Chondromalacia Patella – Best Brace, Treatment, Exercises & Prevention Plan

Knee pain is a daunting experience and it can be caused by chondromalacia patellae. Frontal achy pain, clicking sound while bending the knee, and swelling are few primary symptoms of this condition.

Chondromalacia patellae is one of the most common reasons for anterior knee pain and the statistics show that it is noted in almost every fourth person in the United States. [01]

Knee braces, straps and supports are commonly recommended parts of the rehabilitation and knee injury treatment. Active participation in the sport involves running, turning, suddenly stopping and starting again. These activities greatly affect the health of knee and demand knee support.

Knee brace help to support the tendons and muscles around the knee joint. They can be used as a prophylactic measure to avoid knee injuries or as a part of treatment to prevent the relapse of injury. [02]

Along with the use of best knee braces for chondromalacia patella, medical intervention, and proper exercises found to be beneficial to reduce the pain and enhance the cure. [03]

Though the early use of knee brace date back to 1967, advancement in the technology results in several types of knee braces that serve for different purposes.

BioSkin Compression Knee Wrap

Best fits for: Knee stability in cases of patella tracking disorder, patellofemoral pain, patellar tendonitis, and chondromalacia patella.

Type of brace: Wrap-around brace.

Pros: Multifunctional brace with great paddings, made from the latex-free & neoprene material (hypoallergenic), wrap around the knee and compress, stabilize and helps to reduce the knee pain. When the knee is flexed, it achieves the greater dynamic force which results in reducing the pain. Currently, the brace is available in six different sizes.

Cons: One size small – Need to buy one or two sizes up than the recommended size chart by the manufacturer.

Sizing Chart:

BioSkin Knee Brace Sizing chart

Shop BioSkin Knee Brace on Amazon

DonJoy Performance WEBTECH Knee Support

Best fits for: Light to moderate knee support, playing outdoor games like soccer, running, etc., patellofemoral pain, chondromalacia patella, sports injuries to the knee, and degenerative conditions of the knee joint.

Pros: Made with patented silicone web technology that absorbs the shock, improve fit & articulation of knee joint, breathable & comfortable back pads, easy to wear and take off, added reflective material that enhances visibility during low lights, a preventive brace that can be used while running and playing soccer.

Cons: Velcro has less life than overall brace. It does not hold after using it for a few weeks.

Shop DonJoy Knee Brace on Amazon

What is Chondromalacia Patella?

Chondromalacia patella is a condition affecting the knee joint, characterized by damage to the knee cartilage located underneath the patella, or the kneecap.

The condition is also known as patellofemoral pain syndrome, runner’s knee, and patellar chondromalacia. Repetitive knee motion causes the knee cartilage damage that leads to the chondromalacia patella.[04]

Underneath the kneecap there is a cartilage layer that helps the knee joint function properly, working as a shock-absorbent during movement. However, due to overuse, poor muscle control of the leg and hips, as well as, knee trauma can lead to patellar chondromalacia.

The cartilage underneath the kneecap softens and weakens, a degeneration occurring due to improper alignment of the kneecap with the femur, or the thigh bone.

Normally, the kneecap is pulled over the end of the femur by the quadriceps muscle in a straight line. When this does not occur, and the kneecap is pulled toward the outer side of the femur, patellar chondromalacia develops.

As the undersurface of the patella grates along the femur, it causes chronic inflammation and knee pain.

SummaryChondromalacia patella is caused by a repetitive motion damaging the knee cartilage, such as running and commonly caused as Runner’s knee. It more common in women than in men and mostly diagnosed among young and sporty people.

People who are at a greater risk of developing this condition are:

  • Females – as they have less muscle mass compared to males.
  • Adolescents & young adults – are more likely to develop this condition. However, chondromalacia patella can affect even the elderly, especially those who have rheumatoid arthritis.
  • Flat – feet – increases the risk for chondromalacia patella as it increases the pressure on the knee joint.
  • Previous knee injuries – especially injuries to the kneecap, such as kneecap dislocations increase the risk for chondromalacia patella significantly.
  • People with unusually shaped patellar under surface.

