Knee Pain in Young Adults (Chondromalacia Patella)

What Is the Anatomy of the Knee Joint?

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.

What Is Chondromalacia Patella?

It is nothing but knee pain that occurs due to softening and breaking down of cartilage present below the kneecap.

What Causes Chondromalacia Patella?

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.

Who Share an Increased Risk of Developing Chondromalacia Patella?

• Individuals with a history of kneecap fracture, dislocation, or injury.

• Obese people.

• Young adults, especially females.

• People who have the habit of exercising like those involved in bicycling, playing soccer, running, etc.

How Is Chondromalacia Patella Manifested?

• Pain in the front of the knee.

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• 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).

How Is Chondromalacia Patella Diagnosed?

1. 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.

2. Blood Examination: Blood tests can be standard procedure and might not help.

3. X-rays: X-rays are not helpful as the problem is with cartilage lining, which cannot be seen on X-rays.

4. MRI Scan: MRI (magnetic resonance imaging) scans can detect changes in the cartilage but are used as a last resort in unresponsive cases.

5. 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.

How Is Chondromalacia Patella Treated?

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.

3. Injections:

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.

4. Physiotherapy:

Strengthening the anterior thigh muscles (quadriceps) and muscles around the kneecap (VMO) helps keep the kneecap in the proper position.

5. Surgery:

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.

What Are the Dos and Don'ts I Should Follow With Chondromalacia Patella?

1. Please avoid any movement or position which makes you feel the pain.

2. It is better to avoid kneeling, squatting, or sitting cross-legged.

3. One may occasionally go up and down the steps but avoid repeated stair climbing.

4. Pain may worsen with exercise, bicycling, and walking on a treadmill with an upward gradient (slope).

5. Maintain ideal body weight and if you are overweight, try reducing it.

6. Do stretching and strengthening exercises that involve the hamstring and quadriceps muscles.

7. Try to use supporting devices and special shoe inserts to ease the pain.

8. If the way you do regular exercise is the cause of your pain, change the way.

9. While involved in sporting activities, use the proper shoes that do not cause pain.

What Is the Prognosis of Chondromalacia Patella?

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.

Can We Prevent Chondromalacia Patella?

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.

Conclusion:

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.