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Chondromalacia: Symptoms, Causes, and Treatment

Chondromalacia Patellae: Causes, Symptoms, and Treatment Options

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  • Chondromalacia Patellae: Causes, Symptoms, and Treatment Options
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It occurs when the cartilage – which cushions the moving parts of the knee and prevents them from being damaged by friction – under the kneecap (patella) softens and wears away, causing the knee to lose this protective cushion.

Chondromalacia may lead to dull pain when the knee is bent, or when the knee straightens right after being bent, such as when you:

  • Walk down hills or stairs
  • Climb stairs
  • Straighten the knee while it is bearing weight

This is because such movement means that the kneecap has to slide up and down the thigh bone more frequently, rubbing against the cartilage that is being worn out and causing knee pain. Some may also notice a cracking/ grinding sensation after heavy use of legs and knees.

Plica Syndrome

This is a condition when your medial plica, one of the four folds that line your knee joint, gets irritated. This can happen due to an injury, or overuse of the knee.

If you have plica syndrome, you may experience:

  • Knee pain
    • Hurts to walk up and down the stairs, squat down, bend, or stand up after sitting for awhile
    • Pain may worsen at night/when active
    • Knee does not feel stable (may give way)
  • Swelling (of the knee)
  • Locked knees
  • Clicking sound when bending knee

Inflammatory arthritis (rheumatoid arthritis, gout)

Gout of the knee is a type of inflammatory arthritis that occurs when your knee joint is inflamed. The fluid-filled sacs (bursae), which surrounds and protects the soft tissues and bones of the knee, get infected, causing:

  • Swelling of the knee and surrounding parts
  • Pain
    • Often sudden and severe
    • To the extent where the joint cannot be touched
  • Skin discolouration/ shiny skin around the knee
  • Itchy, peeling skin

Rheumatoid arthritis (RA) is an autoimmune disease that occurs when the body’s immune system mistakes healthy tissue to be foreign bodies. The immune system attacks the healthy body tissue, causing inflammation. While RA occurs in the hands or feet first, it may also occur in any other joint, resulting in pain and difficulty in moving.

What other symptoms are associated with knee pain?

Loss of function

Some symptoms that are associated with knee pain include the inability to squat, climb stairs/ slopes and walk for prolonged periods of time. These symptoms could be due to physical conditions that cause knee pain, such as:

Chondromalacia

It occurs when the cartilage – which cushions the moving parts of the knee and prevents them from being damaged by friction – under the kneecap (patella) softens and wears away, causing the knee to lose this protective cushion.

Chondromalacia may lead to dull pain when the knee is bent, or when the knee straightens right after being bent, such as when you:

  • Walk down hills or stairs
  • Cimb stairs
  • Straighten the knee while it is bearing weight

This is because such movement means that the kneecap has to slide up and down the thigh bone more frequently, rubbing against the cartilage that is being worn out and causing knee pain. Some may also notice a cracking/ grinding sensation after heavy use of legs and knees.

Patellofemoral Pain Syndrome

This refers to dull, aching pain at the front of your knee, around your kneecap (patella). It is a condition that is sometimes referred to as “runner’s knee”, and although it has no known cause, has been associated with overuse of/ injuries to the kneecap and muscle imbalances.

People with this condition feel pain around the kneecap when doing activities such as squatting, running, jumping or kneeling.

Patella Tendonitis

It is an overuse injury to the patellar tendon, which connects your kneecap to shinbone (tibia). Repeated stress on the patellar tendon results in tiny tears in the tendon, and multiple tears can cause inflammation and weakening of the tendon.

Also known as “jumper’s knee”, patella tendonitis is common in those who do sports that involve frequent jumping (e.g. basketball, volleyball). Initially, knee pain is only felt before or after an intense workout; as the pain worsens over time, you may also experience pain when:

  • Climbing stairs
  • Walking up an incline
  • Rising from a chair

Sensation of the Knee giving out

Weak knees or knee instability, which are commonly described as the knee “giving out” or “buckling”, can be the only symptom of a knee condition, or can be accompanied by other symptoms such as popping, locking, pain, bruising or swelling of the knee.

