Pain that occurs in the knee front is becoming common among young people. This article gives detailed information on the causes and treatment of chondromalacia patella or knee pain in young adults.
The most common location of knee pain in young adults is at the front of the knee joint. The problem usually arises from the patella (kneecap bone) and surrounding soft tissue.
The kneecap (patella) is a small bone that lies in front of the lower end of the thigh bone (femur). The backside of the kneecap is lined by smooth tissue called cartilage. This covering helps the patella glide in a groove on the lower end of the thigh bone. The kneecap is held on the top by thigh muscles (quadriceps), and the lower part is connected to the shin bone by the patellar tendon. The function of the kneecap is to aid knee movement and stabilize the knee joint while walking.
It is nothing but knee pain that occurs due to softening and breaking down of cartilage present below the kneecap.
Many theories suggest softening and micro-injuries of this lining to be the cause of knee pain. It could be due to repetitive microtrauma during falls, vigorous unaccustomed exercises, etc. Abnormal position of kneecap over the knee joint with or without weak ligaments may also damage the cartilage lining. As cartilage lining gets softened and roughened, it may cause pain and crepitus (clicks and sounds) over the kneecap. Obesity makes the condition worse.
Individuals with a history of kneecap fracture, dislocation, or injury.
Young adults, especially females.
People who have the habit of exercising like those involved in bicycling, playing soccer, running, etc.
Pain in the front of the knee.
Pain on climbing up and down the steps or ramps.
Sudden 'catch' over the kneecap while getting up from the ground.
Dull aching pain after sitting for a long time.
Discomfort during squatting (using Indian toilet) and sitting cross-legged.
Occasional clicks and sounds over the kneecap.
Swelling (knee swelling/joint swelling).
Physical Examination: Orthopedician can make a diagnosis based on your symptoms and examine the knee. Sometimes there may be slight swelling of the joint. Grating sensation behind the kneecap might give us some idea of the roughness of the patella when you tighten the kneecap muscles.
Blood Examination: Blood tests can be standard procedure and might not help.
X-rays: X-rays are not helpful as the problem is with cartilage lining, which cannot be seen on X-rays.
MRI Scan: MRI (magnetic resonance imaging) scans can detect changes in the cartilage but are used as a last resort in unresponsive cases.
Arthroscopy: It is possible to look inside the knee joint and back of the kneecap with a pencil-shaped camera (arthroscope) to confirm the diagnosis. But arthroscopy is not done just for diagnosis and is only done if there is any need for surgery.
This condition generally improves over a period with some changes in the lifestyle. But in some patients, symptoms persist for several years.
The following are the treatment modalities employed in its treatment:
1. Analgesics (Pain Killers):
Simple painkillers like Paracetamol and Tramadol may be sufficient in most cases. Sometimes anti-inflammatory medications (NSAIDs) may be necessary for a short period.
2. Nutritional Supplements:
Nutritional supplements to cartilage lining like Glucosamine, Chondroitin, MSM, and collagen peptides can be taken for 2 to 3 months, relieving the symptoms.
In some unresponsive cases, intra articular Hyaluronic injections can help. They act by providing lubrication between joint surfaces and help to nourish the cartilage lining of the kneecap.
Strengthening the anterior thigh muscles (quadriceps) and muscles around the kneecap (VMO) helps keep the kneecap in the proper position.
Surgical management is the last resort in severe or unresponsive patients. It can be performed with an arthroscope (keyhole surgery). The principle is to smoothen the rough surface of the back of the kneecap. In some cases where there are significant defects in the cartilage, multiple drill holes into the bone may help regrow some cartilage. Nowadays, this procedure is combined with stem cell treatment in particular cases.
Please avoid any movement or position which makes you feel the pain.
It is better to avoid kneeling, squatting, or sitting cross-legged.
One may occasionally go up and down the steps but avoid repeated stair climbing.
Pain may worsen with exercise, bicycling, and walking on a treadmill with an upward gradient (slope).
Maintain ideal body weight and if you are overweight, try reducing it.
