What are the current management options for patellofemoral joint degeneration? How can we effectively diagnose and treat this condition? Discover the latest insights and recommendations in this detailed review.

Understanding Patellofemoral Joint Degeneration

Patellofemoral joint degeneration, also known as patellofemoral pain syndrome, is a common musculoskeletal condition that affects the joint between the patella (kneecap) and the femur (thigh bone). This condition can lead to pain, stiffness, and decreased mobility in the knee joint, ultimately impacting an individual’s quality of life.

Epidemiology and Risk Factors

Patellofemoral joint degeneration is a prevalent condition, affecting a significant portion of the population. Studies have shown that it is particularly common in young and middle-aged individuals, with an estimated prevalence ranging from 12% to 17% in the general population. Certain risk factors have been identified, including obesity, overuse, and structural abnormalities in the patellofemoral joint.

Pathogenesis and Clinical Presentation

The exact mechanisms underlying the development of patellofemoral joint degeneration are not fully understood, but it is believed to involve a combination of biomechanical, anatomical, and neuromuscular factors. Patients with this condition typically present with anterior knee pain, which can be exacerbated by activities such as stair climbing, squatting, or prolonged sitting.

Diagnostic Approach

Diagnosing patellofemoral joint degeneration involves a comprehensive clinical evaluation, including a detailed patient history and physical examination. Imaging modalities, such as radiography, magnetic resonance imaging (MRI), and single-photon emission computed tomography (SPECT-CT), may be used to further evaluate the joint and rule out other underlying conditions.

Conservative Management Strategies

The initial management of patellofemoral joint degeneration typically involves conservative, non-surgical approaches. These may include physical therapy, exercise-based rehabilitation, bracing or taping, and the use of anti-inflammatory medications. The primary goals of conservative management are to reduce pain, improve function, and address any underlying biomechanical or neuromuscular issues.

Surgical Interventions

In cases where conservative management fails to provide adequate relief, surgical interventions may be considered. These include procedures such as arthroscopic debridement, realignment surgeries, and cartilage repair or replacement techniques. The selection of the appropriate surgical approach depends on the specific factors contributing to the patient’s condition.

Emerging Treatments and Future Directions

Researchers and clinicians are continuously exploring new and innovative approaches to managing patellofemoral joint degeneration. This includes the development of novel regenerative therapies, such as autologous chondrocyte implantation and the use of growth factors, as well as advancements in imaging and diagnostic techniques.

Ultimately, the management of patellofemoral joint degeneration requires a comprehensive and multidisciplinary approach, tailored to the individual patient’s needs and the specific factors contributing to their condition. By understanding the latest research and advancements in this field, healthcare providers can better assist patients in achieving improved outcomes and a better quality of life.

What are the key risk factors for patellofemoral joint degeneration? Patellofemoral joint degeneration is commonly associated with several risk factors, including obesity, overuse, and structural abnormalities in the patellofemoral joint.

How can patellofemoral joint degeneration be diagnosed? The diagnostic approach involves a comprehensive clinical evaluation, including a detailed patient history and physical examination, as well as the use of imaging modalities such as radiography, MRI, and SPECT-CT.

What are the main conservative management strategies for patellofemoral joint degeneration? The initial management typically includes physical therapy, exercise-based rehabilitation, bracing or taping, and the use of anti-inflammatory medications. These conservative approaches aim to reduce pain, improve function, and address underlying biomechanical or neuromuscular issues.

When would surgical interventions be considered for patellofemoral joint degeneration? Surgical interventions may be considered when conservative management fails to provide adequate relief. These include procedures such as arthroscopic debridement, realignment surgeries, and cartilage repair or replacement techniques.

What are some of the emerging treatments and future directions in the management of patellofemoral joint degeneration? Researchers and clinicians are exploring novel regenerative therapies, such as autologous chondrocyte implantation and the use of growth factors, as well as advancements in imaging and diagnostic techniques.

Patellofemoral joint degeneration: A review of current management

1. Gaitonde D.Y., Ericksen A., Robbins R.C. Patellofemoral pain syndrome. Am Fam Physician. 2019 Jan 15;99(2):88–94. [PubMed] [Google Scholar]

2. Lankhorst N.E., Bierma-Zeinstra S.M.A., van Middelkoop M. Risk factors for patellofemoral pain syndrome: a systematic review. J Orthop Sports Phys Ther. 2012 Feb;42(2):81–94. [PubMed] [Google Scholar]

3. Curl W.W., Krome J., Gordon E.S., Rushing J., Smith B.P., Poehling G.G. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy. 1997 Aug;13(4):456–460. [PubMed] [Google Scholar]

4. Habusta S.F., Coffey R., Ponnarasu S., Griffin E.E. StatPearls. StatPearls Publishing; Treasure Island (FL): 2021. Chondromalacia patella.http://www.ncbi.nlm.nih.gov/books/NBK459195/ Internet. [cited 2021 May 29]. Available from: [Google Scholar]

5. Techniques in Cartilage Repair Surgery | A. Ananthram Shetty | Springer [Internet]. [cited 2021 May 29]. Available from: https://www.springer.com/gp/book/9783642419201.

