From the Guidelines
Grade 3 chondromalacia patella is primarily caused by a combination of overuse, biomechanical issues, muscle imbalances, and anatomical predispositions, which lead to significant cartilage damage and softening on the underside of the kneecap. The causes of grade 3 chondromalacia patella can be multifactorial, involving various aspects that contribute to the deterioration of the cartilage.
- Overuse from repetitive stress activities such as running or jumping is a common factor, as it places excessive strain on the knee joint and the patella, leading to cartilage wear and tear 1.
- Biomechanical issues, including improper tracking of the patella in the femoral groove, can also contribute to the development of chondromalacia patella, as this can lead to uneven distribution of forces across the joint, further damaging the cartilage.
- Muscle imbalances, particularly weak quadriceps or tight hamstrings, play a significant role in the progression of the condition, as they can alter the normal movement and stress patterns of the knee joint.
- Previous knee trauma or injury can also predispose individuals to chondromalacia patella, as the initial damage to the cartilage or surrounding structures may not fully heal, leading to ongoing degeneration.
- Anatomical predispositions, such as flat feet or knock knees, can increase the risk of developing chondromalacia patella by altering the normal alignment and movement of the lower limb, thereby placing additional stress on the knee joint.
- Aging is another factor, as cartilage naturally deteriorates over time, making older individuals more susceptible to grade 3 chondromalacia patella.
- Obesity can accelerate cartilage wear by placing additional stress on the knee joints, contributing to the progression of the condition. In grade 3 chondromalacia patella, the cartilage has significant damage with areas of softening, fibrillation (fraying), and fissuring that extends more than 50% through the cartilage thickness, leading to more persistent pain, crepitus (grinding sensations), and functional limitations compared to lower grades 1. The progression to this stage typically occurs over time when earlier stages are not properly addressed or when the mechanical factors causing the condition persist without intervention. Therefore, addressing these underlying causes and implementing appropriate management strategies are crucial in preventing further deterioration and improving the quality of life for individuals with grade 3 chondromalacia patella.
From the Research
Causes of Grade 3 Chondroermalacia of the Patella
The causes of grade 3 chondroermalacia of the patella are multifactorial. Some of the key factors include:
- Trauma 2, 3, 4
- Increased cartilage vulnerability 2
- Patellofemoral instability 2, 3, 4
- Bony anatomic variations 2
- Abnormal patellar kinematics 2
- Occupation hazards 2
- Overuse 4, 5
- Malalignment or malposition of the patella 4
- Degenerative arthritis 4
- Abnormal femoral ridge 4
- Odd-facet syndrome 4
Clinical Features and Diagnosis
Clinical features of chondroermalacia patellae include anterior knee pain, quadriceps wasting, palpable patellofemoral crepitus, and effusion 2, 3, 4, 5. Diagnosis can be confirmed by arthroscopy or direct examination of the posterior surface of the patella 3, as well as radiologic measurements of patellofemoral relations 2, 4. Magnetic resonance imaging (MRI) is also a useful diagnostic tool 2.
Treatment Options
Treatment options for chondroermalacia patellae include conservative management with isometric quadriceps exercises and simple anti-inflammatory drugs 3, 5, as well as operative treatment such as distal patellar tendon medial realignment and lateral release 3. Manual therapy has also been shown to be effective in relieving pain and improving function 6.