Chondromalacia patellae, also known as chondromalacia patellae and chondromalacia patellae, is one of the common causes of anterior knee pain.
It is a degenerative disease caused by injury to the articular cartilage of the cartilaginous surface of the patella and its relative patellar surface of the femur, and is characterized by knee discomfort, pain behind the patella, vague pain on the medial side of the knee, increased pain when moving, followed by a feeling of friction between the patellae and pressure pain in the patella. Wang Hongwei, Department of Orthopedic Surgery, The Third Affiliated Hospital of Xinxiang Medical College, Tang Hengtao, Department of Orthopedics, First Affiliated Hospital of Zhengzhou University
Causes of chondromalacia patellae
Patellar chondromalacia is an osteoarthrosis of the patellofemoral joint formed when the cartilage surface of the patella is swollen, cracked, broken, eroded and dislodged due to chronic injury, and finally the cartilage of the femoral condyle opposite to it also undergoes the same pathological changes.
1. Congenital abnormal patellofemoral development.
2. Long-term wear and tear of the knee joint is a common cause of this disease.
3. Abnormalities in the synovial fluid composition of the joint due to various causes.
Main symptoms: I. It is common in young athletes, initially pain under the patella, relieved after a little activity, then aggravated after too much exercise, and gradually disappears after rest. Second, pressure pain at the edge of the patella, squeezing or pushing the patella in the extended knee position can have a rubbing sensation, accompanied by pain. When patellofemoral joint osteoarthrosis is formed later, synovitis and joint effusion may occur. If the disease is of long duration, quadriceps atrophy may occur. The diagnosis of chondromalacia patella is mainly based on post-patellar pain, which is caused by the patellar compression and grinding test and the single-leg squat test. X-ray examination: frontal, lateral and tangential X-ray of the knee joint, no abnormalities in the early stage, but in the late stage, the gap between the patella and the femoral condyle may be narrowed due to extensive cartilage wear, and there may be osteophytes at the edge of the patella and femoral condyle. Treatment: Non-surgical treatment: braking, physiotherapy, anti-inflammatory, patellar chondromalacia patch, joint cavity closure, etc. If strict non-surgical treatment is ineffective or there is congenital deformity, surgical treatment is feasible.
Why does chondromalacia patella occur
1, congenital patellar developmental disorder, abnormal position and femoral condyles large and small abnormalities, acquired knee joint internal and external rotation deformity, etc., can make the patella unstable, in the sliding process patellofemoral joint surface compressive stress concentrated in a certain point, become the basis of chronic injury.
2, long-term, forceful, rapid flexion and extension of the knee joint, increasing the wear and tear of the patellofemoral joint, such as the training of cyclists and skaters, is a common cause of this disease.
3, the patellar cartilage nutrition mainly from the synovial fluid, various causes of synovial fluid composition abnormalities, can make the patellar cartilage malnutrition, vulnerable to minor injuries and degenerative changes
What are the clinical manifestations and signs and symptoms of chondromalacia patellae?
Clinical manifestations
Direct trauma to the knee can cause fracture of patellar cartilage or osteochondral bone, or multiple injuries, such as sports injuries, can cause degenerative changes to the cartilage.
In severe cases, the cartilage is lost and the bone is exposed, and the femoral articular surface is also damaged. The injury site is mostly in the center of the patella. The main symptom is post-patellar pain in the knee joint, which varies in severity, and is generally not apparent when walking on level ground, but increases after squatting, going up and down stairs, going up and down slopes, or walking long distances.
Symptoms and signs
1, more common in young athletes. Initially, the pain under the patella is obvious at the beginning of training, relieved after a little activity, aggravated by prolonged training and gradually disappears after rest, with the prolongation of the disease, the pain lasts longer than it relieves, so that it cannot squat, has difficulty going up and down steps or suddenly falls down without strength.
2, patella edge pressure pain. When the patella is squeezed or pushed in the extended knee position, there is a feeling of friction and pain, and when the patellar cartilage is damaged, there is no joint effusion. In cases of long duration, there is quadriceps muscle atrophy.
Diagnosis and examination
1.X-ray film is not abnormal in the early stage, but in the late stage, it can be seen that the patellar semicircular redundancy affects the patellofemoral joint surface is not smooth or the gap is narrowed, and the X-ray film can still find some causes, such as small patella, high patella or femoral epicondyle low level deformity.
2, radionuclide bone imaging examination, lateral position shows the patella limited radioactive concentration, has early diagnostic significance.
