What is the best treatment for chondromalacia patellae? What are the treatment methods? Chondromalacia patellae, also known as chondromalacia patellae and chondromalacia patellae, is a common disease of the knee joint, occurring in young adults, especially in athletes and sports enthusiasts, with a higher incidence in women than in men. The main pathological changes are degenerative changes in the cartilage, including swelling, fragmentation, and loss of cartilage, and eventually the same lesions occur in the corresponding parts of the femoral condyles and develop into osteoarthritis of the patellofemoral joint. There are many etiological theories about the disease: 1. Biomechanical factors (1) Trauma theory Among the causative factors of chondromalacia patellae, the trauma theory is gradually recognized, including direct trauma, indirect trauma and various physical stresses that repeatedly act beyond the physiological range of articular cartilage, resulting in the destruction of the “thin shell structure” and “arch structure” of articular cartilage. The destruction of the “thin shell structure” and “arch structure” of the articular cartilage, the loss of chondrocyte protection and necrosis, and the reduction of cartilage matrix synthesis, lead to progressive destruction of articular cartilage. (2) Patellar instability theory refers to high patella, low patella, patellar tilt, patellar subluxation or dislocation. Patellar instability can cause increased pressure and abnormal distribution on the patellofemoral articular surface, resulting in cartilage damage. (3) Patellofemoral pressure doctrine Advances in patellofemoral joint biomechanics research have led to a different understanding of the relationship between patellofemoral pressure and chondromalacia patellae. The effect of contact high pressure on chondromalacia patellae is emphasized. However, it is difficult to explain the clinical phenomenon that the medial deviated surface of the patella is a high incidence area of chondromalacia patellae with the doctrine of excessive pressure. 2, biochemical factors (1) autoimmune theory of articular cartilage surface can prevent anti-collagen antibodies to enter the deep cartilage tissue and have a protective effect on it. (2) Cartilage nutritional disorders various injury-causing factors (especially mechanical stimulation) cause abnormal changes in the secretion of joint fluid and its components (such as enzyme activity, content of various nutrients, osmotic pressure of joint fluid, etc.), which affect the normal nutritional and physiological biochemical processes of patellar cartilage and contribute to the development of cartilage degeneration. (3) The theory of chondrolysis says that the osmotic pressure of the synovial membrane changes after injury, and the enzymes in the plasma enter the synovial fluid with increased activity, which in turn dissolves the cartilage. Chondromalacia patella is the result of a combination of factors, various factors causing pressure changes in the patellofemoral joint is the external cause, autoimmune reaction, cartilage nutritional disorders are the internal cause of chondromalacia patella. Clinical manifestations of direct trauma to the knee can cause fracture of patellar cartilage or osteochondral bone, or due to multiple injuries, such as sports injuries, causing degenerative changes to the cartilage, roughness of the cartilage surface, loss of luster, and in severe cases, the cartilage falls off, the bone is exposed, and its relative 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, but the pain increases after squatting and standing, going up and down stairs, going up and down slopes, or walking long distances. How to treat chondromalacia patellae? What are the treatment methods? The treatment of this disease includes non-surgical treatment and surgical treatment 1, conservative therapy Conservative therapy is the basic and main treatment for this disease, and the following measures are commonly used. (1) Quadriceps exercises are the most common and effective method to prevent and treat chondromalacia patellae. By strengthening the quadriceps, the stability of the joint can be increased, the stress distribution of the patellofemoral joint can be improved, and the fall or accidental injury caused by knee pain and tenderness can be prevented. Commonly used methods such as standing stance, usually against a wall to avoid the painful angle of the stance. Active straight leg raises or weighted straight leg raises can also be done. (2) Patellofemoral adhesive band or brace as an important means of conservative treatment, sports trauma doctors often recommend those patients who do not want to operate to use patellar adhesive band or patellar brace to change the movement trajectory and contact mechanics of the patella to achieve the purpose of pain relief and disease treatment. (3) Intra-articular injections of tretinoin acetate or Coninox pain injection are used once a week, with good short-term effects, and can only be temporarily applied to athletes who need to participate in competition. For cases of chondromalacia patella where conservative treatment is ineffective and the symptoms are severe, surgical treatment can be considered. (1) Limited cartilage resection with drilling is the basic procedure that is still commonly used. An arthroscopic or anterior medial or anterior lateral patellar incision is used to expose the degenerated cartilage, expose the subchondral bone plate, and drill several holes with a 1 to 2 mm drill. The purpose of this procedure is to fill the defective cartilage with fibrous granulation tissue from the bone and eventually transform it into fibrocartilage. The drilling also releases the intraosseous pressure and provides pain relief. (2) Patellar realignment surgery includes proximal and distal realignments. Proximal realignment procedures include lateral support band release (cutting the transverse patellofemoral ligament, the infrapatellar oblique bundle, and part of the lateral femoral tendon) and quadriceps medial head externalization (fixed to the middle of the dorsal surface of the patella). The main distal realignment procedures are tibial tuberosity elevation, or elevation followed by internal displacement. (3) Patellar osteotomy can relieve intraosseous hypertension and relieve pain, while at the same time adjusting the patellofemoral joint surface to make it more compatible with contact. (4) Artificial joint replacement can be considered for patients with severe patellofemoral osteoarthritis, which can be treated with patellofemoral joint artificial surface prosthesis.