Chondromalacia patellae is an osteoarthrosis of the patellofemoral joint that occurs when the cartilage surface of the patella is swollen, cracked, broken, eroded, and dislodged due to chronic injury, and eventually the corresponding cartilage of the femoral condyle also undergoes the same pathological changes.
What causes chondromalacia patellae
1, congenital patellar developmental disorders, position abnormalities and femoral condyles large and small abnormalities; or acquired knee joint internal and external rotation, tibial external rotation deformity, etc., can make the patella unstable and become the basis of chronic injury.
2, long-term, rapid, forceful flexion and extension of the knee joint, increasing the wear and tear of the patellofemoral joint, is a common cause of this disease.
3, various causes of synovial fluid composition abnormalities, can make the patellar cartilage malnutrition, vulnerable to minor injuries and degenerative changes.
What are the symptoms of chondromalacia patellae?
1, young athletes are common, the initial pain under the patella, slightly relieved after activity, and aggravated after too long exercise, gradually disappeared after rest. With the prolongation of the disease, the pain time is more than the relief time, resulting in the inability to squat, difficulty in going up and down the ladder or sudden weakness and fall.
2, 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 the patellar cartilage is damaged alone, there is no joint effusion, but when osteoarthrosis of the patellofemoral joint is formed later, synovitis may occur and joint effusion may appear. If the disease is of long duration, quadriceps atrophy may occur.
What tests are needed for chondromalacia patellae
1, patellar compression and grinding test: check the patella and its relative femoral intercondylar joint surface extrusion grinding or up and down sliding, there is a rough grinding feeling, grinding sound and pain discomfort; or the inspector force one hand to push the patella to one side, the other hand thumb press the patella edge behind can cause pain. The floating patella test can be positive when there is joint cavity effusion.
2, single-leg squat test: the patient holds the weight on one leg and gradually squats to 90° to 135° with pain, tenderness, and cannot stand up on one leg after squatting.
3. 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 narrow due to wear of the cartilage, and there may be osteophytes at the edge of the patella and the femoral condyle.
Radionuclide bone imaging shows limited radioactive concentration of the patella in the lateral position, which has early diagnostic significance. The main basis for the diagnosis of chondromalacia patella is post-patellar pain, which is caused by the patellar compression-abrasion test and the single-leg squat test. Attention should be paid to check for combined meniscal injury and traumatic arthritis.
Treatment is based on non-surgical treatment
1, after the appearance of symptoms first brake the knee joint for one to two weeks, and at the same time carry out quadriceps resistance exercise to increase the stability of the knee joint.
2. Cold compresses should be applied when the swelling and pain suddenly increase, and after 48 hours, wet heat and physical therapy should be used instead.
3. The anti-inflammatory drug aminoglycoside should be applied in moderation, both for pain relief and for cartilage repair.
4.Intra-articular injection of sodium vitrate can increase the viscosity and lubricating function of joint fluid, relieve pain and increase joint mobility.
5.Although joint cavity closure can relieve symptoms, it is not good for cartilage repair and should be used with caution.
6.Surgical treatment is feasible for those whose strict non-surgical treatment is ineffective or who have congenital deformity.
Surgical objectives.
1.Increase the stability of the patella during joint activity.
2, scrape away the smaller erosion lesions on the patellofemoral articular cartilage to promote repair.
3, patellofemoral articular cartilage has been completely destroyed useful patellar resection method to reduce the development of patellofemoral joint osteoarthropathy, but the postoperative knee joint is obviously weak, difficult to engage in heavy physical labor.
The patellar cartilage is only 0.4 centimeters thick and is usually the cushion between the patella and the femur. When we run, climb stairs or climb mountains, the load on the knee is several times heavier than usual, and if the thigh muscles are not strong enough, the patellar cartilage will easily wear out.
Knee pain caused by softening and injury of the patellar cartilage is especially common in women, who usually walk and move as normal, but when they need to go up and down stairs or bend and get up, their knees start to hurt.
To have a healthy knee joint and to avoid chondromalacia patellae and worsening of symptoms, the first and foremost task is to strengthen the thigh muscles by following the instructions of exercises, such as leg lifts with the back on the ground, swimming and cycling (the seat cushion should be adjusted higher), which are all good exercises, but be careful not to bend the knee more than 90 degrees.
In daily life, patients with chondromalacia patellae and injuries should avoid squatting, kneeling, running, jumping, lifting heavy objects, etc. When sitting or standing, it is best to straighten the feet to reduce the pressure inside the knee, and when getting up, it is best to hold the handrail to share the force on the knee.
According to statistics, women who wear high heels and often climb up the stairs have a knee joint that is three times more stressful than their body weight, which can increase seven to nine times when wearing high heels down the stairs. For female patients with patellar cartilage injuries, choosing a pair of flat, comfortable shoes will help protect the injured cartilage from pain.