Treatment Of Chondromalacia

Grade I and II chondromalacia need quadriceps strengthening and other exercises, as activity without overdoing it will strengthen the cartilage.

With regard to a patellofemoral syndrome this means that running needs to be given up for a period of time, but that walking and swimming would be appropriate exercises (Ref. 1). Also, quadriceps exercises and physiotherapy treatments would be ordered by the treating physician.

For grade III and IV chondromalacia it depends how the clinical condition of the patient is. If there is a lot of pain and there is some intermittent locking of the knee, it may well be that some loose bodies (basically sloughed off pieces of hyaline cartilage) are at times locking the knee.

For grade III and IV chondromalacia it can be justified for the orthopedic surgeon to do an arthroscopy, assess the damage, shave off any irregularities and flush out any loose particles from the knee. This will likely give the patient at least 5 more good years without knee problems, until likely more degenerative changes happen, which might require orthopedic surgery again.

Ref. 2 reviews the various options for osteochondral injuries such as mosaicplasty, osteochondral transplantation and chondrocyte transplantation.

Any of these procedures are very specialized procedures that would only be done by experts in the field and often they would not be applicable for the majority of cases. Alignment problems such as genu varus and genu valgus are approached by the orthopedic surgeon by offloading procedures such as wedge excisions to realign the bones. This allows the pressure gradients to be such that premature wear and tear is minimized. Weight control with the help of a sensible diet (Ref. 3) is also advisable.

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 62.

2. EL Cain et al. Clin Sports Med 2001 Apr;20(2):321-342.

3. B. Sears: "Zone perfect meals in minutes". Regan Books, Harper Collins, 1997.

3. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders

4. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

5. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

6. Suzanne Somers: "Breakthrough" Eight Steps to Wellness-- Life-altering Secrets from Today's Cutting-edge Doctors", Crown Publishers, 2008

Last Modified: April 1, 2012