From the Guidelines
Chondromalacia is primarily caused by trauma, labral tears, and femoroacetabular impingement (FAI), among other factors, which lead to articular cartilage damage and degeneration. The management of chondral injuries is complex and challenging, especially in weight-bearing joints such as the hip. Several causative factors have been implicated, including:
- Trauma
- Labral tears
- Femoroacetabular impingement (FAI)
- Arthritis
- Osteonecrosis
- Dysplasia As reported by McCarthy and Lee, most chondral injuries in the hip joint were associated with labral tears and were located in the anterior quadrant of the acetabulum (59%) 1. Patients with chondral injuries of the hip typically have a history of hip catching or locking and present with pain in the groin area that occasionally radiates to the buttock or thigh.
The underlying problem of chondral damage is not solved by nonsurgical methods of alleviating pain, which are considered temporizing measures. Hip-preserving strategies are particularly applicable in younger patients (age ≤50 years) to preempt degeneration of the entire joint. Early detection and management of focal chondral injuries are crucial to prevent the progression of the disease. According to the study published in The Journal of the American Academy of Orthopaedic Surgeons, additional research is needed to expand our knowledge of and develop guidelines for management of chondral injuries of the hip 1.
In terms of diagnosis, physical examination should be thorough, focusing on intra-articular and extra-articular causes of pain. Plain radiography can be used to detect joint space narrowing but not focal chondral defects. Advances in hip arthroscopy have broadened the spectrum of tools available for diagnosis and management of chondral damage 1. Surgical options, such as microfracture, articular cartilage repair, autologous chondrocyte implantation, mosaicplasty, and osteochondral allograft transplantation, may be considered in severe cases. However, the literature is still not sufficiently robust to draw firm conclusions regarding best practices for chondral defects 1.
From the Research
Causes of Chondromalacia
- Chondromalacia patellae (CMP) is caused by several factors, including trauma, increased cartilage vulnerability, patellofemoral instability, bony anatomic variations, abnormal patellar kinematics, and occupation hazards 2
- The initial pathological changes include cartilage softening, swelling, and edema 2
- Quadriceps wasting, patellofemoral crepitus, and effusion are obvious clinical indications of CMP 2
Risk Factors
- Young patients are typically affected by CMP, which is characterized by anterior knee pain (AKP) that is associated with visible changes in patellar cartilage 2
- Anterior knee pain commonly affects young women, resulting in the declination of the quality of life 3
- Occupation hazards may also contribute to the development of CMP 2