Chondromalacia Patella

By Chloe Wilson, BSc(Hons) Physiotherapy

Find out all about the common causes, symptoms, diagnosis and treatment options for Chondromalacia Patella of the Knee

Chondromalacia patella is a common knee condition where there is softening and damage to the cartilage on the back of the patella (kneecap). 

Chondromalacia causes front knee pain, swelling and clicking/grinding noises when moving the knee.

It tends to affect young, healthy and often sporty people, most commonly affecting adolescents and young adults. It is more common in women than men.

Chondromalacia patella is frequently misdiagnosed as Runners Knee, which is actually a problem with how the kneecap moves rather than the cartilage itself.

Here we will look at the most common causes and symptoms of chondromalacia as well as the best ways to treat it and the recovery process.

Why Do We Have Kneecaps?

To fully understand Chondromalacia Patellae we first need to understand a bit about the kneecap (patella) and how it works. 

Chondromalacia Patella occurs when there is softening and damage to the cartilage lining the back of the kneecap.

The patella is a small, triangular shaped bone that sits inside the quads muscles at the front of the thigh.

It rests in a special groove (patella groove) on the front of the thigh bone (femur) where it moves up and down as you move your leg.

The patella is lined with the thickest cartilage in the whole body which:
1) ensures the patella glides smoothly over the knee bones
2) works as a shock absorber

Not only does the patella help to protect the knee joint, it also helps the quads muscles work more effectively, by reducing the amount of force needed to move the knee.

Causes of Chondromalacia Patella

Chondromalacia patella occurs when the kneecap rubs against the edge of the patella groove rather than gliding smoothly in the middle of the groove. This causes small tears in the cartilage which get inflamed and cause pain. There are a number of reasons for this:

1) Muscle Imbalance

Muscles work in pairs. To move a joint, one muscle contracts (agonist) while the other relaxes (antagonist). If the strength and length of the agonist and antagonist aren't balanced, then movement is affected.

Chondromalacia Patella is a condition where the is softening and degeneration of the cartilage that lines the kneecap

In chondromalacia patella, a combination of muscle tightness, in the quads muscles and outer knee structures e.g. the retinaculum, and muscle weakness, on the inside of the knee (VMO), affects the position of the kneecap in the patella groove.

When this happens, the kneecap, instead of gliding easily up and down the centre of the groove, is pulled slightly to the side. As a result, when the kneecap moves, it rubs on the edge of the patella groove, resulting in a lot of friction which ends up damaging the cartilage.

This is also known as patella maltracking. The good news is that it can easily be fixed with the right exercises.

2) Poor Alignment of the Kneecap

For some people, their patella doesn’t sit in the right position, but rests either too high or too low. Some people are born this way, but it doesn’t become apparent until adolescence.

3) Overuse of the Leg

Any activities that place strong, repetitive forces through the kneecaps, e.g. running, jumping, twisting, can damage the back of the cartilage leading to chondromalacia.

4) Flat Feet

Having flat feet is a another common cause of chondromalacia patella. When the foot arches drop, as with flat feet, it changes the way the forces are distributed through the knee as we walk and run which makes the cartilage more prone to damage.

Chondromalacia Patellae Symptoms

The most common symptoms associated with Chondromalacia Patella are:

1) Front Knee Pain: tends to be achy rather than sharp 

2) Grinding/Grating Sensation: when moving the leg, known as crepitus

3) Minor Swelling: usually around the patella

4) Tenderness: with any pressure through the kneecap

5) Pain On Stairs: tends to worse going downstairs rather than upstairs

6) Pain After Prolonged Rest: when you first get up after sitting down for a while

How is Chondromalacia Diagnosed?

Your doctor will normally diagnose patella chondromalacia from your description of symptoms and by carrying out some simple tests. 

Skyline view showing the back of the patella

These may include looking at the movement of the knee, and putting pressure through the knee cap

Standard x-rays don’t usually show up the problem, although a “skyline view x-ray” taken from the side of the leg can be used to see the back of the kneecap.

