Cartilage is the smooth, tough tissue that caps the ends of the bones in your knee and lets them glide without friction. When that cartilage is damaged, whether from gradual wear or a sudden injury, the result can be pain, swelling and a knee that does not move as smoothly as it should. One of the most common forms is chondromalacia, a softening and breakdown of the cartilage on the underside of the kneecap. It is a frequent cause of pain at the front of the knee, especially in active people.

If you have knee pain that flares with activity or stairs, understanding the cartilage involved can help. The board-certified and fellowship-trained knee and sports medicine specialists at Resurgens Orthopaedics diagnose and treat chondromalacia and other knee cartilage injuries at locations across metro Atlanta.

Overview

• Knee Cartilage and How It Gets Injured
• What Is Chondromalacia?
• What Causes Chondromalacia?
• Chondromalacia Symptoms
• How Chondromalacia Is Diagnosed
• Chondromalacia and Cartilage Injury Treatment
• Schedule an Appointment for Knee Pain

Knee Cartilage and How It Gets Injured

The knee relies on a layer of smooth articular cartilage that covers the ends of the thighbone and shinbone and the underside of the kneecap. This cartilage lets the joint move easily and helps absorb stress. It can be damaged in two broad ways. The first is gradual wear, where repeated stress slowly softens and frays the cartilage over time, which is what happens in chondromalacia. The second is an acute injury where a fall, a twist or a direct blow chips or tears a piece of cartilage, sometimes called a chondral defect. Because cartilage has a limited ability to heal on its own, damage that is left unaddressed can worsen and, over time, contribute to arthritis.

What Is Chondromalacia?

Chondromalacia, often called chondromalacia patellae, is the softening and breakdown of the cartilage on the underside of the kneecap. The word itself comes from the Greek for cartilage softening. As the cartilage loses its smooth surface, the kneecap no longer glides cleanly over the groove in the thighbone, which can cause pain at the front of the knee. Because it is a common cause of anterior knee pain in active people, it is sometimes nicknamed runner's knee. That nickname is also used for patellofemoral pain syndrome, so the terms are related but not interchangeable: patellofemoral pain describes pain around the kneecap from any cause, while chondromalacia means the cartilage itself has softened or broken down. Chondromalacia is different from knee arthritis: it affects mainly the surface under the kneecap rather than the whole joint, and it often appears in younger, active adults, though it can progress toward patellofemoral arthritis over time.

What Causes Chondromalacia?

Chondromalacia usually develops when the kneecap does not track smoothly through its groove, putting uneven pressure on the cartilage. Common causes and risk factors include:

• Kneecap maltracking, where the patella tilts or shifts to one side instead of gliding straight
• Muscle imbalance or weakness in the thigh and hip muscles that help control the kneecap
• Overuse from activities that load the knee, such as running, jumping, squatting or stair climbing
• A previous kneecap injury or dislocation
• Differences in leg alignment or foot mechanics, such as flat feet, that change how the knee loads

Chondromalacia is more common in women, which is often linked to differences in the angle at which the thigh meets the knee. Often, a mix of alignment and overuse is at work, which is why treatment usually addresses both.

Chondromalacia Symptoms

The main symptom is a dull ache at the front of the knee, around or behind the kneecap. Symptoms tend to build gradually and flare with certain activities. Common signs include:

• A dull, aching pain around or behind the kneecap
• Pain that worsens with stairs, squatting, kneeling or running
• Pain after sitting for a long time with the knee bent, sometimes called theater sign
• A grinding, crackling or popping sensation when bending or straightening the knee
• Occasional swelling or a feeling of tightness in the knee
• In some cases, a sense that the knee catches or gives way during movement

Please Note: Front-of-knee pain has several possible causes, and the right treatment depends on which one it is. If knee pain does not improve with rest or keeps returning, a knee specialist can identify what is behind it and help you avoid further cartilage wear.

How Chondromalacia Is Diagnosed

A knee specialist can usually identify chondromalacia with a physical examination. Your physician will ask about your symptoms and activities, check how the kneecap tracks and moves, including its side-to-side mobility, and feel for tenderness and grinding around the kneecap. An X-ray can show how the kneecap sits in its groove and rule out other problems. When more detail is needed, an MRI can show the cartilage itself and how much it is affected, which also helps tell chondromalacia apart from patellofemoral pain syndrome and other causes of knee pain.

Chondromalacia and Cartilage Injury Treatment

Most cases of chondromalacia improve with non-surgical care that calms symptoms and corrects the underlying mechanics. Surgery is reserved for cartilage damage that does not respond to conservative treatment.

Non-Surgical Treatment

Conservative care is almost always the first step:

• Activity changes to reduce the load on the kneecap while staying active with low-impact options like swimming or cycling
• Physical therapy to strengthen the thigh and hip muscles and improve how the kneecap tracks is the cornerstone of treatment
• Over-the-counter anti-inflammatory medication to ease pain and swelling
• A brace or taping to support the kneecap and improve its alignment
• Supportive shoes or orthotics when foot mechanics contribute to the problem

Surgical Treatment

If pain continues despite a full course of non-surgical care, or if a piece of cartilage is torn or loose, your physician may recommend knee arthroscopy, a minimally invasive procedure that uses small incisions and a tiny camera. During the procedure, the surgeon can smooth damaged cartilage, remove loose fragments or, in the case of a defect, use a cartilage repair or restoration technique to rebuild the surface. When kneecap maltracking is the underlying driver, a procedure to realign the kneecap may also be considered, and more extensive realignment is occasionally done through open surgery. Your Resurgens surgeon will explain which option fits your knee and your goals.

Schedule an Appointment for Knee Pain

If front-of-knee pain is getting in the way of your activities, a knee specialist can find the cause and build a plan to relieve it. Book an appointment online today with a Resurgens knee specialist or call us at (404) 847-9999.