.

From the Research

Treatment Options for Chondromalacia Patellae

The treatment for chondromalacia patellae (cartilage softening) of the patella (kneecap) can be conservative or surgical.

• Conservative treatment methods include:
  • Rehabilitative exercise
  • Bracing
  • Spinal manipulation 2
  • Injections of Arteparon, short waves, and iontophoresis with histamine, although these methods did not yield statistically significant better results than other methods 3
• A comprehensive conservative management program has been shown to be effective in 82% of athletes with symptomatic patellofemoral syndromes, with only 8% requiring surgical treatment 4

Surgical Treatment

Surgical treatment options include:

• Arthroscopic surgery, which has been shown to be effective in managing chondromalacia patellae, with minimal morbidity 5
• Shaving of the patellar cartilage, which offered a particular advantage in post-traumatic groups 5
• Lateral release plus shaving and lavage, which was beneficial in groups with maltracking patellae and in half of the idiopathic group 5
• Cartilage excision and drilling of the subchondral bone, which was satisfactory in adults over 20 years of age with Grade I and II changes in the patellar cartilage 6
• Patellectomy, which is recommended in adults with Grade III and IV changes, and in adolescents with Grade IV changes in the patellar cartilage 6