KNEE PROBLEMS: CHONDROMALACIA

Chondromalacia, one of the most common causes of knee pain in younger people, can be caused by a traumatic injury to the patella, such as a severe blow, but can sometimes occur for no apparent reason. Chondromalacia also appears to be part of the normal aging process. In fact, in older people, the wearing away of articular cartilage is called osteoarthritis. However—and this is what’s confusing for so many patients— there is no evidence that chondromalacia in younger people will lead to arthritis down the road. We used to assume that chondromalacia in the young would automatically develop into arthritis. However, careful studies have shown that there is no clear-cut progression. In fact, we now believe that although the end result is the same, chondromalacia and arthritis may be very different problems caused by different circumstances. In addition, there is no direct correlation between patellar pain and destruction caused by chondromalacia. Sometimes a person with mild symptoms can actually have more destruction than someone who is in constant pain.
Chondromalacia is rated according to the severity of the condition on a scale of 0 to grade 4, with 0 considered healthy, smooth cartilage. In grade 1 chondromalacia, there is some blistering or disturbance on the surface of the articular cartilage; grade 2 chondromalacia, the surface is scratched or fissured; grade 3 chondromalacia, the Assuring is deeper or down to the bone; grade 4 chondromalacia, the surface is worn away down to the bone and the bone is also worn out.
The pain caused by chondromalacia is somewhat mysterious, because there are no nerve endings in the articular cartilage. However, it is believed that when the articular cartilage is damaged to the point that it is no longer an efficient shock absorber, the force exerted through the bones, which are rich in nerve endings, is all the greater. We perceive the extra force as pain.
Chondromalacia is usually diagnosed by symptoms. An X ray will not show chondromalacia. An arthroscope will conclusively show the presence of chondromalacia and the stage of the disease. However, if your doctor suspects that chondromalacia is the problem, he will probably prescribe a good strengthening program since there is little that can be done surgically to improve the situation. In some cases, the surgeon may wash out the area, that is, smooth the surface of the articular cartilage (on the back of the patella) and remove any debris that may be causing the joint to “catch.” Patients are also usually advised to refrain from activities that may aggravate the pain.
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