MRI scans are occasionally used to confirm the diagnosis.

Treatment Options

To treat chondromalacia patellae it is vital to discover what is causing the problem in the first place, so your doctor should refer you to a physiotherapist who will look more closely at your leg muscles.  Treatment may include:

1) Knee Exercises

Kneecap exercises and stretches can really help with chondromalacia as well as general strengthening exercises.

They all help to combat any muscle imbalance and improve how the kneecap moves, which takes the pressure off the kneecap. I have never known anyone with chondromalacia patella who has not had muscle imbalance.

Knee straps can help reduce the pain associated with Chondromalacia Patella

2) Knee Brace Straps

They might not look like much but wearing a strap directly under the kneecap helps take pressure off the joint, which can dramatically reduce knee pain.

They are simple to use and very effective. Visit the knee strap section to find the best strap for you.

3) PRICE

Protect, Rest, Ice, Compress, Elevate is one of the simplest and underused treatments for chondromalacia. It helps reduce pain and swelling and can speed up recovery.

Visit the PRICE section to find out how to use it safely and effectively.

4) Ice

Using ice regularly and before and after activity can help reduce swelling and pain associated with chondromalacia.

5) Shoe Inserts

If are suffering from chondromalacia and you have flat feet, then wearing insoles known as orthotics can really help. They simply slip into your shoe and help to correct alignment by supporting the foot arches which helps to reduce the force through the kneecap.

If you are going to use shoe inserts, make sure you wear them in both shoes otherwise you end up with one leg slightly longer than the other which can lead to back and hip problems. You should also start by only wearing them for short periods and gradually build up to allow your body to adjust.

Medication can help reduce the pain and swelling associated with chondromalacia patella

6) Medication

Non-steroidal anti-inflammatories (NSAID’s) such as ibuprofen will help to relieve the inflammation and pain associated with chondromalacia. Always check with your doctor before taking any medication.

7) Taping

Taping around the knee can help to realign the patella and take the pressure off the kneecap. This is particularly useful for when you are playing sports.

Initially, I would recommend a physical therapist applies the tape, but once they have found the best taping technique for you, they can teach you how to do it yourself. 

8) Modifying your Activity

An important part of Chondromalacia Patella treatment is to try and avoid the activities that placing pressure through the kneecap.

Limit running and instead try swimming or cycling. If you want to run, ensure you are wearing good shoes with cushioned shoes, and stay off hard surfaces e.g. concrete.

9) Knee Pads

Gel Pads are an excellent way to reduce kneecap pain and irritation when you are kneeling. They take the pressure off the back of the kneecap and provide cushioning.

There are loads of different options out there, some more effective than others. Visit the gel knee pads section to find the best one for you.

10) Surgery

Surgery for chondromalacia patella is only considered if nothing else works and the pain is really affecting your daily life.

Most commonly it will be a knee arthroscopy, keyhole surgery where they make 2-3 small holes around the knee and insert a camera. The surgeon cuts any tight ligaments to allow the patella to sit in the right place in the groove and/or shave off any damaged bits of cartilage so the kneecap can move correctly.

Recovery Process

Chondromalacia Patellae usually settles down with medication and exercises but it is likely to take a few months.

The sooner you get going with exercises, the sooner it will get better. Check out the strengthening exercises and stretches sections for exercises you can do at home to help. Surgery is rarely necessary.

Common Misdiagnosis

Front knee pain is commonly misdiagnosed as chondromalacia patellae when it isn’t. Another common cause of similar pain is Runners Knee (aka Anterior Knee Pain or Patellofemoral Pain).

While the symptoms can be similar, there is not the softening and damage to the cartilage that is characteristic of chondromalacia. Treatment is however similar for both conditions. 

If chondromalacia patella doesn't sound quite like your problem, visit the knee pain diagnosis section for help working out what your problem is and what you can do about it.  

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Page Last Updated: 19/9/18
Next Review Due: 19/9/20


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