6. Insall J.N. Patella pain syndromes and chondromalacia patellae. Instr Course Lect. 1981;30:342–356. [PubMed] [Google Scholar]

7. Hinman R.S., Lentzos J., Vicenzino B., Crossley K.M. Is patellofemoral osteoarthritis common in middle-aged people with chronic patellofemoral pain? Arthritis Care Res. 2014 Aug;66(8):1252–1257. [PubMed] [Google Scholar]

8. Crossley K.M. Is patellofemoral osteoarthritis a common sequela of patellofemoral pain? Br J Sports Med. 2014 Mar;48(6):409–410. [PubMed] [Google Scholar]

9. Eijkenboom J.F.A., Waarsing J.H., Oei E.H.G., Bierma-Zeinstra S.M.A., van Middelkoop M. Is patellofemoral pain a precursor to osteoarthritis?: patellofemoral osteoarthritis and patellofemoral pain patients share aberrant patellar shape compared with healthy controls. Bone Joint Res. 2018 Sep;7(9):541–547. [PMC free article] [PubMed] [Google Scholar]

10. Petersen W., Ellermann A., Gösele-Koppenburg A. , et al. Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2014 Oct;22(10):2264–2274. [PMC free article] [PubMed] [Google Scholar]

11. Coggon D., Reading I., Croft P., McLaren M., Barrett D., Cooper C. Knee osteoarthritis and obesity. Int J Obes Relat Metab Disord. 2001 May;25(5):622–627. [PubMed] [Google Scholar]

12. Dixit S., DiFiori J.P., Burton M., Mines B. Management of patellofemoral pain syndrome. Am Fam Physician. 2007 Jan 15;75(2):194–202. [PubMed] [Google Scholar]

13. van Jonbergen H.-P.W., Poolman R.W., van Kampen A. Isolated patellofemoral osteoarthritis. Acta Orthop. 2010 Apr;81(2):199–205. [PMC free article] [PubMed] [Google Scholar]

14. Rathleff M.S., Roos E.M., Olesen J.L., Rasmussen S., Arendt-Nielsen L. Lower mechanical pressure pain thresholds in female adolescents with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2013 Jun;43(6):414–421. [PubMed] [Google Scholar]

15. Jensen R., Hystad T., Baerheim A. Knee function and pain related to psychological variables in patients with long-term patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2005 Sep;35(9):594–600. [PubMed] [Google Scholar]

16. Manske R.C., Davies G.J. Examination OF the patellofemoral joint. Int J Sports Phys Ther. 2016 Dec;11(6):831–853. [PMC free article] [PubMed] [Google Scholar]

17. Qiu Y., Lin C., Liu Q., et al. Imaging features in incident radiographic patellofemoral osteoarthritis: the Beijing Shunyi osteoarthritis (BJS) study. BMC Muscoskel Disord. 2019 Aug 7;20(1):359. [PMC free article] [PubMed] [Google Scholar]

18. Wolfe S., Varacallo M., Thomas J.D., Carroll J.J., Kahwaji C.I. StatPearls. StatPearls Publishing; Treasure Island (FL): 2021. Patellar instability.http://www.ncbi.nlm.nih.gov/books/NBK482427/ [Internet] [cited 2021 May 30]. Available from: [Google Scholar]

19. Ro D.H., Lee H.-Y., Chang C.B., Kang S.-B. Value of SPECT-CT imaging for middle-aged patients with chronic anterior knee pain. BMC Muscoskel Disord. 2015 Jul 26;16:169. [PMC free article] [PubMed] [Google Scholar]

20. Rodrigues M. B., Camanho G.L. Mri evaluation OF knee cartilage. Rev Bras Ortop. 2010 Aug;45(4):340–346. [PMC free article] [PubMed] [Google Scholar]

21. Shetty A.A., Kim S.J., Shetty V., Jang J.D., Huh S.W., Lee D.H. Autologous collagen induced chondrogenesis (ACIC: shetty-Kim technique) – a matrix based acellular single stage arthroscopic cartilage repair technique. J Clin Orthop Trauma. 2016 Sep;7(3):164–169. [PMC free article] [PubMed] [Google Scholar]

22. Macri E.M., Crossley K.M., Hart H.F., et al. Clinical findings in patellofemoral osteoarthritis compared to individually-matched controls: a pilot study. BMJ Open Sport Exerc Med. 2020 Dec;6(1) [PMC free article] [PubMed] [Google Scholar]

