K

(Anterior) Knee Pain (Chondromalacia)

This term is most often associated with the knee, but can also be associated with any joint that has articular cartilage. "Chondromalacia" is a Latin word meaning "cartilage softening" . "Chondromalacia" is a surgical determination, not a clinical one. Two common types of cartilage are: hyaline/articular and fibrocartilage. The former is a glistening, near friction-free surface that covers the ends of bones, allowing for smooth movement. The latter is a tougher type of cartilage, like the meniscus of the knee, which helps in stabilizing the joint. Chondromalacia is graded from I to IV, the latter implicating "bone on bone" wearing. A recent study (1) proved that one can have as much as a Grade III wearing without pain. So, pain is variable. The source of chondromalacia pain (2) is not the articular cartilage itself, but the thinning of it, which transfers loads onto the underlying subchondral bone, which is pain-sensitive.

Patello-Femoral pain is the most common of knee problems. This involves the joint between the knee cap(patella) and the thigh bone(femur). It is chronic, but usually only episodically painful. There is often no one trauma associated with it, just a sense of discomfort with fluctuations of pain over time. It is often associated with sub-optimal biomechanics around the knee cap and lower limb, but not always. When biomechanics are good, but there is PF pain, this may be due to a predisposition towards soft articular cartilage, which is poorly understood. Direct trauma to the knee cap can instigate PF pain and softening of the cartilage over time. Biomechanics are unalterable conservatively, but can be influenced by selective muscle stretching and strengthening exercises around the knee, pelvis, hip and foot. This helps to reduce the abnormal vector forces influencing the patella.
PF Pain is characterized by a poorly localized, deep aching under the patella, which often refers towards the front and inner aspects of the knee. Aggravating factors are: prolonged sitting, descending/ascending stairs or hills, and squatting. There is only rarely very mild swelling.
The treatment of PF Pain is conservative. This means seeking the advice of a Physical Therapist who will identify selective exercises to optimize lower limb mechanics. McConnell PF taping may also be indicated. Occasionally, modalities such as Ultrasound and Biofeedback may be helpful. The prescribed exercises are a life-long commitment, like brushing your teeth.
If conservative care of PF Pain fails, and the pain is significant, then the advice of a surgeon should be sought. But surgery is the last resort.
Other conditions such as patellar subluxation(partial dislocation) or dislocation often cause PF pain.