Treatment of chondromalacia of the knee joint. Classification, manifestations and therapy of chondromalacia of the femoral condyles

Chondromalacia of the articular surfaces of the heads of the bones is a common problem in people with excess body weight. Also at risk are people who lead an active lifestyle and are fond of active and traumatic sports.

Simultaneous chondromalacia of the femoral and tibial condyles is rare, mainly as a complication of systemic pathology of cartilage tissue. In most clinical cases, degeneration of only one of the bone heads included in the joint capsule is detected. This is due to the uneven distribution of mechanical and physical load during movement.

In the early stages, chondromalacia of the condyles practically does not produce pronounced clinical symptoms, so patients seek medical help already in the second and third stages of the pathology. This often becomes the reason that treatment can only be effectively carried out through surgery. although at the initial stage, chondromalacia of the femoral condyles responds well to conservative treatment using manual therapy methods. With a properly designed course, it is possible to completely restore the integrity of cartilaginous synovial tissue, which leads to recovery and restoration of freedom of movement.

We invite all patients who have signs of chondromalacia of the knee to have an initial consultation with an orthopedic surgeon at our manual therapy clinic. During the initial examination, the doctor will determine the degree of destruction of the cartilaginous synovial tissue and, depending on this result, will give a prognosis for treatment using manual therapy methods. Perhaps our doctors will be able to only partially restore the mobility of the joint, or perhaps their influence will lead to the patient’s pain disappearing. Those. Even in advanced cases, it is possible to provide effective assistance. But in the early stages, we guarantee complete recovery, provided the patient follows all the individual recommendations of the orthopedist.

Causes of chondromalacia of the tibia and femur

Chondromalacia of the femur is a degenerative destructive process that begins with a disruption of the blood supply to the muscle fiber surrounding the knee joint. Cartilage tissue does not have its own vascular network of capillaries. Therefore, it can receive liquid and nutrients dissolved in it only through diffuse exchange with nearby muscle fibers. Partial nutrition is provided by the endplates, which separate the periosteum, richly permeated with a capillary network, and the cartilaginous shell of the bone head.

Constant compression pressure on the endplates (with excess body weight) and compression of the muscle fibers by the lipid mass lead to disruption of the nutritional process of the hyaline fibers of the cartilage. If the process of blood supply and diffuse metabolism is disrupted, dehydration of the synovial membrane gradually begins. It loses its ability to quickly contract and expand during physical activity. The secondary process of reducing the volume of synovial fluid begins. Instability of the position of the bone heads in the joint capsule occurs.

With chaotic movement, the condyles of the femur and tibia begin to exert additional compression and traumatic effects on the dehydrated cartilage tissue. It begins to disintegrate and thin out. This is already the second stage of chondromalacia, in the early stages of which conservative treatment without surgery is still possible.

The third stage is the complete or partial exposure of the heads of the bones and the beginning of the formation of rough bone growths on them. After their formation, the disease enters the phase of deforming osteoarthritis of the knee joint. With it, the patient loses the ability to move independently. Treatment requires joint replacement surgery.

The following negative factors may be the reasons for the development of such a pathological process:

maintaining a sedentary lifestyle;
incorrect placement of the feet in the form of flat feet or clubfoot, which provokes displacement of the condyles of the heads of the femur and tibia in the articular cavity;
valgus and varus deformity of the leg bones with curvature of the lower extremities;
injuries to bones, cartilage, muscle, ligament and tendon tissue;
destruction of the medial and lateral menisci of the knee joint;
inflammatory processes in the joint capsule (synovitis) and bursa (bursitis);
overweight and obesity;
diseases of the circulatory system (atherosclerosis, obliterating endarteritis, varicose veins of the lower extremities);
occupational hazards;
playing sports that carry a high risk of knee injury;
wrong choice of shoes.

In addition, chondromalacia can be associated with hereditary genetic abnormalities, systemic diseases of cartilage tissue, the development of rheumatism, ankylosing spondylitis, tuberosity of the heads of bones, the formation of calluses in places of fractures and cracks, etc. Only an experienced specialist can identify the exact cause based on the information obtained during the collection of anamnesis when comparing it with the data obtained during clinical examinations.

How does chondromalacia of the femoral condyles of the knee joint manifest?

At the initial stage, chondromalacia of the femoral condyles can cause mild pain above the knee joint after undergoing unusual physical activity. For example, after a long period of standing on a person’s feet, suddenly, against the background of general well-being, he begins to pull just above the knee. When you try to bend your leg, the pain slightly intensifies. After a short proper rest, all unpleasant sensations completely disappear and do not appear until the next episode of extreme or unusual physical activity. This may continue for several years.

Then chondromalacia of the condyles of the knee joint moves into the next stage. In this case, more pronounced clinical symptoms appear:

frequent pain in the knee area;
it intensifies while going up and down the stairs;
an unpleasant crunching sound when moving your leg;
frequent periods of inflammation, manifested in the form of redness of the skin, swelling of soft tissues;
impaired mobility of the lower limb;
slight lameness (the patient tries to place his leg when walking in such a way as to relieve the load on the damaged condyle).

At this stage, with at least partially preserved cartilage layer, treatment without surgery is possible. But for diagnosis, you must first do an MRI scan.

When moving to the third stage, chondromalacia of the medial condyles leads to a significant change in gait - pronounced lameness and a “duck-like” waddle when walking appear. Upon examination, shortening of the limb on the affected side is detected due to deformation of the cartilaginous layer by 1 - 2 cm.

Chondromalacia of the medial condyle of the femur can lead to deformation of the bones of the lower leg, the development of flat feet or clubfoot. Secondary destruction of the hip joint usually begins after 6 to 8 months.

