Chondromalacia patella is a common cause of kneecap pain or anterior knee pain. Often called "Runner's Knee," this condition often affects young, otherwise healthy athletes.

Chondromalacia is due to an irritation of the undersurface of the kneecap. The undersurface of the kneecap, or patella, is covered with a layer of smooth cartilage. This cartilage normally glides effortlessly across the knee during bending of the joint. However, in some individuals, the kneecap tends to rub against one side of the knee joint, and the cartilage surface become irritated, and knee pain is the result.

Chondromalacia is due to changes of the deepest layers of cartilage, causing blistering of the surface cartilage. The pattern of cartilage damage seen with chondromalacia is distinct from the degeneration seen in arthritis, and the damage from chondromalacia is thought to be capable of repair, unlike that seen with arthritis.

Chondromalacia is interesting in that it often strikes young, otherwise healthy, athletic individuals. Women are more commonly affected with chondromalacia. Exactly why this is the case is unknown, but it is thought to have to do with anatomical differences between men and women, in which women experience increased lateral forces on the patella.

The treatment of chondromalacia remains controversial, but most individuals can undergo effective treatment by resting the knee and adhering to a proper physical therapy program. Allowing the inflammation of chondromalacia to settle is the first step of treatment. Avoiding painful activities that irritate the knee for several weeks, followed by a gradual return to activity is important. In this time, cross-training activities, such as swimming, can allow an athlete to maintain their fitness while resting the knee. The next step in treatment is a physical therapy program that should emphasize strengthening and flexibility of the quadriceps and hamstring muscle groups. Use of nonsteroidal anti-inflammatory medication is also helpful to minimize the pain associated with chondromalacia. Treatment with surgery is declining in popularity for two reasons: good outcomes without surgery, and the small number of patients who actually benefit from surgical treatment.

Is surgery necessary for chondromalacia?
Sometimes chondromalacia is not cured by conservative therapy, and it may be determined that surgery is needed for definitive treatment. By looking into the knee with an arthroscope, the surgeon can assess the damage done to the cartilage. He or she can also assess the mechanics of the joint to ascertain if there is an anatomic misalignment that could be corrected.

One common misalignment is due to abnormal tracking of the patella (tracking is simply the movement of the patella as the knee moves) caused by tight tissue on the outside (lateral) of the kneecap. For this problem, a procedure known as a lateral release can be performed. The lateral release involves cutting the tight lateral ligaments to allow for normal position and tracking of the patella. If this is not sufficient to correct the misalignment there is more extensive surgery that can be performed.