23. Muhle C., Brossmann J., Heller M. Kinematic CT and MR imaging of the patellofemoral joint. Eur Radiol. 1999;9(3):508–518. [PubMed] [Google Scholar]

24. Brossmann J., Muhle C., Schröder C., et al. Patellar tracking patterns during active and passive knee extension: evaluation with motion-triggered cine MR imaging. Radiology. 1993 Apr;187(1):205–212. [PubMed] [Google Scholar]

25. McNally E.G., Ostlere S.J., Pal C., Phillips A., Reid H., Dodd C. Assessment of patellar maltracking using combined static and dynamic MRI. Eur Radiol. 2000;10(7):1051–1055. [PubMed] [Google Scholar]

26. Kobayashi S., Pappas E., Fransen M., Refshauge K., Simic M. The prevalence of patellofemoral osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2016 Oct;24(10):1697–1707. [PubMed] [Google Scholar]

27. Yang W., Sun C., He S.Q., Chen J.Y., Wang Y., Zhuo Q. The efficacy and safety of disease-modifying osteoarthritis drugs for knee and hip osteoarthritis-a systematic review and network meta-analysis. J Gen Intern Med. 2021 Apr 12 [PMC free article] [PubMed] [Google Scholar]

28. Cohen Z.A., Roglic H., Grelsamer R.P., et al. Patellofemoral stresses during open and closed kinetic chain exercises. An analysis using computer simulation. Am J Sports Med. 2001 Aug;29(4):480–487. [PubMed] [Google Scholar]

29. Benjafield A.J., Killingback A., Robertson C.J., Adds P.J. An investigation into the architecture of the vastus medialis oblique muscle in athletic and sedentary individuals: an in vivo ultrasound study. Clin Anat. 2015 Mar;28(2):262–268. [PubMed] [Google Scholar]

30. Rogan S., Haehni M., Luijckx E., Dealer J., Reuteler S., Taeymans J. Effects of hip abductor muscles exercises on pain and function in patients with patellofemoral pain: a systematic review and meta-analysis. J Strength Condit Res. 2019 Nov;33(11):3174–3187. [PubMed] [Google Scholar]

31. Hoglund L.T., Pontiggia L., Kelly J.D. A 6-week hip muscle strengthening and lumbopelvic-hip core stabilization program to improve pain, function, and quality of life in persons with patellofemoral osteoarthritis: a feasibility pilot study. Pilot Feasibility Stud. 2018;4:70. [PMC free article] [PubMed] [Google Scholar]

32. Nam C.-W., Kim K., Lee H.-Y. The influence of exercise on an unstable surface on the physical function and muscle strength of patients with osteoarthritis of the knee. J Phys Ther Sci. 2014 Oct;26(10):1609–1612. [PMC free article] [PubMed] [Google Scholar]

33. John Prabhakar A., Joshua A.M., Prabhu S., Dattakumar Kamat Y. Effectiveness of proprioceptive training versus conventional exercises on postural sway in patients with early knee osteoarthritis – a randomized controlled trial protocol. Int J Surg Protoc. 2020;24:6–11. [PMC free article] [PubMed] [Google Scholar]

34. Gigante A., Pasquinelli F.M., Paladini P., Ulisse S., Greco F. The effects of patellar taping on patellofemoral incongruence. A computed tomography study. Am J Sports Med. 2001 Feb;29(1):88–92. [PubMed] [Google Scholar]

35. Denton J., Willson J.D., Ballantyne B.T., Davis I.S. The addition of the Protonics brace system to a rehabilitation protocol to address patellofemoral joint syndrome. J Orthop Sports Phys Ther. 2005 Apr;35(4):210–219. [PubMed] [Google Scholar]

36. Barton C.J., Munteanu S.E., Menz H.B., Crossley K.M. The efficacy of foot orthoses in the treatment of individuals with patellofemoral pain syndrome: a systematic review. Sports Med. 2010 May 1;40(5):377–395. [PubMed] [Google Scholar]

37. Clarke S., Lock V., Duddy J., Sharif M., Newman J.H., Kirwan J.R. Intra-articular hylan G-F 20 (Synvisc) in the management of patellofemoral osteoarthritis of the knee (POAK) Knee. 2005 Jan;12(1):57–62. [PubMed] [Google Scholar]

38. Kamat Y.D., Patel N.G., Galea A., Ware H.E., Dowd G.S.E. Platelet-rich plasma injections for knee pathologies: a review. Eur Orthop Traumatol. 2014 Dec 1;5(4):341–347. [Google Scholar]

39. Hinman R.S., Crossley K.M. Patellofemoral joint osteoarthritis: an important subgroup of knee osteoarthritis. Rheumatology (Oxford) 2007 Jul;46(7):1057–1062. [PubMed] [Google Scholar]