Causes of Chondromalacia Patellae

In order to fully understand the chondromalacia patella and its causes, first let’s understand what patella is, how it normally works and what are its functions.

The patella is a triangular-shaped bone located in the patella groove in the front of the femur, sitting inside the quadriceps muscles. It is a small bone that moves up and down with every knee movement.

The thickest cartilages in the human body line the patella ensuring that this small bone glides smoothly over the knee with every knee movement.

The patella works as a shock absorber helping the knee joint function properly.

In cases when, the kneecap rubs against the femur, instead of smoothly gliding over them, chondromalacia patella develops.

Common causes of chondromalacia patella include:

  • Leg and knee overuse.
  • Muscle imbalance.
  • Flat feet.
  • Poor kneecap alignment.

Leg and knee overuse are some of the causes of chondromalacia patella, such as while jumping, twisting the legs, running, etc.

Muscle imbalance is another cause of chondromalacia patella. Due to muscle imbalance, mostly weakness of the muscles inside of the knee and muscle tightness on the outer side of the knee, the kneecap position in its groove is affected.

Also, the kneecap instead of gliding easily up and down this groove, it gets pulled on the sides, causing friction of the kneecap and damaging the cartilage underneath the kneecap.

Muscle imbalance between the hamstrings and quadriceps muscles located in the back and the front of the thighs can lead to the development of this condition as well, and not only muscle imbalance between the adductor and abductor muscles located on the outer and inner side of the thighs.

Flat feet changes the distribution of forces and pressure through the knee, damaging the cartilage located underneath the kneecap.

Poor kneecap alignment is a condition characterized by a misalignment of the patella. Instead of its position inside the groove, the patella is located either too high or too low.

Sometimes, this is a problem present even at birth, but which doesn’t get diagnosed until adolescence when the first symptoms of chondromalacia patella start appearing.

Certain types of sports can lead to chondromalacia patella as well. In these cases, just taking some rest for a couple of days and not training can help relieve the signs and symptoms. In other cases, proper medical treatment is required to fully recover.

Sign & Symptoms

Common sign and symptoms of chondromalacia patella include:

  • Knee pain
  • Swelling of the knee
  • Grinding/clicking noise while moving the affected knee
  • A sensation of tightness in the knee area
  • A sensation of fullness in the knee area
  • Leg weakness
  • Knee pain is located at the front of the knee joint, in the area around the patella.

This pain tends to get worse with some movements such as while climbing the stairs or descending them, kneeling, sitting with a bent knee for a long period of time, squatting, etc.

Knee pain due to chondromalacia patella also tends to get worse after resting for a prolonged period of time. The knee pain is achy rather than sharp knee pain.

The swelling of the knee is usually minor and occurring around the patella.

A grinding/clicking noise, medically known as crepitus usually accompanies this condition.

A sensation of tightness in the knee area, as well as, a sensation of fullness in the knee area develops usually due to swelling of the knee, which doesn’t allow the knee joint to function normally.

Grading

Based on the severity of the condition, there are 4 grades of chondromalacia patella:

Grade I – Softening of the cartilage underneath the kneecap.

Grade II – Softening of the cartilage & abnormal surface of the cartilage

Grade III – Thinning of the cartilage & active deterioration of the tissue.

Grade IV – Significant deterioration of the cartilage & bone to bone rubbing. This is the most severe grade.

Treatment Options

The goal of the treatment in cases of chondromalacia patella is to create a straight and more natural way for the patella to follow with every knee movement.

As the patella is moved with every knee movement from the quadriceps muscles, it is very important to strengthen the inner portion of the quadriceps muscle. Strengthening this muscle will help normalize the patella tracking.

In most cases, conservative treatment for chondromalacia patella is very effective.

Conservative treatment options include:

  • PRICE
  • Physical therapy
  • Shoe inserts
  • Medications
  • Knee braces
  • Knee pads
  • Surgery

PRICE – which means protection, rest, ice, compress and elevate, is one of the first measures when it comes to the treatment of knee problems including chondromalacia patella.