Diagnosis of this disease always begins with a visual examination, palpation of the knee joint and functional tests. After such an examination, an experienced orthopedist can make a preliminary diagnosis and suggest the degree of destruction of the cartilage tissue of the knee. He then orders examinations using X-rays, ultrasounds, MRIs and CT scans. In each clinical case, a set of research methods is always compiled individually. It is important to identify not only the degree of joint destruction, but also the probable reason why the pathological changes occurred. Without eliminating the cause, it is pointless to begin treatment, since the doctor’s efforts will not be crowned with success.

Often, to identify vascular problems, scanning of veins and arteries and angiography are additionally prescribed. To identify diabetic angiopathy, systemic lupus erythematosus, scleroderma, psoriasis and other systemic pathologies, it is necessary to prescribe a biochemical blood test.

Once an accurate diagnosis is made, effective treatment is possible. Until this moment, you can only take measures to eliminate the pain syndrome and stop the pathological destructive process.

Treatment of chondromalacia of the tibial condyles

To treat chondromalacia of the tibia, as well as in the destruction of the cartilaginous layer of the femoral head, conservative therapy and surgery are used. Conservative measures are applied at an early stage. In the city clinic they are symptomatic and are used as a wait-and-see approach. Official medicine considers chondromalacia a continuously progressive and incurable condition. Therefore, the doctor’s efforts are aimed at eliminating the patient’s pain syndrome and, if possible, extending the period of his working capacity. As the joint deteriorates, surgery to replace it will be scheduled.

In manual therapy, a fundamentally different approach is used for conservative treatment. In our clinic, the treatment of chondromalacia of the medial condyle of the tibia and femur is based on the following principles:

identifying and eliminating the potential cause of cartilage tissue destruction;
regeneration of cartilaginous synovial tissue in the articular cavity;
restoration of normal diffuse metabolism and blood supply to hyaline cartilage fibers;
strengthening the performance of muscle fibers;
acceleration of metabolic processes in the affected area;
increasing the overall vitality of the body.

To effectively treat chondromalacia of the tibial and femoral condyles, we use osteopathy, massage, physical therapy, kinesiotherapy, and acupuncture. In some cases, laser treatment helps to quickly restore damaged cartilage layers. Other methods of physiotherapy are also used.

The course of treatment is developed individually. During the first consultation, the doctor conducts an examination and makes a preliminary diagnosis. This allows him to prescribe effective treatment and give the most accurate prognosis for the treatment period.

You can schedule a free initial consultation at our manual therapy clinic. Here you will receive comprehensive information about the possibilities and prospects of treatment using manual therapy methods in your individual case.

Chondromalacia patella is a pathology of the cartilage of the knee joint. A sick patella can significantly impair a person's quality of life. The anatomy of the knee joint is related to this disease as follows.

The kneecap, or patella, is a fairly small element of the knee joint, the anatomy of which is represented by the sesamoid bone, located in front and above the knee joint, above the level of the femoral condyle. The patella, despite its size, plays a critical role in the functions of the knee. The anatomy of the patella provides for its functions such as:

protection of ligaments and other elements of the knee joint from injury;
providing the necessary force to flex the quadriceps femoris muscle.

For severe knee bruises, they may be observedXia fracture, subluxation or dislocation of the patella. In athletic people, habitual luxation of the patella is quite common.

Chondromalacia patella is a common condition in which the cartilage of the posterior surface of the patella is destroyed.

The reasons for this phenomenon may be:

Congenital weakness of the ligament structure, low muscle strength, poorly fixed patella.
Special anatomy of the knee joint (dysplasia), high location of the patella.
Acute dislocation of the patella, after which the ligament was not restored, or long-term and constant trauma, which leads to destruction of tissue structures.

Damage to the cartilage tissue of the articular surface of the patella is called chondromalacia patella. The pathological process can spread to other elements of the femoral-patellar joint, in this case they speak of arthrosis. In both cases, the constant symptom is pain.

Osteochondropathy of the patella is quite common in adolescents. This disease is characterized by severe pain and lameness, and the x-ray shows symptoms of deforming arthrosis and marginal osteophytes (aseptic necrosis). This may resemble a patellar fracture.

Chondromalacia of the patella can develop as a consequence of traumatic injuries, especially if there is often a fracture of the patella or its dislocation. The lateroposition of the patella occupies an important place as a risk factor. As the disease progresses, the patella with localized areas of disarticulation, detachment and softening of the cartilage becomes vulnerable to increasingly extensive damage with defects and dense areas of the subchondral region.

Clinical manifestations of the disease

Chondromalacia is diagnosed if the following symptoms are observed:

Pain in the knee joint (anterior) when running, climbing stairs, squats.
Crepitation (crunching when moving or pressing) in combination with fluid effusion into the cavity of the knee joint, which requires excluding a diagnosis such as a fracture of the patella.
Weakness or atrophic changes in the structure of the quadriceps femoris muscle.
Painful symptoms due to gap narrowing in the femoral-patellar joint during motor activity in the knee joint.

Chondromalacia can develop due to the following reasons:

rapid increase in the volume of physical activity on the patella;
uncomfortable shoes, as well as shoes with too thin soles;
fracture in the knee joint;
chronic overload of the knee joint;
flat feet and hyperpronation (inward tilt) of the feet;
tendinitis.

Diagnosis of pathology

The most commonly used diagnostic method by traumatologists and available to patients, x-ray, unfortunately, is not informative, since chondromalacia is not visible on it. An x-ray can only determine the symptoms of arthrosis or patellar dislocation. To establish a more accurate diagnosis, CT, MRI and ultrasound are used.