40. Kim Y.-M., Joo Y.-B. Patellofemoral osteoarthritis. Knee Surg Relat Res. 2012 Dec;24(4):193–200. [PMC free article] [PubMed] [Google Scholar]

41. Naik A., Shetty A.A., Kim S.J. Patellar stabilization-Minimally invasive arthroscopic technique (Shetty & Kim) J Clin Orthop Trauma. 2020 May;11(Suppl 3):S412–S413. [PMC free article] [PubMed] [Google Scholar]

42. Post W.R. Clinical evaluation of patients with patellofemoral disorders. Arthroscopy. 1999 Dec;15(8):841–851. [PubMed] [Google Scholar]

43. Wetzels T., Bellemans J. Patellofemoral osteoarthritis treated by partial lateral facetectomy: results at long-term follow up. Knee. 2012 Aug;19(4):411–415. [PubMed] [Google Scholar]

44. Saleh K.J., Arendt E.A., Eldridge J., Fulkerson J.P., Minas T., Mulhall K.J. Symposium. Operative treatment of patellofemoral arthritis. J Bone Joint Surg Am. 2005 Mar;87(3):659–671. [PubMed] [Google Scholar]

45. Dall’Oca C., Elena N., Lunardelli E., Ulgelmo M., Magnan B. MPFL reconstruction: indications and results. Acta Biomed. 2020 May 30;91(4-S):128–135. [PMC free article] [PubMed] [Google Scholar]

46. Thompson P., Metcalfe A.J. Current concepts in the surgical management of patellar instability. Knee. 2019 Dec;26(6):1171–1181. [PubMed] [Google Scholar]

47. Joo S.Y., Park K.B., Kim B. R., Park H.W., Kim H.W. The “four-in-one” procedure for habitual dislocation of the patella in children: early results in patients with severe generalised ligamentous laxity and aplasis of the trochlear groove. J Bone Joint Surg Br. 2007 Dec;89(12):1645–1649. [PubMed] [Google Scholar]

48. Huh S.W., Shetty A.A., Ahmed S., Lee D.H., Kim S.J. Autologous bone-marrow mesenchymal cell induced chondrogenesis (MCIC) J Clin Orthop Trauma. 2016 Sep;7(3):153–156. [PMC free article] [PubMed] [Google Scholar]

49. Nho S.J., Foo L.F., Green D.M., et al. Magnetic resonance imaging and clinical evaluation of patellar resurfacing with press-fit osteochondral autograft plugs. Am J Sports Med. 2008 Jun;36(6):1101–1109. [PubMed] [Google Scholar]

50. Peterson L., Minas T., Brittberg M., Nilsson A., Sjögren-Jansson E., Lindahl A. Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res. 2000 May;(374):212–234. [PubMed] [Google Scholar]

51. Torga Spak R. , Teitge R.A. Fresh osteochondral allografts for patellofemoral arthritis: long-term followup. Clin Orthop Relat Res. 2006 Mar;444:193–200. [PubMed] [Google Scholar]

52. Mithoefer K., McAdams T., Williams R.J., Kreuz P.C., Mandelbaum B.R. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med. 2009 Oct;37(10):2053–2063. [PubMed] [Google Scholar]

53. Mosier B.A., Arendt E.A., Dahm D.L., Dejour D., Gomoll A.H. Management of patellofemoral arthritis: from cartilage restoration to arthroplasty. J Am Acad Orthop Surg. 2016 Nov;24(11):e163–e173. [PubMed] [Google Scholar]

54. Laskin R.S., van Steijn M. Total knee replacement for patients with patellofemoral arthritis. Clin Orthop Relat Res. 1999 Oct;(367):89–95. [PubMed] [Google Scholar]

Patellofemoral Arthritis – OrthoInfo – AAOS

Patellofemoral arthritis affects the underside of the patella (kneecap) and the channel-like groove in the femur (thighbone) that the patella rests in. It causes pain in the front of your knee and can make it difficult to kneel, squat, and climb and descend (go down) stairs.

The patella is a small bone located in front of the knee joint — where the thighbone (femur) and shinbone (tibia) meet. It protects your knee and connects the muscles in the front of your thigh to your tibia.

The patella rests in a groove on top of the femur called the trochlear groove. When you bend and straighten your knee, the patella moves back and forth inside this groove.

A slippery substance called articular cartilage covers the ends of the femur, trochlear groove, and underside of the patella. Articular cartilage helps your bones glide smoothly against each other as you move your leg.

(Left) The patella rests in a small groove at the end of the femur called the trochlear groove. (Right) As you bend and straighten your knee, the patella slides up and down within the groove.

Reproduced and adapted from The Body Almanac. American Academy of Orthopaedic Surgeons, 2003.

