I. Overview.
Chondromalacia patellae is also known as patellofemoral strain, chondromalacia patellae, chondromalacia patellae, etc. This disease is a degenerative degeneration of the patellofemoral joint cartilage, in the patellar cartilage surface degeneration at the same time, accompanied by degenerative degeneration of the cartilage surface of the femoral talus, is a more common disease of the knee joint.
The patellofemoral articular surface is covered by cartilage with a smooth surface and corresponds to the intercondylar notch articular surface of the femur to form the patellofemoral joint. When the knee is extended, the lower part of the patella is in gentle contact with the femoral condylar surface due to the relaxation of the quadriceps muscle; when the knee is flexed at 90°, the upper part of the patella is in contact with the femoral condylar surface; when the knee is fully flexed, the entire patellar surface is in close contact with the femoral condylar surface.
Chondromalacia patellae occurs in adolescents with high activity intensity, athletes, middle-aged obese women and the elderly. Repeated sprains, accumulated strain or long-term exposure to wind, cold and dampness can cause the disease. During long-term extension and flexion activities, the patellofemoral joint surface is repeatedly rubbed or bumped against each other under strong pressure due to weight-bearing, prolonged walking, twisting and other activity factors, resulting in the cartilage surface being worn and poorly nourished, resulting in degenerative changes. At this time, the cartilage surface has limited cartilage softening of the original fiber formation, lusterless, elasticity is weakened, and even the formation of cracking, defect and cause the disease. At the same time, the synovial membrane and fat pad are also involved and changes such as congestion, exudation and hypertrophy occur.
In addition, changes in the position of the joint, such as malalignment, high or low patella, and other abnormal stresses on the articular cartilage can accelerate the process of degeneration and softening of the articular cartilage.
Diagnosis
Chondromalacia patellae has a slow onset and is usually seen in middle-aged and elderly people with a history of knee strain or sprain. At the beginning of the disease, the knee feels vague pain or soreness, then the pain increases, and the symptoms worsen when going up and down stairs or after exertion, and decrease or disappear after rest. There is usually no obvious swelling in the knee, or limited swelling if there is fluid accumulation. Occasionally, there is a sensation of catching and a popping sound when walking. Knee movement is usually not significantly impaired.
There is pressure pain behind the patella on both sides, peripatellar crushing pain, and small to coarse friction sounds can be heard when the patella is pushed. The examiner pushes down on the patella and asks the patient to forcefully contract the quadriceps muscle, if it causes pain, it is a positive jerk patella test. If the quadriceps muscle is mildly atrophied, the affected knee may have deformities such as internal or external knee valgus and high or low patella.
In the early stage of X-ray examination, there is no change in the patella, but in the lateral or tangential view, we can see osteophytes on the edge of the patella, roughness and unevenness of the patellofemoral joint surface, sclerosis of the subchondral bone, and narrowing of the patellofemoral joint space. Knee arthroscopy is a valuable diagnostic tool that can not only detect lesions, but also clarify the breadth and depth of the lesions.
III. Treatment
1. After the onset of symptoms, the knee joint should be braked for 1-2 weeks and quadriceps resistance exercises should be performed to increase the stability of the knee joint.
2.
Intra-articular injection of sodium vitrate (sodium hyaluronate) can increase the viscosity and lubricating function of joint fluid, protect joint cartilage, promote 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.
3. oral glucosamine drugs, such as glucose, Vigor, etc., and topical ointment for blood circulation and blood stasis can be used.
4. Physiotherapy has certain efficacy, such as the choice of local heat-transfer therapy such as electrotherapy, magnetic therapy, ultra-short wave, etc., has certain effect.
5. If strictly non-manipulative treatment is ineffective, or those with congenital deformity can be treated surgically.
IV. Prevention
Strengthen joint protection and wear elastic knee pads.
Prevent continuous pressure on the patellofemoral joint surface. The patella is under greater pressure in the flexed knee position, which can easily damage the articular surface, so avoid continuous squatting pressure on the patellofemoral articular surface.
Avoid climbing mountains, stairs and other sports.