A much more informative method for diagnosing this diagnosis is arthroscopy. With its help, it is possible to assess all the components of the knee joint and the degree of damage. Another modern informative method is computer analysis of the patient’s gait, which allows one to analyze the causes of problems.

Based on the results of the arthroscopic examination, the degrees of patellar damage (1, 2, 3 and 4) are determined according to the Outerbridge system. The most severe are grades 3 and 4, the mildest and most treatable are grades 1 and 2. Depending on the shape, location, depth and size of the defect, the following degrees are distinguished:

there are soft areas of thickening, possibly swelling;
characterized by defects up to 1 cm in diameter;
appears as deep cracks with a diameter of more than 1 cm, reaching the bone;
areas of exposed subchondral bone are observed.

The most common are grade 2 and 3 lesions. This is due to the fact that people are in no hurry to seek medical help if minor problems arise. But already at grade 2 or 3 it becomes difficult to perform usual actions.

Chondromalacia patella most often occurs due to trauma or deformation of the lower extremities

Chondromalacia is confirmed when such diagnoses of patellar damage as:

meniscus tear,
bursitis,
deforming osteoarthritis,
tendinitis.

Tendinitis is the development of an inflammatory process in the tendons, most often in the places of their attachment to the bone, but it is possible that the pathology can spread to the muscle itself. Patellar tendinosis (“jumper’s knee”, tendonitis or tendinopathy) is an inflammation of the patellar tendon. It is a tendon of the quadriceps femoris muscle, and is attached to the tibia in front.

Tendinitis can develop:

against the background of an X-shaped or O-shaped curvature of the legs;
with pathological location of the patella;
with flat feet;
as a result of incorrect execution of the exercise with hyperextension of the knee joint;
if there is a simple or habitual dislocation of the patella.

An important role is also played by age-related changes in tendons, when tendonitis is increasingly likely. If there is a damaged patella, then it is important to correctly carry out differential diagnosis, on which treatment will depend. Thus, a fracture of the patella requires immediate immobilization of the joint, dislocation of the patella requires reduction, tendinitis requires anti-inflammatory measures.

Therapeutic measures and prevention

A set of measures to eliminate a disease such as chondromalacia is determined depending on the degree of damage (often 2 or 3). Treatment of patients with such a diagnosis should be comprehensive. It includes:

rest;
non-steroidal anti-inflammatory drugs;
comfortable shoes;
physiological training regimen.

Returning to training is possible only if the symptoms of the disease do not appear during physical activity on the knee joints. In general, exercise, like all treatment, should be supervised by a physiotherapist or sports trainer, who, if necessary, can adjust the exercises according to the degree of the disease. Effective treatment is also achieved through quadriceps strengthening exercises. This muscle is the main one for the knee joint, as it controls the motor activity of the knee. The exercises should certainly not put undue stress on the sore knee or cause pain to the patient. For therapeutic purposes, the following classes are recommended:

on an exercise bike;
swimming;
with a cross-country ski simulator;
isometric exercises to strengthen the quadriceps muscle.

To treat this disease, medication, exercise therapy and physiotherapy are indicated.

In some cases, chondromalacia may require surgical treatment. In such cases, the clinical manifestations resemble a fracture of the patella. This issue is especially relevant at a young age in the presence of prolonged pain, since surgery can significantly alleviate the manifestations of this pathology. Surgical treatment includes the following techniques:

Smoothing the kneecap (the surface of the patella that faces inward).
Relaxation of the tension of the lateral femoral muscles and tightening of the medial muscle.
Implantation of own cartilage tissue.

Chondromalacia will not occur if you follow some recommendations. So, it is necessary to perform exercises to strengthen and stretch the muscles of the thighs and lower legs. It is better to choose shoes with orthopedic inserts to correct gait and posture.

Chondromalacia of the patella is pain that occurs along the front of the joint as a result of mechanical injuries and biomechanical disorders. Wear of articular cartilage on the posterior surface is manifested by inflammation, swelling, destruction and sclerosis of adjacent bone tissue. Many orthopedists make a diagnosis of arthrosis without telling patients what chondromalacia is and leaving no choice for physical therapy.

Chondromalacia patella is one of the most common causes of pain in young, active people. The term comes from the Greek words chondros and malakia, which literally means softening of cartilage. Trauma to the posterior part of the patella affects the movement of the knee joint. The disease must be distinguished from patellofemoral pain syndrome and tendinopathy.

As part of the joint, it allows the quadriceps tendon to slide to perform extension. Any displacement of the trajectory will be reflected on the cartilaginous surface of the patella.

The quadriceps femoris muscle has four heads: rectus, vastus intermedius, vastus lateralis and vastus medialis. Muscles, depending on their location, are joint stabilizers. The wide medial one is needed for the normal position of the patella.

On the lateral side, the knee is affected by the iliotibial band, which becomes tense when the gluteus maximus muscle is weak.

Internal rotation of the femur can lead to injuries to the patella when the angle of flexion of the joint changes. What is important is the Q-angle formed between the line drawn from the ilium and the center of the kneecap, as well as from the center of the knee to the tibial tuberosity. With internal rotation of the femur and adduction, the angle increases and the pressure on the medial structures of the knee also increases.

The etiology of chondromalacia includes trauma, which increases the activity of proteolytic enzymes and leads to instability of the patella and joint. Therefore, the main causes of the disease are:

changes in the relationship between the hip and knee joints;
spasm of the rectus femoris muscle;
tension in the iliotibial band;
overload of the biceps femoris muscle during training;
spasm of the calf muscles and;
pronation of the subtalar joint ();
shortening of the patellar ligaments;
weakness of the vastus lateralis muscle.

