Chondromalacia is the process of gradual damage to the cartilage surface of a joint. Chondro - means cartilage, paints - softening. Chondromalcia is not only a disturbance of the mechanical properties of cartilage, but also a disturbance of its structure - cracks and cavities, reaching even the subcartilage layer, i.e. bones.

Patellar chondromalacia directly affects the cartilage located on the inner articular surface of the patella. Although a similar problem also appears on the corresponding articular surface of the femur in the so-called intercondylar sulcus. Almost 80% of patients who report knee pain locate it in the area of ​​the kneecap.

In the past, pain in the anterior knee was directly associated with chondromalacia. We currently know that chondromalacia in the initial stage does not have to be associated with pain, and moreover, better diagnostics allows us to distinguish other causes of ailments in this area.

The causes of patellar chondromalacia are divided into 3 main groups. The first - traumatic or instability-related, which occurs when the kneecap is dislocated. This most often applies to children in the age group 12-16, because statistically this type of injury occurs most often.

The second group is chondromalacia resulting from the dysfunction of the patella. Most often they concern people who are physically inactive or with incorrect training habits, aged 20-30. The third group includes patients with degenerative cartilage damage.

Contents:

  1. Patellar chondromalacia - symptoms
  2. Patellar chondromalacia - imaging examination
  3. Patellar chondromalacia - non-invasive treatment
  4. Patellar chondromalacia - surgical treatment

Patellar chondromalacia - symptoms

Chondromlalacia may be asymptomatic in its early stages. When a patient reports to a doctor, the most common complaints are pain in the front part of the joint, which increases when climbing stairs or squats. A characteristic symptom is the "kinomancer symptom" the need to straighten the knee while sitting for a long time, for example in the theater, cinema or during a longer journey by car.

During the examination, the doctor will evaluate not only the patient's knee joints, but the entire limbs. Importantis not only to find chondromalacia of the patella, but to explain the possible causes of the disease. Therefore, it is important to assess the limb axis, muscle atrophy, bone rotation disorders or patellar instability. During the examination, the doctor will try to induce crepitations - this is the name of the characteristic "crunch", which can also occur when climbing stairs or squats.

A specific examination is the Zohlen test (symptom) - the patient is lying on his back, with the knee joint straightened. The examiner presses the kneecap to the thigh articular surface, while the patient, trying to further straighten the knee, tightens the quadriceps. Pain in the held patella while contracting the quadriceps muscle indicates chondromalacia of the patella.

Patellar chondromalacia - imaging examination

X-ray examination is still the basic examination in the diagnosis of diseases of the knee joint. It allows not only to exclude degenerative changes and dysplasia of the patellofemoral joint, but also to assess the position of the patella. In addition to the standard AP and BOK projections, you can take an axial photo of the patella, the so-called Merchant.

Ultrasound examination, although very common, does not allow to visualize the cartilage on the kneecap. Currently, the best test to assess chondromalacia is high-field magnetic resonance. It allows you to determine the degree and extent of chondromalacia. The examination should be performed with the use of the knee coil - it is a special clip placed on the knee in order to improve the image quality.

The assessment of cartilage is facilitated by a large number of sequences. Unfortunately, this has an impact on the length of the examination, which may take more than an hour.

The most common method of assessing the degree of chondromlation is the Outerbridge scale:

  • I Cartilage structure soft, bends under point pressure, superficial damage
  • II Fissures and cracks, damage up to 50% of the cartilage thickness
  • III Cartilage defects, damage over 50% of the cartilage thickness
  • IV Full thickness loss with exposed subcartilage layer

Patellar chondromalacia - non-invasive treatment

Treatment includes pharmacotherapy (non-steroidal anti-inflammatory drugs, drugs that improve metabolism of articular cartilage), modification of physical activity, weight loss (if necessary) and an individually tailored exercise and rehabilitation program.