Patellofemoral arthritis occurs when the articular cartilage along the trochlear groove and on the underside of the patella wears down and becomes inflamed.

When cartilage wears away, it becomes frayed and, when the wear is severe, the underlying bone may become exposed. Moving the bones along this rough surface may be painful.

Illustration shows patellofemoral arthritis. The patella (kneecap) has been removed to show damage to the cartilage on the underside.

(Left) This X-ray shows a normal knee from the side. The arrows point to the normal amount of space between the bones. (Middle) In this X-ray, the arrows point to narrowed joint space due to patellofemoral arthritis. (Right) Here, the arrows point to bone spurs that have developed due to the arthritis.

Dysplasia

Dysplasia occurs when the patella does not fit properly in the trochlear groove of the femur. Because of this, when the knee moves, there are increased stresses on the cartilage. This begins to wear the cartilage down.

X-ray taken from above the knee shows dysplasia that has developed into severe arthritis. There is no joint space remaining in the knee on the left. On the right, the trochlear groove has become deformed.
Courtesy of Ronald P. Grelsamer, MD

Kneecap Fracture

Patellar (kneecap) fractures often damage the articular cartilage that covers and protects the underside of the bone. Even though the broken bone heals, the joint surface may no longer be smooth. There is friction when the patella moves against the joint surface of the femur. Over time, this can lead to arthritis.

The main symptom of patellofemoral arthritis is pain. Because the patellofemoral joint is in front of the knee, you may have pain in this area. The pain can be present at rest or with no activity at all. Most of the time, however, it is brought on by activities that put pressure on the kneecap, such as kneeling, squatting, climbing and descending stairs, and getting up from a low chair.

In addition, you may experience a crackling sensation called crepitus when you move your knee. Crepitus is sometimes painful and can be loud enough for other people to hear. When the disease is advanced, your kneecap may get stuck, or catch, when you straighten your knee

When you visit the doctor, they will do a complete medical history and physical examination, as well as order imaging tests.

Medical History

Your doctor will ask you several questions about your general health, your knee pain, and your ability to function.

It is important for your doctor to determine the exact location of your pain. Patients typically have pain only behind the kneecap, or anterior knee pain. the pain usually occurs during activities that put pressure on the kneecap, such as:

• Going up and down stairs
• Sitting with the knee bent
• Rising from a chair

Physical Exam

Your doctor will examine the affected knee in various positions to see if there is pain or restricted motion. They will look for creaking or grinding noises (crepitus) that indicate bone-on-bone friction, muscle loss (atrophy), and signs of injury to muscles, tendons, and ligaments.

During the exam, the doctor will:

• Inspect your knee to determine the overall alignment of the joint
• Palate (feel) around your knee to see if your pain can be reproduced
• Test range of motion to determine if you have knee stiffness or problems with patellar tracking (the kneecap moves out of place when the knee straightens or bends)
• Assess the quality of the ligaments around the joint and the overall stability of your knee

Imaging Tests

X-rays. X-rays provide images of dense structures, such as bone. Your doctor will order X-rays from several different angles to ensure that your arthritis is limited to the space between the kneecap and the femur, and to assess the overall alignment of your knee.

Magnetic resonance imaging (MRI) scans. MRI scans create better images of the soft tissues in your knee than X-rays do. Your doctor may order an MRI to better evaluate the cartilage in your knee.

Nonsurgical Treatment

Treatment of patellofemoral arthritis is similar to the treatment of knee arthritis in general. Most cases can be treated without surgery. Nonsurgical options include:

Nonsteroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory drugs like aspirin, naproxen, and ibuprofen reduce both pain and swelling.

Exercise. Regular exercise can decrease stiffness and strengthen the muscles that support your knee. Patients who have patellofemoral arthritis should try to avoid activities that put stress on the front of the knee, such as squatting. If you regularly do high-impact exercise, switching to low-impact activities will put less stress on your knee. Walking and swimming are good low-impact options.

Activity modification.  In many cases, avoiding activities that bring on symptoms — such as climbing stairs — will help relieve pain.

Weight loss. If you are overweight, losing just a few pounds can make a big difference in the amount of stress you place on your knee. Losing weight can also make it easier to move and maintain independence.

Physical therapy. Specific exercises can improve range-of-motion in your knee. Exercises to strengthen the quadriceps muscles will help relieve pressure on the kneecap when you straighten your leg. If an exercise causes pain, stop the exercise and talk to your doctor or physical therapist.

Cortisone (steroid) injections. Cortisone is a powerful anti-inflammatory medicine that can be injected directly into your knee.

Viscosupplementation. In this procedure, a substance is injected into the joint to improve the quality of the joint fluid.  The effectiveness of viscosupplementation in treating arthritis is unclear and continues to be studied by researchers.