The balance between the external and internal muscles of the knee joint is extremely important. Injuries to the hip joint and lower leg increase the risk of chondromalacia. Degenerative changes in articular cartilage are caused by trauma, inflammation and microdamage, patellar dislocations, and pelvic problems.

Degrees of chondromalacia patella

In the early stages, patellar chondropathy is manifested by swelling, which is caused by the accumulation of fluid and thickening of the cartilage. As it progresses, the surface becomes thinner and bone tissue is exposed.

The only method for diagnosing chondromalacia is arthroscopy, which reveals:

thinning of the cartilage layer;
subchondral sclerosis of the periosteum.

MRI shows only severe stages of pathology.

There are four degrees of chondromalacia of the patella:

Softening and swelling of the cartilage due to vertical rupture of collagen fibers corresponds to grade 1. The cartilage takes on the structure of a sponge.
The formation of compactions due to the separation of the superficial and deep layers of cartilage, the affected area is up to 1.5 cubic centimeters. At grade 2, the bone is not yet affected.
The appearance of cracks, exposure of the subchondral part of the bone in approximately 50% of the articular surface, sclerosis and erosive processes. At grade 3, x-rays and MRI reveal osteophytes.
Grade 4 is characterized by extensive cartilage damage of more than 50%, muscle atrophy, pain and medial or lateral displacement of the tibia. An x-ray makes a diagnosis of arthrosis.

Since cartilage does not have nerve endings, damage to it does not lead to pain in the front of the knee. Discomfort is associated with ligament tension and muscle spasm.

Signs on X-ray

The disease is difficult to diagnose only by the symptom of pain in the front of the knee. Patients complain of discomfort and swelling on one side of the patella - inside or outside, which is due to the topography of muscle overload and cartilage damage. With chondromalacia patella 2 degrees, weakness develops when extending the knee.

X-ray signs are usually subtle in the early stages. In the later stages, femoral-patellar arthrosis is determined. Only with severe changes are articular changes such as osteoarthritis and the proliferation of osteophytes detected. The patient needs to know that arthrosis is most often a consequence of impaired joint biomechanics, and not the cause of pain.

The doctor should check the mobility of the patella by moving it left and right. Test the quadriceps femoris muscle for isometric resistance and the symptom will be pain under the kneecap.

The doctor is obliged to study the posture and position of the joint: (turning the knees inward, turning the foot outward), hyperlordosis - all indicate that the joint is suffering due to muscle imbalance.

Treatment of chondromalacia patella

Biomechanical disorders cannot be completely cured with medication. Without exercises and physical therapy, treatment leads to relapses and the development of oateoarthrosis. Therefore, sooner or later, patients are offered surgery. In this case, a chondectomy is performed, which involves removing part of the cartilage, or completely removing the kneecap, which entails weakness. Sometimes chondrocyte transplantation and prosthetics are performed. The choice of how and with what to treat chondromalacia of the patella comes down to passive exposure, which leads to degeneration.

Medications

Non-steroidal anti-inflammatory drugs are prescribed as drug therapy, including intra-articular injections, steroids, and chondroprotectors. The drugs may temporarily reduce pain, but have no therapeutic effect.

Treatment with folk remedies

Folk remedies are relevant for effusion (swelling) and redness. It is important to use ice compresses, when it is wrapped in a towel and applied to the inflamed area for 15 minutes three times a day. It makes no sense to independently treat chondromalacia of the patella with folk remedies, since we are talking about muscle imbalance.

Exercises for chondromalacia patella

Conservative treatment of chondromalacia must necessarily include physical therapy:

short-wave diathermy reduces pain and improves nutrition of cartilage;
Shock wave therapy relieves inflammation and accelerates regeneration.

Exercises for chondromalacia patella are the primary treatment approach to restore joint stability. Isometric exercises to strengthen and stretch the quadriceps muscle should be performed regularly:

Before training, roll the quadriceps and biceps femoris muscles using a bottle filled with warm water or a foam roller.

Prevention

The knee occupies an intermediate position between the feet and the hip joint. Any stress in the upper and lower parts of the limb affects its biomechanics. The best prevention is to avoid high heels, walk, and strengthen the gluteal muscles. When sitting for a long time, you can stand at the back of the chair and move your legs back. At the same time, make sure that the heel points straight up and there is no tension in the lower back.

Conclusion

Chondromalacia of the patella is a thinning of the cartilage caused by an imbalance between the muscles that control the joint. In the short term, you can use painkillers, but the main therapy is therapeutic exercises and walking.

In contact with

Chondromalacia is a change in the structure of cartilage tissue, which becomes thinner and exposes the articular surfaces of the knee joint. Violation of the integrity of the cartilage occurs under the influence of constant physical activity and due to a number of other factors that negatively affect the condition of the knee joint.

Chondromalacia of the knee joint occurs mainly in young people who are actively involved in sports. Elderly people are also susceptible to the disease, since with age the tissues wear out and the knee's resistance to stress sharply decreases. Prolonged walking or standing can provoke an exacerbation in an elderly person.

In children, chondromalacia is observed in extremely rare cases.

Causes and risk group

The onset of the disease is preceded by increased friction of the articular surfaces of the patella and femur. This may be caused by:

trauma - dislocation or fracture of the bones that form the knee joint;
congenital abnormalities of joint development;
excessive physical stress on the lower extremities associated with sports training or work;
weak muscle corset of the thigh and lower leg;
calcium metabolism disorders;
kidney pathologies;
arthritis;
overweight;
rickets suffered in childhood.