Do stretching and strengthening exercises that involve the hamstring and quadriceps muscles.
Try to use supporting devices and special shoe inserts to ease the pain.
If the way you do regular exercise is the cause of your pain, change the way.
While involved in sporting activities, use the proper shoes that do not cause pain.
Prognosis in these cases is usually good. The severity of symptoms may vary from time to time, and the patient may have good and bad days. There are no severe side effects of any nutritional supplements, and one can use them without hesitation. Maintaining ideal body weight with exercises to strengthen the knee muscles plays a crucial role in recovery.
Strengthening the muscles of the quadriceps help in gaining muscle portion that makes the tracking of the kneecap easy and hence helps prevent chondromalacia patella in the long run. In terms of knee pain associated with chondromalacia patella, only the aggravation of symptoms can be prevented by avoiding activities that accentuate the knee pain.
Chondromalacia patella has become an increasing problem among young adults with a sedentary lifestyle. Therefore, try to maintain the ideal body weight and do regular exercises. While doing workouts, choose the correct form of exercise that fits you. If you have been diagnosed with chondromalacia patella, do not worry because it has a good prognosis.
The causes for chondromalacia are:
- Sprains and strains.
The common symptom of chondromalacia is pain around the patella. This pain can radiate to the inner part of the knee cap. Some patients also experience sharp pain in the surrounding areas of the patella.
Yes, it is possible to cure chondromalacia. It is not a life-threatening condition. Initially, rest is recommended for the patients. Physical therapy can relieve the symptoms of the individual. Reducing the inflammation caused by chondromalacia can pave the way for the treatment.
If the patient undergoes physical treatment, then they can heal within four to six weeks. Some patients might take up to one or two months also. A non-surgical method is the most recommended treatment option for this condition.
Chondromalacia patella is a condition in which there are alterations in the region of the patella. If chondromalacia is not treated well, then it can result in a condition called osteoarthritis, where the knee joints are affected.
The exercises that are recommended for chondromalacia patella are:
- Straight leg lift.
- Wall slide.
- External hip rotation.
- Dumbbell deadlift.
- Quadricep contraction.
Yes, you can exercise with chondromalacia patella. Exercising can help you relieve the stress in the involved site. Exercises can help in providing support to the muscles so that the overall symptoms in the knees due to chondromalacia patella can be improved.
The risk factors for chondromalacia are:
- Female gender.
- Flat foot.
- Aged people.
- Increased level of activity.
In chondromalacia patella, a crackling sound will be heard due to the accumulation of fluid in the joints. It is referred to as water on the knees. This sound can be heard whenever there is irritation in the joints.
Chondromalacia is not a very serious problem but the damages caused by chondromalacia can cause permanent damage. During the initial stages, the doctor tries to perform treatment with the help of non-surgical treatment options. If they are unsuccessful, then the irreparable damage can be treated by surgical procedures.
Yes, physical therapy is very useful for treating the condition of chondromalacia patella. The symptoms can be relieved with the help of this condition. Physical therapy is the most conservative method for treating patients. You should consult your doctor and ask for tips in preventing and handling chondromalacia patella.
MRI can indicate the cracking of the cartilage that could be seen on the undersurface of the patella. If the condition of chondromalacia is in a more severe stage, then it can be easily visualized in an MRI.
The diagnosis of chondromalacia requires a physical examination by the doctor. X-ray of the joints might be necessary to see the damage in the joints. The arthroscopic examination will be helpful to detect the internal structures of the joints. In some cases, MRI might also be necessary to see the wear and tear of the cartilage.
The patient should avoid using the stairs for a while. They can also choose to go for ice and heat therapy. Braces are available that can stabilize the knee joints. In addition to this, they can also go for strengthening the joints with the help of exercises.
The following tips can help in preventing chondromalacia.
- Avoid stress while playing sports. Choose to wear a knee cap always.
- It is necessary to strengthen the quadriceps muscles along with the hamstring.
- If you have flat feet, wear suitable shoes.
Last reviewed at:
20 Jan 2022 - 4 min read
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