Surgical Treatment

Surgery is an option when nonsurgical treatment has failed. Several types of surgical procedures are available.

Chondroplasty. This procedure is done with arthroscopy — inserting thin surgical instruments into small incisions around your knee. During a chondroplasty, your surgeon trims and smooths roughened arthritic joint surfaces. Chondroplasty is an option in cases of mild to moderate cartilage wear.

Realignment. The soft tissues on either side of the kneecap are tightened or released to change the position of the kneecap in the trochlear groove.

Cartilage grafting. Normal healthy cartilage tissue may be taken from another part of the knee or from a tissue bank to fill a hole in the articular cartilage. This procedure is typically considered only for younger patients who have small areas of cartilage damage.

Tibial tuberosity transfer. This procedure can help relieve pain in patients with arthritis in specific portions of the patella. The patellar tendon below the kneecap attaches to a bump on the front of the knee called the tibial tuberosity. Shifting the bump in any direction will change the position of the kneecap. After the procedure, the patella should move more smoothly in the trochlear groove, reducing pressure on the arthritic areas and relieving pain.

Patellofemoral replacement. During this partial knee replacement, the surgeon uses special tools to remove damaged cartilage and a small amount of bone from the patellofemoral compartment. A plastic button, or cover, is used to resurface the backside of the patella. This button will line up with a thin metal component that is used to resurface the trochlear groove at the end of the femur. These parts are typically secured to the bone with cement.

(Left) X-ray taken from above the knee. The patella and the trochlear groove of the femur have become deformed due to arthritis. There is bone rubbing on bone. (Right) The same knee after patellofemoral replacement. The patellar implant on the underside of the kneecap does not show in an X-ray.

Patellofemoral replacement surgery cannot be carried out if there is arthritis involving other parts of the knee. If this is the case, your doctor may recommend a total knee replacement.

Total knee replacement. In a total knee replacement, all the cartilage surfaces of the knee are resurfaced. The end of the femur and the top of the tibia are capped with a metal prosthesis. A plastic spacer is placed in between these components to create a smooth gliding surface. Additionally, the patella itself is usually resurfaced with a plastic button.

(Left) Patellofemoral replacement. This partial knee replacement can be used to treat arthritis that is limited to the underside of the patella and the trochlear groove.  If other parts of the knee are involved, a total knee replacement (Right) may be recommended. 

For most patients, treatment for patellofemoral arthritis is successful in relieving pain and improving function. Outcomes vary, however, depending on patient-specific factors and the type of treatment. Your doctor will talk with you about the expected outcome of treatment in your specific situation. 

To help doctors in the nonsurgical management of osteoarthritis of the knee — the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case. For more information: Osteoarthritis of the Knee – Clinical Practice Guideline (CPG) | American Academy of Orthopaedic Surgeons (aaos.org)

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Chondromalacia of the patella – causes, symptoms, diagnosis, treatment and prevention

Chondromalacia is a thinning, decrease in density and subsequent gradual destruction of the articular cartilage. Most often, pathology occurs in the cartilage of the patella, chondromalacia of the shoulder, elbow or other joint is less common.

ON CLINIC employs experienced doctors who quickly and correctly make an accurate diagnosis and prescribe adequate treatment. We have our own diagnostic base and the necessary equipment of the latest generation – CT, MRI, ultrasound. You can go through all the prescribed examinations with us and immediately get a consultation with a specialist.

Causes of chondromalacia

The occurrence and development of chondromalacia can be triggered by various factors. Among them:

• genetic predisposition;
• anatomical features;
• traumatic injuries in which the impact is directed directly to the patella;
• microtraumas that occur in athletes during systematic running, jumping, squatting;
• muscle imbalance due to decreased quadriceps femoris tone, which makes normal calyx movement difficult;
• acute inflammatory diseases of the knee joint and nearby soft tissues;
• metabolic disorders;
• hormonal disorders;
• overweight.

If several factors act at once, then this leads to the development of more severe chondromalacia of the patella. Due to the peculiarities of the anatomy, the disease is more common in women.

Stages of development of chondromalacia

At first, the disease may not manifest itself in any way. Then aching pains will begin to appear, aggravated while walking up the stairs or standing for a long time. Further, a crunch may appear when bending, redness and swelling of the knee. Depending on the stage of development of chondromalacia, the following degrees of damage are distinguished:

• Grade 1 – the cartilage on the inside becomes softer, swelling and small microcracks appear in it. There is almost no pain or it is insignificant;
• 2 degree – the softening process continues, the cartilage is divided into fibers. Microcracks turn into cracks and depressions. This causes pain, especially during physical exertion. You may feel a crunch when getting up from your knees;
• Grade 3 – connective tissue is involved in the process of destruction, the cartilage is already divided into fragments, the bone is exposed. It brings constant severe pain. Movement in the joint is difficult, it becomes difficult to squat;
• 4 degree – the bone is exposed in large areas, the cartilage no longer protects it. On the surface of the bone, degenerative changes are detected. The pain becomes unbearable, movement is possible only on crutches.