Most often, chondromalacia develops as a result of permanent injury to the knee joint. Particularly dangerous is a dislocation of the kneecap, and the lack of adequate treatment for this. Frequent displacement of the patella leads to excessive load on the cartilage, which, in turn, is fraught with its gradual destruction.

Damage to cartilage tissue is also caused by:

improper performance of exercises involving the knee joint;
wearing uncomfortable shoes of the wrong size, with flat soles or high heels;
existing foot deformities – flat feet, inward pronation;
meniscal injuries, patella fractures;
inflammation of ligaments and tendons.

The high-risk group includes people in the following categories:

athletes and manual workers;
women - due to the special structure of the pelvic bones;
elderly people in whom chondromalacia is accompanied by a pathology such as arthritis;
obese people - increasing weight by 10 kg greatly increases the load on the joints.

Symptoms and stages

The clinical picture of the disease is quite clearly expressed; chondromalacia can be suspected based on the following signs:

with active movements of the lower extremities, pain appears. For example, after jogging, squats or climbing a flight of stairs;
pain occurs as a result of sitting for a long time with bent legs;
When walking, it is difficult to straighten your knees completely, as this is accompanied by pain and crunching.

If symptoms appear, a visit to the doctor should not be postponed, since the disease is prone to progression and can cause complications. With serious damage to the cartilage tissue, inflammation often begins, the pain intensifies, and the knee swells.

According to Outerbridge's classification, there are 4 degrees of chondromalacia:

Grade 1 is characterized by the presence of local edema and softening of the cartilage;
with grade 2 chondromalacia, surface disintegration, fragmentation and cracks up to 1.25 cm deep are observed;
chondromalacia grade 3 is characterized by a deepening of the gap, the cartilage tissue cracks to a depth of more than 1.25 cm;
the last, 4th degree is the complete exposure of the subchondral bone, which serves as the foundation of the articular cartilage, due to the destruction of the latter.

At the initial stage of the disease, only discomfort is felt, but when cracks occur, the pain does not go away even at rest. Severe, almost unbearable pain syndrome is observed in grades 3 and 4, when the destruction of cartilage affects the bone. In advanced forms of chondromalacia, the patient loses motor ability because the integrity of the joint is compromised.

Diagnostics

The following methods are used to make a diagnosis:

clinical. Physical examination, specification of symptoms according to the patient, medical history;
ray. X-ray or magnetic resonance imaging;
arthroscopy.

X-rays for chondromalacia are not informative enough, since osteochondral lesions are practically invisible in the images. Therefore, an MRI is prescribed, with which you can see even minor depressions up to 1 mm, and for defects larger than 3 mm, the accuracy of the study approaches 100%. In some cases, diagnosis is only possible using the arthroscopic method.

Treatment

Currently, medical professionals are well aware of what chondromalacia of the knee joint is. With grade 1 or 2, treatment of the disease can be conservative. The exception is when there is severe synovitis, which is accompanied by accumulation of fluid in the joint, or damage to the capsular-ligamentous apparatus is observed.

The main goal of therapy is to return the kneecap to its normal position.

The complex of treatment measures includes:

immobilization of the limb, eliminating any load on the joint;
taking anti-inflammatory non-steroidal drugs. The most effective remedy for chondromalacia is Diclofenac sodium, which the patient takes for a month at a dosage of 100-150 mg per day. Subsequently, the drug is replaced with Diclofenac Retard;
taking chondroprotectors – glucosamine and chondroitin sulfates;
intra-articular injections of drugs based on hyaluronic acid (Osteonil, Sinvisc, Fermatron);
physiotherapy – laser, ultrasound, electro- and phonophoresis, magnetic therapy, ozokerite;
Exercise therapy, swimming (after relieving acute symptoms).

If an inflammatory process has begun in the joint, then glucocorticosteroids, B vitamins and analgesics are additionally prescribed. This is followed by long-term treatment with chondroprotectors. It should be noted that the latest generation of drugs can reduce the duration of therapy while maintaining its effectiveness. These drugs include Teraflex Advance and Movex.

After relief of pain and inflammation, as well as in the case of complete restoration of the function of the knee joint, the patient can return to the normal rhythm of life and engage in physical activity. If discomfort in the knee persists, then after 2 or 3 months a second course of treatment is carried out. During this period, physical activity should be limited.

In case of low effectiveness of therapy or complete absence of positive dynamics, the patient is sent to a hospital where surgical intervention is performed.

Surgery

For chondromalacia of any degree, surgery always begins with arthroscopy to visually assess the severity and location of articular cartilage damage. The diagnostic procedure lasts only a few minutes, then proceed directly to endoscopy.

If stage 1 of the disease is detected, the joint cavity is washed with sodium chloride solution. In stages 2 and 3, the affected areas of cartilage tissue are removed, and if necessary, damaged fragments of nearby tissue are also excised. Then, using special tools, the surface of the joint is leveled, and the joint is washed with two to three liters of saline solution.

Stage 4 chondromalacia is characterized by a large affected area and exposed bone. Surgical procedures not only remove damaged cartilage, but also create conditions for normalizing microcirculation. To do this, holes up to 4 mm deep are made in the subchondral bone at a distance of 3-4 mm from each other. Thus, the pressure in the bone is reduced and sufficient oxygen is supplied to the tissues. It should be noted that in case of inflammation in the joint, such an operation is not performed.

Autoplasty

The essence of the operation is the replacement of cartilage with a graft, which is taken from the healthy parts of the patient’s outer and inner femoral condyles. During diagnostic arthroscopy, loose bodies are removed from the joint cavity, and the question of the method of surgical intervention is decided.