Common knee conditions that lead to the knee giving out include:

Ligament Tears

Partial or complete tears to one or more of the four ligaments of the knee can cause knee instability:

  • ACL tear
    • Occurs with sudden movements, such as a change in direction during sports or a motor vehicle accident
    • Complete ACL tears occur with the sensation of the knee giving out completely, often followed by pain and swelling
  • PCL tear
    • Occurs during a fall, when the person lands directly on the front of the knee, or when the front of the shin is forcefully hit (e.g. during a motor vehicle accident)
    • For PCL tears, the knee does not actually give out, but feels like it could
  • MCL tear
    • Occurs when the outer side of the knee is hit
    • If a sensation of the knee giving out is present, it could imply that a significant MCL tear is present
  • LCL tear
    • Occurs when there is excess pressure on the inside of the knee, or when the knee bends inwards excessively due to quick stops or collisions

Similar to MCL tears, if there is a sensation of the knee giving out, it could imply that there is a significant LCL tear

Meniscal Tears

A tear in the meniscus – a ​​cartilage that absorbs shock – is one of the main causes of a locked knee.

The torn portion of the cartilage can be stuck in the joint, causing the knee to swell. Your knee may also make a popping sound, stiffen, and/ or be painful when moving. A torn cartilage may occur due to an injury or wear and tear.

Meniscal Tears

Plica Syndrome

This is a condition when your medial plica, one of the four folds that line your knee joint, gets irritated. This can happen due to an injury, or overuse of the knee.

If you have plica syndrome, you may experience:

  • Knee pain
    • Hurts to walk up and down the stairs, squat down, bend, or stand up after sitting for awhile
    • Pain may worsen at night/when active
    • Knee does not feel stable (may give way)
  • Swelling (of the knee)
  • Locked knees
  • Clicking sound when bending knee

Patella dislocation

Some injuries may cause your kneecap (patella) to move into an abnormal position. As such, your knees may lock when you extend your knees.

A variety of reasons may cause a pseudo locked knees:

Knee injury (fracture, dislocation)

The pain from a knee injury may activate your body’s automatic defence mechanism. As your body recognises that your knee has been injured and is weak, your knee muscles spasm and contract, restricting your movement. This helps to protect your knee as it prevents any further damage.

Inflammatory arthritis (rheumatoid arthritis, gout)

Gout of the knee is a type of inflammatory arthritis that occurs when your knee joint is inflamed. The fluid-filled sacs (bursae), which surrounds and protects the soft tissues and bones of the knee, get infected, causing:

  • Swelling of the knee and surrounding parts
  • Pain
    • Often sudden and severe
    • To the extent where the joint cannot be touched
  • Skin discolouration/ shiny skin around the knee
  • Itchy, peeling skin

Rheumatoid arthritis (RA) is an autoimmune disease that occurs when the body’s immune system mistakes healthy tissue to be foreign bodies. The immune system attacks the healthy body tissue, causing inflammation. While RA occurs in the hands or feet first, it may also occur in any other joint, resulting in pain and difficulty in moving.

Sensation of Locking

A locked knee occurs when the knee cannot be bent or straightened. A complete loss of mobility of your knee joint (true locked knee) and extreme difficulty in moving the knee joint (pseudo locked knee) are considered to be locked knees.

There are a few causes of a true locked knee:

  • Meniscal tear (see above)
  • Plica syndrome (see above)
  • Patella dislocation (see above)
  • “Loose body”
    • A “loose body” in the joint may cause true locked knees
    • When the “loose body”, which may be a fragment of bone or foreign bodies left in the body after surgery, gets stuck in the knee joint, the knee may be “locked”

Painful Clicking

You may hear a clicking sound when you bend/ straighten your knees, or when you climb up the stairs. This clicking sound is referred to as crepitus. Sometimes, crepitus may occur even if you do not feel any pain. Do not worry as this is entirely normal and it occurs to everyone every now and then. However, for the clicking sounds that occur along with pain, these are the following causes:

Patellofemoral pain syndrome (PFS)

PFS causes a clicking sound along with pain behind your kneecap, especially when there is a sudden increase in activity level. In severe cases, it could cause painful grating when you move your knee.

Osteoarthritis

This is a condition when the cartilage degenerates, leaving the bones unprotected and potentially resulting in inflammation. When the bones rub against one another, the lack of lubrication causes pain and stiffness, and occasionally crepitus.

Cartilage Tear

  • Meniscal tear
  • Chondromalacia patella

For more information or if you require a medical consultation, please contact The Orthopaedic & Pain Practice at +65 9898 3595, or visit us at Novena Specialist Center, #06-08, 16, 17, 18, 19, Novena, Singapore, Singapore, 307470.

 

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Sarah Taylor

Obstetrics & Gynaecology