Chondromalacia of patella (Kneecap)
Chondromalacia patella is the softening, cracking and breakdown of the cartilage that lines the underside of the knee cap (patella)
Chondromalacia of the patella is a very common source for pain in the knee, especially pain in the front of the knee. It is more common in women because of the alignment of the lower legs in women compared to men. Chondromalacia of the patella (patella is the medical term for knee cap) is most times caused by some degree of malalignment of the kneecap with which you are born. The knee cap is either too tight, too high, too low, or angled by an increased what is called the “Q” angle. Regardless of the cause, the pain of chondromalacia is typically increased by going up and down stairs or standing up from a sitting position, or sitting in bent knee position for a long time. Chondromalacia is the most common cause of pain in the front of the knee. It is frequently manifested by a clicking or crunching sound and swelling of the knee (water in the knee) .
The nonsurgical management of chondromalacia of patella is to place the person on anti-inflammatory pills, and recommending avoidance of the inciting activity (if there is one such as running, playing basketball or volleyball, or using a Stairmaster or elliptical trainer). Sometimes with rest and anti-inflammatory pills, the situation improves.
In many cases, due to the fact that the kneecap has been out of line for a person's whole life, the condition worsens with activity and improves with rest. Many patients elect to have this problem surgically corrected. Surgically correcting this problem is relatively easy with arthroscopic surgery. The surgery for this consists of smoothing off the roughness on the underside of the patella(patella shaving), which looks like icicles arthroscopically and most importantly, in performing a lateral retinacular release. The lateral release is the key component in this procedure in that it loosens up excessive pressure of the kneecap against the femur and corrects the malalignment of the kneecap in most cases.
Arthroscopic smoothing of the kneecap and lateral release is an excellent operation for most patients with pain due to this problem. Please click on the video on to the right which shows the smoothing of the kneecap and the lateral release. Very few patients are unhappy with the results of this type of surgery.. If this arthroscopic procedure does not work, then a few patients are candidates for more major types of surgery including patellofemoral replacement which is shown elsewhere on this website.
If you have any further questions, please contact Dr. Likover.