Singapore Sports and Orthopaedic Clinic

SYMPTOMS

There is gradual onset of diffuse exercise-induced pain around the anterior part of the knee. Prolonged sitting or squatting often trigger the symptoms (positive movie sign). Walking down stairs is more difficult than up.

AETIOLOGY

Chondromalacia means ‘soft cartilage’. The exact aetiology is unknown. The correct diagnosis must be identified, by arthroscopic probing, before treatment can be successful, since this is only one of many diagnoses that result in anterior knee pain.

CLINICAL FINDINGS

There is recurrent effusion and a positive grinding test. Tests of core stability, proprioception, muscle strength and balance and the flexibility of the entire kinetic chain must be thoroughly evaluated.

INVESTIGATIONS

X-ray can exclude fractures, OCD, patella abnormalities, other osteochondral injuries and bone tumours. MRI can exclude soft tissue tumours and other localised soft tissue lesions but often underestimates chondromalacia and other superficial chondral injuries as well as many meniscaltears and medial plica syndrome. CT scans can rule out severe patella mal-tracking, which in some cases may be the cause of the chondromalacia. Ultrasound can be useful for evaluating functional tendon and ligament disorders such as jumper’s knee or tendinosis around the knee. Arthroscopic probing is required for the diagnosis.

TREATMENT

Long-term symptomatic and functional treatment by a physiotherapist is required.

REFERRALS

These patients are very much helped by being evaluated clinically by their physician, surgeon and physiotherapist in close collaboration.

EXERCISE PRESCRIPTION

Cycling and water exercises are good alternatives to keep up general fitness.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Meniscus tear, chondral injuries, OCD, medial plica syndrome, chondromalacia patellar, patellar instability
or mal-tracking, quadriceps insufficiency, Sinding-Larsen’s syndrome, synovitis, PVNS, patellar tendon disorders, referred pain, secondary symptoms from ankle or back insufficiency, core instability and more.

PROGNOSIS

Because many cases never reach an absolute diagnosis and correct treatment, chondromalacia patella ends the career of many young athletes.