From the Guidelines
Chondromalacia of the knee is primarily caused by the softening and deterioration of the cartilage on the undersurface of the patella (kneecap), which leads to pain and inflammation, and is most commonly associated with biomechanical issues, overuse, and age-related wear and tear 1. The condition typically results from a combination of factors, including:
- Muscle imbalances, particularly weakness in the quadriceps muscles that help stabilize the kneecap
- Misalignment of the patella, which can cause it to track improperly during knee movement
- Overuse from repetitive stress activities like running, jumping, or squatting
- Previous knee injuries or trauma
- Anatomical factors such as flat feet, knock knees, or abnormal patellar shape
- Age-related wear and tear, as cartilage naturally degenerates over time Women are more frequently affected due to their wider pelvis and resulting knee alignment 1. The most recent and highest quality study on the management of knee osteoarthritis, which includes chondromalacia, recommends a combination of non-pharmacological, pharmacological, and surgical modalities, with a focus on educating the patient, alleviating pain, optimizing and maintaining function, and preventing or retarding progression of adverse structural change affecting the joint tissues 1. Treatment typically involves rest, physical therapy focusing on quadriceps strengthening, anti-inflammatory medications like ibuprofen (400-800mg three times daily with food for acute pain), and activity modification to reduce stress on the knee joint 1. In severe cases that don't respond to conservative treatment, surgical interventions may be necessary, such as microfracture, articular cartilage repair, autologous chondrocyte implantation, mosaicplasty, and osteochondral allograft transplantation 1.