3.Arthroscopy (some treatment can be performed at the same time, but it is expensive, about 3000 RMB)
Arthroscopy is the most valuable method to confirm the diagnosis of chondromalacia patellae. It can clarify whether there is a lesion in the articular cartilage and the extent of involvement, and the degree of patellar chondromalacia, and can better differentiate it from diseases characterized by anterior knee pain, especially in difficult patients.
4, Magnetic resonance imaging (MRI), also has early diagnostic significance.
Treatment options
Non-surgical treatment
1. After the onset of symptoms, the knee joint is first braked for 1-2 weeks, while quadriceps resistance exercises are performed to increase the stability of the knee joint.
2. When swelling and pain suddenly increase, cold compresses should be applied, and after 48 hours, wet heat and physical therapy should be used instead.
3.Anti-inflammatory drug “Aminoglycoside” contains glucosamine, which helps synthesis of protein mucopolysaccharide in cartilage. 0.2-0.4g orally, twice daily, can not only relieve pain, but also help cartilage repair.
4, intra-articular injection of sodium vitreous acid (sodium hyaluronate) can regulate the viscosity and lubrication of joint fluid, protect joint cartilage, promote the healing and regeneration of joint cartilage, relieve pain and increase joint mobility. Usually 2ml is injected once a week for 4-5 times as a course of treatment.
5, intra-articular injection of prednisolone acetate can relieve symptoms, but it should be used with caution because it inhibits the synthesis of glycoprotein and collagen, which is detrimental to cartilage repair.
6.Strictly non-manipulative treatment is ineffective, or those with congenital deformity can be treated surgically.
The purpose of surgery
(1) To increase the stability of the patellofemoral joint in the course of activity, such as lateral capsular release, femoral epicondyle padding, etc.
(2) To scrape away smaller eroded lesions on the patellofemoral articular cartilage to promote repair.
(3) For those whose patellofemoral articular cartilage has been completely destroyed, patellar resection is useful to reduce the development of patellofemoral osteoarthropathy, but the knee joint is obviously weak after surgery, making it difficult to continue its athletic career.
Daily attention
1.Activate the joint before exercise
Fully moving the joint before exercise can make all parts of the patellofemoral joint surface stimulated, and the synovial fluid nutrients can evenly penetrate into the cartilage tissue to enhance the lubrication of the joint.
2, avoid strenuous exercise
Avoid continuous squatting and strenuous exercise, such as climbing mountains, stairs and other knee flexion exercise. Avoid sudden changes in the intensity of exercise, and activities to increase strength and endurance should be gradual and increase gradually.
3. Maintain proper body weight
Appropriate weight can reduce the gravitational force on the knee joint, while obesity will increase the risk of degenerative diseases of the knee joint, forming a vicious circle, the greater the weight, the heavier the pain; conversely, the lighter the weight, the lighter the pain.
4.Supplement cartilage nutrition
Eat more food containing vitamins and proteins, such as fruits, vegetables, meat, seafood, etc.
5.Pay attention to keep warm and cold
During the cold season, keep the joints warm to prevent wind and cold invasion.
6, timely treatment
When there is discomfort or unlocalized pain in the knee joint, consider the possibility of early chondromalacia patellae, and take timely rest and timely treatment to prevent aggravation of joint cartilage degeneration.
Chondromalacia patella prevention
Avoid long-term, forceful, rapid flexion and extension movements.
The occurrence of chondromalacia patella has both intrinsic and extrinsic factors for middle-aged and elderly people. The intrinsic factor is the degeneration of the articular cartilage itself, which is related to age and other factors. The extrinsic factor is the chronic damage to the articular cartilage caused by mechanical factors. Prevention of chondromalacia patellae is mainly from reducing the continuous pressure on the patellofemoral joint and improving the nutrition of the cartilage.
1, active full joint movement. To be carried out under non-weight-bearing conditions. Such as lying in bed actively extend and flex the knee joint. Insist on 10 minutes once a day, once in the morning and once in the evening. Adequate movement of the joint can make all parts of the patellofemoral joint surface are stimulated, synovial fluid nutrients can evenly penetrate into the cartilage tissue, and can enhance the lubrication of the joint.
2, to prevent continuous pressure on the patellofemoral articular surface. The patella is under greater pressure in the flexed knee position, which can easily damage the joint surface. To avoid continuous squatting pressure on the patellofemoral articular surface.
3, cast fixation or lower limb traction treatment. When the quadriceps muscle is contracted, it can drive the patella up and down, which is conducive to the nutritional penetration of the cartilage and reduces the continuous pressure on the patellofemoral articular surface.
4, when the knee joint discomfort or non-localized pain. To consider the possibility of early patellar chondromalacia, timely rest and timely treatment to prevent aggravation of articular cartilage degeneration.