The operation can be performed endoscopically or through an incision (arthrotomy). After eliminating the defect of the articular surface, the reliability of fixation of the grafts is checked during passive movements of the knee joint. Then the joint is drained and the incision is sutured layer by layer.

If 1 or 2 grafts are transplanted, limb immobilization is not required. In case of transplantation of 3 or more grafts, a plaster splint is applied.

Rehabilitation

After arthroscopy, immobilization of the leg is not required, and the patient is allowed minor loads on the fourth day. If subchondral bone tunneling was used, you can move your leg only after a week.

Full restoration of motor ability occurs on average within a month; during the rehabilitation period, physiotherapy, exercise therapy and limb massage are also carried out.

After autoplasty, patients are given injections of antibiotics for 3 days, as well as painkillers. You can get up using crutches in a day or two. Dosed loads on the limb are allowed after one and a half months.

When the plaster is removed, rehabilitation measures begin, including therapeutic exercises to strengthen muscles, physiotherapy and massage. You can put weight on the limb and move independently no earlier than 2 months after surgery. All this time, the patient must wear an orthosis or an elastic bandage, and also use a cane.

Traditional methods

Home remedies can help relieve the condition by reducing pain and inflammation. On the first day after an injury or exacerbation of the disease, you need to apply ice or a cold compress to the sore spot. This will reduce blood flow to the knee joint and prevent swelling.

In the future, on the contrary, dry heat will be useful - it helps improve blood circulation in the joint tissues.

There are several effective recipes, the components of which can be found in every home:

onion. A decoction of this vegetable is prepared as follows: chop two onions and cook in a liter of water over low heat for an hour. Onion broth is consumed one glass a day before meals;
cabbage. A cabbage leaf compress is made at night, tied to the sore knee. Before use, the sheet needs to be slightly wrinkled;
lemon. The recipe is very simple - cut a lemon and rub it on the sore spot;
vegetable oil. Rub slightly warmed sunflower or olive oil into the knee joint with massage movements;
propolis. A small amount of this product should be rubbed into the joint; just two tablespoons will be enough.

If a patient is diagnosed with arthritis, then tinctures, decoctions and compresses based on the following components will help prevent the development of chondromalacia:

birch buds, 1 tbsp. l. and 100 gr. mix alcohol and leave for about 3 weeks. Then strain and drink a teaspoon 3 times a day. It is better to dilute the tincture with water before use. This product is also used for rubbing the knee;
lingonberry leaves, 2 tbsp. l. pour a glass of water and simmer over low heat for several minutes. Can be consumed immediately after cooling at any time;
Grate raw potatoes and place on a bandage or gauze. Apply the compress to the joint and wrap a bandage on top. This procedure is best done at night for maximum effect. The treatment course lasts a week;
Wash fresh burdock leaves thoroughly with soap to remove waxy deposits, and warm them up a little - this will make the plant more effective. Before applying burdock to your leg, you need to lubricate it with vegetable oil, and apply the plant with the smooth side to the skin. Cover the top of the sheet with a cloth or bandage. This compress is also best done at night, but the course of treatment is longer, lasting 3 or 4 weeks;
A decoction of bay leaves will help prevent the accumulation of salt in the body. To prepare the drink you will need 20 leaves and ½ liter of water. Boil the mixture and leave for 2-3 hours. Drink the decoction for 3 days without restrictions, then take a break for a week.

It should be borne in mind that home remedies are not always harmless, and you should consult a doctor before using them. Bee products can cause allergies, and medicinal herbs can change the effectiveness of medications.

Prevention measures

high-quality and comfortable shoes are the key to healthy feet, so you need to choose shoes and boots strictly according to size and take into account the degree of their comfort. High heels can only be worn for a few hours a day to prevent the development of pathologies of the lower extremities. The same applies to flat-soled shoes - ballet flats, sneakers and a variety of frog slippers, appropriate exclusively in resort areas;
special attention should be paid to physical education, not ignoring them, but also not overworking during training. If there is a high load on the joints, it is better to play it safe and wear knee pads or an elastic bandage. This will help prevent sports injuries;
at the beginning of training, regardless of the sport, you must do a warm-up. Performing light exercises activates blood circulation, prepares muscles for stress and prevents injury to the ligamentous apparatus and joints;
when performing household work, you need to avoid sudden movements while lifting weights, and when carrying heavy bags, distribute the load evenly on both hands;
If symptoms such as pain and discomfort in the knee appear, as well as swelling, redness, limited movement in the joint and crunching, this is a reason to visit a doctor. The sooner treatment is started, the higher the chance of a favorable prognosis and full recovery.

It must be remembered that after treatment, even conservative ones, the load on the lower limbs should be increased gradually. Hiking, swimming, and riding an exercise bike will be very useful. It is also recommended to use a device that simulates cross-country skiing. Spa treatment will help improve your health and maintain the healing effect. The attending physician will tell you what procedures are needed and where it is best to go.

What is chondromalacia patella: symptoms and treatment of the knee joint

The patella is the upper part of the knee joint, the main function of which is to protect articular fragments from injury and mechanical damage. The destruction of cartilage tissue and degenerative-dystrophic changes in the dorsal surfaces of the joint are called chondromalacia of the patella in medicine. The main cause of deformation of the knee joint is regular physical activity.

This disease is most often diagnosed in athletes. The second, popular name for the disease is “twisted knee.” Often, chondromalacia of the patella is a consequence of a knee joint injury, dislocation or subluxation. Treatment of the disease is usually long-term, requiring attention and patience.

