From the Guidelines
Patellofemoral pain syndrome and chondromalacia patella are distinct knee conditions, with patellofemoral pain being a broader diagnosis characterized by anterior knee pain, and chondromalacia specifically referring to the softening and deterioration of the cartilage on the underside of the kneecap. The key difference between the two conditions lies in their underlying causes and the presence of structural damage. Patellofemoral pain syndrome is primarily a clinical diagnosis based on symptoms, such as anterior knee pain around or behind the kneecap that worsens with activities like climbing stairs, squatting, or sitting for long periods, without necessarily having structural damage 1. On the other hand, chondromalacia patella involves actual cartilage damage that can be confirmed through imaging or arthroscopy.
Key Characteristics of Each Condition
- Patellofemoral pain syndrome:
- Characterized by anterior knee pain
- Worsens with activities like climbing stairs, squatting, or sitting for long periods
- Primarily a clinical diagnosis based on symptoms
- May resolve completely with proper management
- Chondromalacia patella:
- Specifically refers to the softening and deterioration of the cartilage on the underside of the kneecap
- Involves actual cartilage damage
- Can be confirmed through imaging or arthroscopy
- May not fully reverse but can be effectively managed to reduce symptoms
Treatment Approaches
Best practice for patellofemoral pain should include delivering knee-targeted exercise therapy, with supportive interventions as required, and education should underpin all interventions, adjusted to reflect the needs of the person 1. Treatment for both conditions is similar, focusing on physical therapy to strengthen quadriceps and hip muscles, activity modification, and anti-inflammatory medications for pain relief. Proper footwear, patellar taping or bracing, and weight management can also help. Surgery is rarely needed and reserved for severe cases of chondromalacia that don't respond to conservative treatment. The use of patellofemoral braces can be beneficial as part of a comprehensive knee rehabilitation program 1.
From the Research
Patellofemoral Pain vs Chondromalacia
The key differences between patellofemoral pain and chondromalacia are:
- Definition: Patellofemoral pain syndrome (PFPS) is a condition characterized by pain in the anterior knee, typically worsening with activities that load the patellofemoral joint, such as squatting, jumping, or climbing stairs 2. Chondromalacia patella, on the other hand, refers to the softening of the cartilage on the underside of the kneecap (patella) 3.
- Causes: PFPS is often associated with biomechanical and neuromuscular factors, such as quadriceps weakness, hip abductor weakness, and altered patellar tracking 4, 5. Chondromalacia patella is thought to result from repetitive stress and trauma to the patellar cartilage, which can be exacerbated by factors such as patellar malalignment and trochlear dysplasia 3.
- Symptoms: Both conditions can cause anterior knee pain, but PFPS tends to be more activity-related, whereas chondromalacia patella may cause more constant pain and stiffness 2, 3.
- Diagnosis: PFPS is typically diagnosed based on clinical examination and history, with findings such as pain with squatting, crepitus, and quadriceps weakness 2, 4. Chondromalacia patella is often diagnosed using imaging studies, such as MRI, which can reveal cartilage softening and degeneration 3.
- Treatment: Treatment for PFPS typically involves a combination of rest, physical therapy, and modalities such as patellar taping and orthotics 2, 5, 6. Treatment for chondromalacia patella may involve similar conservative measures, as well as procedures such as cartilage repair or patellar realignment surgery in more severe cases 3.
Key Findings
- A study published in 2021 found that trochlear and patellar morphologies, as well as clinical scores, play a key role in understanding chondromalacia patella 3.
- A review published in 2021 highlighted the importance of physical examination and musculoskeletal ultrasound in diagnosing PFPS 4.
- A systematic review published in 2021 evaluated clinical practice guidelines for physical therapist management of patellofemoral pain and found that exercise therapy, foot orthoses, and patellar taping are recommended interventions 6.