It brings great results in as much as 85 percent! Rehabilitation involves changing the work of the muscles, re-educating the muscles of the lower limb. Exercises are aimed at increasing the activity of the medial head of the quadriceps, stretching the iliotibial band, the lateral head of the musclequadriceps as well as stabilizing the pelvis. It is worth trying kinesiotaping (dynamic taping) - patches applied in an appropriate way will change the path of the patella movement or reduce its support in the patellofemoral joint.

Additionally, the doctor may perform viscosupplementation, i.e. administration to the patellofemoral joint in the form of an injection of concentrated hyaluronic acid.

In the form of an injection, you can also administer plasma prepared from the patient's blood, platelet-rich anti-inflammatory protein and even stem cells. These are the latest methods with very promising results, although they still require long-term randomized trials to fully confirm their effectiveness and usefulness.

Patellar chondromalacia - surgical treatment

Surgical treatment should be used when changes in the structure of cartilage and the discomfort caused by them make it difficult for the patient to function in everyday life, and when conservative treatment has not brought any improvement. There are several operating methods:

  • arthroscopy - is the basic surgical procedure for chondromalacia of the patella. The procedure involves introducing two optical fibers containing a webcam and surgical micro-tools into the knee through small incisions. The procedure is performed under local anesthesia. It takes about 30 minutes. He returns home after the procedure. Usually the patella stabilizer is applied afterwards. The stitches are checked and removed after 2 weeks. The arthroscopy procedure does not change the regular way of life. After the procedure, children receive approx. 6-week leave from school activities
  • treatment with the microfraction technique - it is used for deeper cracks or cartilage defects
  • OATS autologous bone and cartilage transplant - involves taking a small piece of cartilage or cartilage cells from the patient and multiplying them for about 6-8 weeks until the amount of 10 to 12 million chondrocytes is obtained. During the next procedure, the area of ​​the defect is cleaned and a fragment of the periosteum is taken from the front surface of the tibial tuberosity, which is sewn like a lid over the cartilage defect. Then the cultured chondrocytes are injected under this "lid"
  • collagen membranes or scaffolds - these are biomaterials that constitute a kind of scaffolding for cells filling the cavities
  • plasty with periosteal flaps and marrow cells
According to an expertBow. Mateusz Janik, specialist in orthopedics and traumatology of the musculoskeletal system at the Carolina Medical Center

Arthroscopy is a procedure involving the insertion into the knee joint through two small incisions of the fiber with a camera and micro tools.The procedure is most often performed under spinal block anesthesia.

Arthroscopy allows for a precise assessment of cartilage damage and its repair. If the damage is not extensive and advanced, we can only work on the edges and remove free fragments of the so-called debrigment. In the case of larger cavities, we can make micro fractures, which allow for the formation of a godmother "scar" filling the damage and protecting the subcapular layer.

You can also cover the defect with special membranes or adhesives. Patellar defects related to instability and dislocation (in young people) require intervention and surgical treatment related to the change of the patella position.

You need to strengthen the medial patellofemoral ligament, which stabilizes the kneecap, or change the geometry of the joint, i.e. create a new furrow. This is where the kneecap glides. The third solution is bone dislocation, or osteotomy, where the position of the kneecap is changed in its path, that is, the mechanisms that cause it to dislocate. It is about changing the distribution of forces that destabilize the kneecap.

We must remember that the treatment of cartilage is a long-term process that requires the patient's involvement, but also the direct cooperation of the physiotherapist with the doctor. Each technique is associated with a different rehabilitation protocol.

The patient must be aware that despite numerous operational possibilities, we are not able to restore fully he althy cartilage from before the injury. Our goal is to reduce pain and slow down the degenerative processes of cartilage.

Therefore, it is very important to prevent chondromalacia. It has been known for a long time that prevention is better than treatment. It is worth not to neglect our joints by providing them with regular activity, remembering about the technique and not overloading.

Category:

Spine, bones, joints