How to recognize the disease

Chondromalacia of the knee joint manifests itself as follows:

Frequent aching pain in the knee area, which becomes more intense with physical activity;
Slight stiffness in the knee joint during flexion, extension, and squats;
Pain when staying in one position for a long time, for example, squatting. If you change your position, the pain decreases;
Sometimes swelling and swelling of the joint;
With intense movements, crunching and cracking in the joint.

The last symptom indicates that the disease is progressing. Chondromalacia of the patella of this degree requires immediate treatment. As load distribution is disrupted, atrophy of the quadriceps femoris muscle may develop. And this will inevitably lead to limited functionality of the limb.

Important information: if chondromalacia of the knee joint is suspected, an x-ray or ultrasound is required. With such an examination, a chondromic body is often found in the cavity of the knee joint. This suggests that another disease is developing - chondromatosis of the knee.

The formation of a chondromic body can be caused by the following factors:

Injuries and mechanical damage to the kneecap.
Changes in the structure of the bone tissue of the knee.
Tumors in the synovium of the knee joint.

The chondromic body is found mainly in men aged 25 to 50 years.

To accurately determine the extent of the changes and determine the optimal treatment, diagnostic methods such as computed tomography and magnetic resonance imaging are used.

Chondromatosis of the hip joint

Physical activity often leads to pain in the hip joint. The causes of pain can be very different:

Sprained or torn ligaments and muscles;
Severe bruise, fracture or dislocation of the articular bone;
Chronic diseases of the musculoskeletal system.

Regardless of the severity of the injury and the intensity of pain, it is necessary to be examined by a traumatologist. Treatment will be more effective and faster if it is started as early as possible, avoiding complications. You should be especially concerned if the pain radiates to the knee joint, and vice versa - pain in the knee radiates to the hip.

If chondromalacia patella is diagnosed in a professional athlete, it is necessary to adjust the training schedule and workload for the period while treatment is being carried out. Physical activity cannot be completely eliminated to avoid muscle atrophy. But the loads must be strictly dosed.

In case of grade 1 chondromalacia of the knee, treatment with anti-inflammatory non-steroidal drugs is sufficient to relieve the inflammatory process and reduce pain. They are usually taken for 7-10 days - this is enough for the complete restoration of articular surfaces and bone tissue. You can include painkillers in your course for joint pain.

If grade 2 chondromalacia of the knee joint is diagnosed, surgical treatment is necessary. During the operation, the deformed patella is returned to its normal position relative to the femur.

After surgical treatment, the patient must undergo a rehabilitation course to fully restore the functionality of the limb.

How is chondromalacia patella treated?

In addition to medication, treatment of this disease using trusted folk recipes is very effective. In the first two days after an injury or exacerbation of the disease, ice and cold compresses are applied to the affected knee.

This helps relieve pain, reduces blood flow to the joint and prevents swelling.

Then, on the contrary, heat should be applied to improve microcirculation of blood and lymph in the joint tissues. You can try these popular recipes based on medicinal plants:

Chop two onions, add a liter of water and cook over low heat for at least 1 hour. The resulting decoction is consumed daily, 200 ml. before every meal.
Cut the lemon into halves. Rub the kneecap with half a lemon.
Unrefined sunflower oil should be thoroughly warmed, take 2 tablespoons and rub into the knee until the substance is completely absorbed.
For swelling and pain, cool the cabbage leaf, mash it a little and wrap it around the sore knee overnight.
Rubbing and massage of the knee joint with arthrosis with propolis will help relieve inflammation and pain. You need to rub in a tablespoon of the product until completely absorbed.

It is a mistake to believe that treatment with traditional methods is completely safe. Medicinal herbs can also cause allergic reactions; they have many contraindications, and in case of overdose they can cause serious poisoning and deterioration of the patient’s well-being.

In addition, some herbs and substances can increase or decrease the effectiveness of medications. Therefore, it is not recommended to start a course of treatment with folk remedies without consultation and agreement with a doctor.

Prevention and rehabilitation

After treatment for joint diseases is completed, a rehabilitation course is always carried out to completely restore the functions of the limbs and prevent relapse. At the first stage, physical activity should be moderate and should be increased gradually.

Hiking, outdoor exercise, and swimming are recommended. Rest in medical institutions of the resort-sanatorium type has a general strengthening effect. The attending physician can tell you which institution is best to purchase a ticket to and what health program to choose.

A general term for damage to the cartilage under the kneecap. In the international classification of diseases ICD-10 it is assigned the code M94.2.

Cartilage acts as a shock absorber, absorbing shock, and allows pain-free sliding between the groove of the kneecap and the femur. Over time or due to injury, this cartilage wears out or softens, causing friction between the articular surfaces and inflammation, which leads to the development of chondromalacia of the femoral and tibial condyles.

A more precise term for this phenomenon is patellofemoral pain syndrome, which means that chondromalacia affects not only the patella, but also the ankle and hip joints. Chondromalacia of the ankle joint occurs less frequently than chondromalacia of the patella.

Causes of the disease

The patella normally sits above the knee joint. When you bend the knee, the back of the kneecap slides over the femoral cartilage in the knee. Tendons and ligaments connect the kneecap to the tibia and femur muscles. When one of these components does not function properly, it can cause the kneecap to rub against the femur. This pathology can lead to destruction of the kneecap - Chondromalacia patella 1st degree.

Causes of abnormal movement of the kneecap:

its congenital malposition;
weak hamstrings and quadriceps muscles;
imbalance in the functioning of the adductor and abductor muscles;
repetitive stress on the knee joints, such as from running, jumping or skiing;
direct blow or injury to the kneecap.