Symptoms of chondromalacia

• Acute pain that worsens with increasing load on the knee: climbing or descending stairs, running, squatting, kneeling.
• Chronic persistent pain at rest, but less severe than with movement.
• Characteristic clicks and crunches that occur when moving the joint.
• Limited range of motion in the knee.
• Swelling and redness of the skin in the area of ​​the patella, indicating the development of an inflammatory reaction.

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Endoprosthetics of joints. Treatment of osteoarthritis of the joints in ON CLINIC

Chondromalacia diagnostics

Chondromalacia is diagnosed and treated by an orthopedic surgeon. To confirm the diagnosis and accurately assess the degree of damage, he will collect an anamnesis, listen to complaints and study the symptoms. He will conduct a visual examination, during which he will assess muscle tone, range of motion of the joint, and anatomical features. The method of palpation will reveal painful points and the presence of swelling.

He will also prescribe the necessary examinations: CT, MRI, radiography, ultrasound of the knee joint, diagnostic arthroscopy.

The modern equipment of our international CELT clinic allows for high-quality comprehensive diagnostics.

Treatment of chondromalacia

Treatment of chondromalacia is always complex: it should include conservative drug therapy, physiotherapy and surgery. The volume and direction of therapeutic measures depends on the severity and localization of the pathological process and is selected by an orthopedic doctor.

Conservative treatment

Therapeutic treatment may include:

• taking non-steroidal anti-inflammatory drugs to reduce swelling and pain;
• regular exercise, which is selected individually;
• restriction or refusal of certain types of movements to eliminate the load on the joint;
• use of tape, bandage or special sleeve to properly align the patella;
• intra-articular injections of special preparations.

Surgical treatment

If conservative treatment does not bring the desired effect or the degree of development of chondromalacia has reached the last stage, then the doctor may prescribe surgery;

• 1 degree — washing of the joint capsule zone;
• Grade 2 – excision of the inflamed area and flushing of the internal cavity of the joint;
• Grade 3 – graft plasty;
• 4th degree – endoprosthesis replacement.

Surgical treatment is carried out by sparing methods: arthroplasty and abrasive chondroplasty.

Minimally invasive operations allow early development of the joint. After the operation, you will spend only 1-3 days in the hospital, and then you will walk with a cane for a month.

Orthopedists at ON CLINIC practice early rehabilitation after joint operations.

Benefits of treating chondromalacia at ON CLINIC

• International clinic ON CLINIC has been operating since 1993, successfully overcoming all crises and economic shocks.
• We recruit only the best world-class doctors who treat joint diseases in accordance with modern protocols and international recommendations.
• We care not only about the health and safety of patients, but also about their psychological and physical comfort.
• In our clinics we use the most modern equipment to make accurate diagnoses and provide effective treatment.
• We provide early rehabilitation and early development of the joint after surgery.
• The operation is performed by an orthopedic traumatologist, candidate of medical sciences, Samoilov V.V.

Q&A

How can chondromalacia be prevented?

Wear comfortable shoes, eat right, avoid bumps and falls on your knees. Before training, be sure to warm up and wear bandages on your knees during heavy loads.

What is the treatment prognosis for chondromalacia?

If chondromalacia of the patella is detected in a timely manner, the prognosis for the disease is favorable.

Do you accept overweight patients?

Yes, we accept. Sign up at the phone number listed on the site.

Treatment. Knee-joint. Chondromalacia knee cartilage company blog

Description of the disease, symptoms and causes, methods of treatment.

What is “chondromalacia patella”?

This is the destruction of the cartilage of the posterior (articular) surface of the patella. As a result, the former elasticity is lost and its loosening is observed. According to statistics, chondromalacia of the patella is in first place for the causes of pain at a young age, with the exception of traumatism and consequences from it. Most often, this pathological process occurs in athletes and people engaged in heavy physical labor. Some anatomical features of the joint structure imply a more frequent incidence in women.

A number of authors consider chondromalacia of the patella cartilage as one of the manifestations of an autoimmune process, which currently requires a greater evidence base.
Read more about the treatment of chondromalacia cartilage of the knee

Symptoms

Clinically, chondromalacia of the patella does not manifest itself for a long time, pains appear with a sufficient spread of the inflammatory process in the cartilaginous tissue. Swelling of the knee joint is often found, the temperature, as a rule, is either normal physiological or subfebrile.

