Stephen Brown, M.D ., Orthopaedic surgeon with the Alegent Health Orthopaedic Institute
Find out more about Dr. Brown
Q: I had surgery on my right knee in 1977 to remove a piece of cartilage. I was very active in college sports and use to run and lift weights. Recently, the knee is making a "grinding" noise under the knee cap and it is painful when I bend it or walk up and down stairs. Could this be chondromalacia? How should I treat the knee?
A: Chondromalacia, or as it is often called, chondromalacia patellae, is related to softening of the cartilage of the kneecap.
Symptoms of chondromalacia include:
- a dull pain around or under the kneecap that worsens when walking down stairs or hills
- pain when climbing stairs or during other activities when the knee bears weight as it is straightened
- Some individuals notice a clicking and/or grinding noise in the knee
Chondromalacia may be caused by trauma, overuse, parts out of alignment, or muscle weakness, and is often found in young people and is one of the most common causes of knee pain in runners. Cases are also seen with soccer players, skiers and cyclists.
Chondromalacia occurs when the kneecap rubs against the lower end of the thigh bone instead of moving smoothly across it. The effect is a roughening of the cartilage underneath the kneecap. The damage might result in only a slight abnormality of the surface of the cartilage to a situation where the cartilage surface has been worn completely to the bone.
Traumatic chondromalacia happens when an injury to the kneecap tears off either a small piece of articular cartilage or a large fragment containing a piece of bone.
Patients with chondromalacia should strengthen muscles, specifically the inner portion of the quadriceps through low-impact exercises such as swimming, or other exercises that do not require the knee to bend more than 90 degrees. If the condition fails to improve, arthroscopic surgery may be required to smooth the surface of the articular cartilage and remove cartilage fragments that interfere with the joint during bending and straightening.
If your knee fails to respond to an exercise program, then you should consider seeing your primary care physician or an orthopaedic surgeon.