Risk factors

There are a number of factors that increase the risk of developing chondromalacia patella.

Age. Adolescents are at risk for this disease. During growth spurts in children, muscles and bones develop very quickly, which can lead to temporary muscle imbalances.
Floor. Chondromalacia of the femoral condyles is more common in women than in men due to lower muscle mass.
Flat feet may add additional stress to the knee joints.
Previous injuries. Knee injuries, such as dislocations, can increase the risk of developing grade 2 chondromalacia patella.
Meniscectomy, removal of the articular meniscus can provoke flattening of the femoral condyles and narrowing of the joint space.
Arthritis. Chondromalacia of the internal condyle of the femur can be a symptom of arthritis, a disease associated with inflammation of the joint surfaces and tissues. Inflammation prevents the kneecap from functioning properly.

Very often, people involved in a car accident chondromalacia is diagnosed medial condyle of the femur. The injury is the result of a strong impact with the dashboard of the car.

Symptoms

Chondromalacia of the knee joint cartilage is usually accompanied by dull, aching pain in front of the knee. The pain intensifies when going up or down stairs. When bending or straightening the knee, the patient complains of a grinding or crunching sensation, but this is not always an indicator of destruction of cartilage tissue. The pain may also worsen with prolonged sitting or during activities that place excessive stress on the joints, such as long periods of standing or certain exercises. In some cases, the affected knee may appear inflamed and swollen.

You should see a doctor if knee pain does not go away within a few days.

Diagnosis and stages of disease development

The doctor will examine the affected area for swelling, tenderness, deformity, and compare the affected knee with the healthy one. He may also check how symmetrical the kneecap is in relation to the femur, as misalignment may be a sign of chondromalacia of the knee.

To determine the sensitivity and severity of the disease the doctor performs palpation with pressure on the extended knee and may also ask if there has been any bleeding or inflammation in the knee area.

After this, the doctor will suggest additional diagnostic examinations:

X-ray most often used only to determine the cause of pain, to detect arthritis, bone destruction or misalignment of the kneecap;
Arthroscopy, a minimally invasive procedure to visually inspect the medial femoral condyle and the knee as a whole from the inside. It is performed by inserting an endoscope, a flexible tube with a camera, into the knee joint. This method is used only to confirm chondromalacia.
MRI images clearly show what the affected area looks like and the degree of its destruction; for example, with chondromalacia, the doctor may notice pathological softening of the lateral condyle of the femur.

There are four degrees of chondromalacia patella:

1st degree has softening of the patellar cartilage;
2nd degree: softening of the cartilage with abnormal cavity characteristics, the beginning of tissue erosion. Chondromalacia of the medial femoral condyle, grade 2, is often the result of excessive sports training, so it is necessary to take a break of several days in between;
3rd degree characterized by thinning of cartilage and active tissue destruction;
the heaviest 4th degree means significant destruction of cartilage, medial condyle, exposure of bone, that is, friction of two bones against each other.

Treatment of chondromalacia

The goal of treatment for chondromalacia is reducing the load on the kneecap and joint. Rest, immobility of the limb, and application of ice may be the first stage of treatment. Cartilage damage often heals on its own with proper rest. Your doctor may prescribe an anti-inflammatory medication, such as Ibuprofen, for several weeks to relieve swelling and inflammation around the joint.

Treatment with traditional methods for chondromalacia The tibia is also aimed at relieving inflammation and reducing pain with the help of cold compresses and ointments.

Physiotherapy

Chondromalacia of the articular surfaces of the knee joints is usually treated medication in combination with special exercises in less than a few months. The speed of recovery depends on how soon you start exercising.

Physical exercises are aimed at strengthening the quadriceps, hamstrings, adductors and abductors. Healthy muscle tone helps prevent kneecap misalignment. Exercise therapy includes swimming, riding an exercise bike and completely avoiding weight lifting. Additionally, grade 3 chondromalacia patella may involve sequential tension and relaxation of the muscles, which helps maintain muscle mass.

Surgery

Due to the fact that articular cartilage takes a long time to regenerate, chondromalacia can become a permanent problem. However, non-surgical treatment can often relieve pain for several months. You should consult with your doctor whether grade 4 chondromalacia of the patella can be cured without surgery, but most often such methods do not help, and the doctor will suggest surgery to remove the affected area of cartilage.

Before this, a procedure such as arthroscopy, which is necessary to examine the joint and clarify the skew or asymmetry of the patella. For this procedure, a camera is inserted into the joint through a small incision. Another routine procedure is superficial resection, cutting several ligaments, which will relieve tension and allow the knee to function normally. Other surgical options include realigning the back of the kneecap, placing a cartilage graft, or repositioning the insertion of the femoral muscle.

Prevention

There are a huge number of different sets of exercises for chondromalacia of the knee. Here are some of them:

While sitting on a chair, slightly extend your leg forward and hold it in this position for 5 seconds. Switch legs.
Lying on your back on a bed or soft floor, slowly lift one leg half a meter up, then slowly lower it. Then the other leg.
Try Pilates. Do exercises for 30-50 minutes, skip those exercises that cause pain.
Swim with a swimboard and fins. Vigorous, low-effort swimming will strengthen your quadriceps and hamstrings.
Walk on the asphalt less, walk in the park on the grass and along paths in the forest. Alternate between walking and jogging in flat shoes.
When it becomes easier to move, you can engage in more active sports, play soccer with your children, or ditch the frisbee.
If your knees begin to bear the load, try exercises on a leg press machine. Bend your knees relative to your toes at an angle of no more than 40-45 degrees to stimulate the quadriceps muscles.