Conservative treatment

Treatment usually begins with conservative methods:

• rest;
• NSAIDs;
• changing the training regimen;
• after that, a rehabilitation program is prescribed, which is based on stretching the extensor muscles, the ilio-tibial tract, the ligaments that hold the patella, and the posterior thigh muscles.
• building strength of the quadriceps muscle, especially the oblique part of the medial wide muscle, as the main limiter of the mobility of the patella. It is believed that due to the weakness of this muscle in comparison with the vastus lateralis muscle, the patella is subjected to external subluxation. Small-range quadriceps strengthening exercises and straight leg raises weaken the femoropatellar response to this imbalance.
• in addition to exercises, you can prescribe elastic bandaging of the knee joint, fixing the patella with a bandage or orthopedic apparatus.

Surgical treatment

There are many options for the surgical treatment of chondromalacia patellae. Most of them are aimed at restoring the correct anatomical position of the femoral-patellar joint, a small part is aimed at regenerating the cartilage lining. In severe cases, contouring of the articular surfaces and patellectomy are indicated.

Arthroscopy of the knee

It is not only an important diagnostic, but also a treatment procedure. Although the feasibility of washing the joint cavity and removing pathologically altered tissues during arthroscopy remains a matter of controversy, the value of this examination for determining the stage of the disease and planning surgical treatment is obvious. Arthroscopic lavage reduces pain for a short time and improves function by removing dead tissue and proteoglycans formed during inflammation. But since the cause of the disease is not eliminated during this manipulation, the symptoms usually reappear. In arthroscopic staging, the Outerbridge system is widely used because of its simplicity and reproducibility. The system is based on determining the location, shape, size and depth of the defect. Such minimally invasive technologies have an extremely favorable effect on the outcomes of the disease, on the terms of rehabilitation, etc. The treatment of chondromalacia of the cartilage of the knee joint now seems to be a simpler task that does not burden the patient, which is important.

• I degree defects are soft thickenings, sometimes swellings.
• Grade II is characterized by depressions and cracks with a diameter of less than 1 cm.
• Grade III injuries look like deep cracks with a diameter of more than 1 cm, reaching the bone.
• Grade IV is characterized by exposure of the subchondral bone.

Lavage and dead tissue removal are more suitable for injuries without signs of patellar instability than for degenerative lesions of a non-traumatic nature. With a tilt of the patella and minimal damage to the articular surfaces, especially the outer facet, arthroscopy can mobilize the lateral edge of the patella. This intervention is advisable only with a clinically obvious tilt of the patella without severe joint damage. In general, arthroscopic lavage and removal of pathologically altered tissues with or without mobilization of the lateral edge of the patella are justified in grade I–II lesions; at III-IV degree, long-term results are usually poor.

Arthroscopic chondroplasty

With severe cartilage degeneration, arthroscopic chondroplasty is used. Methods of abrasive and microslit chondroplasty include mechanical penetration into the underlying bone with the introduction of bone marrow mesenchymal stem cells into defects, stimulating the regeneration of fibrocartilaginous tissue. Arthroscopic chondroplasty is usually performed in people younger than 30 with well-demarcated grade III lesions; with more severe lesions, it is contraindicated. Such surgical interventions have their positive and negative aspects and have found their application in sports medicine. Clinically, the treatment of chondromalacia is no different, but from a functional point of view, the range of motion in the joints returns in full.

Additional methods are aimed at restoring hyaline (articular) cartilage. For cartilage regeneration, implantation of own chondrocytes, bone-cartilage auto- or allograft transplantation, and fragmented bone-cartilage graft plasty (mosaic plasty) are carried out. Implantation of own chondrocytes is carried out with significant through defects in the cartilaginous lining of the femoral condyle, which manifest themselves clinically. First, the patient’s chondrocytes are harvested, then they are cultivated and planted under the periosteal flap, on the articular surface defect cleared of pathological tissues. According to long-term collaborative studies, good and excellent results were obtained in 79% of cases. The method is indicated for young (20–50 years old) active patients with isolated (2–4 cm²) traumatic defects in the cartilaginous lining of the femoral condyles. The results of filling defects of the patella surface of the femur or patella are much worse. Contraindications include extensive osteoarthritis, instability or tilt of the patella with subluxation, and past meniscectomy.

Transplantation of bone and cartilage autograft and mosaic plasty are interesting in that their own intact cartilage is used to fill deep defects. However, to accurately restore the relief of the articular surface, considerable technical skill is required. In addition, the number of donor zones is limited and complications in cartilage harvesting sites are not excluded. Osteo-cartilaginous allografts are usually used for large (10 cm² or more) defects of the femoral condyles and often after failure of other methods. In fresh allografts, chondrocytes are more viable, but at the same time they are more immunogenic and increase the risk of infection transmission. Moreover, fresh allografts are difficult to handle and require the surgeon and the patient to clearly plan the timing of the intervention in a relatively short time.