Physical Therapy – It is focused on strengthening the muscles of the leg and thigh which move the kneecap with every knee joint movement. In order to build up the muscle mass of the adductor, abductor, quadriceps and hamstring muscles of the leg and thigh, various exercises are recommended by a physical therapist.

Shoe Inserts – These are especially beneficial in cases of flat feet. These shoe inserts, also known as orthotics are insoles that help correct flat feet, reducing the force and pressure through the kneecap.

Medication – Usually NSAIDs (Non – steroidal anti-inflammatory drugs) such as Ibuprofen are recommended in cases of knee pain.

Knee Braces – These knee braces work by protecting the knee joint, improving patellar tracking and reducing the inflammation around the patella at the same time.

Knee Pads – Often, bending your knees or kneeling is something that we can’t avoid. If your job requires to constantly kneel, such as in cases of carpenters, then always wear knee pads, as they can help you minimize the pressure on patella.

Surgery – In cases when the conservative treatment methods fail to provide relief, surgical treatment of the affected knee is necessary.​ Arthroscopy is a minimally invasive surgical procedure during which a surgeon with the help of a small camera can remove any fragments of the damaged cartilage and repair those damages. In severe cases, a surgical procedure to realign the kneecap and ease the pressure on the cartilage underneath the kneecap is necessary.

Chondromalacia Patellae Exercises

In general, exercises for chondromalacia patella aim to strengthen the leg and hip muscles, without increasing the pressure on the knee joint.

Here are some great exercises for chondromalacia patella which you can benefit from:

Straight Leg Lift:

  • Lie down on the ground, keeping one leg bent at 90-degree angle and the other one fully extended.
  • Tighten the quadriceps muscle of the leg that you have fully extended and raise the leg to a 45-degree angle slowly.
  • Hold the leg in that position for a couple of seconds, slowly return the leg to the starting position.
  • Repeat this exercise 20 times, Switch the legs and repeat 2 or 3 sets of straight leg lift a day.

Wall Slide:

  • Stand and press your back and butt against the wall while keeping your heels about 6 inches away from the wall.
  • Keep your feet about one foot apart, slowly slide down until your knees are bent at a 45-degree angle.
  • Hold your body in that position for a couple of seconds, slowly side back up to the starting position.
  • Don’t bend too quickly or too deeply as it will make your condition worse, irritating, even more, the knee.
  • Repeat this exercise 10 to 15 times.

External Hip Rotation:

  • Lie on your side on the floor. The affected knee should be pointed toward the ceiling.
  • Open and close the legs just like clamshells, while keeping your heels close together then relax
  • Repeat this exercise for about 10 times.

Quadriceps Contractions:

  • Sit, keeping your legs extended in front of you, slide a towel or blanket under the knee.
  • Lift your feet off the ground so that your knees are fully straightened, hold the knee in this position for a couple of seconds.
  • Relax the quadriceps muscles, slowly return the leg to the starting position. Repeat this exercise 10 times.
  • Switch the legs and repeat this exercise 3 to 5 times a day.

Dumbbell Deadlifts:

  • Stand and pick the dumbbells, hold the dumbbells in front of you. Keeping your feet shoulder-width apart, slowly lower the dumbbells.
  • Keep your chest and head up, your back straight and your weights close to your body.
  • Bend your knees slightly but not that much, once you have lowered the weights slowly extend the knees, hips, and waist.
  • Repeat the exercise 3 to 6 times.

How to Prevent Chondromalacia Patellae?

The following tips can help you prevent chondromalacia patella:

Strengthen your muscles with regular exercise, especially the quadriceps, the hamstring, the adductor and the abductor muscles of your body.

By strengthening these muscles you will have a better body balance, preventing damage to the cartilage located underneath the patella.

Treat flat feet – If you have a problem with flat feet you should wear shoe inserts. By wearing these shoe inserts regularly, the pressure on the knees will be reduced, preventing this way chondromalacia patella from occurring.

Reduce knee stress– Avoid repeated stress on your knees and kneecaps. If you have a job that requires a lot of kneeling, you should wear kneepads.

If you are overweight or obese you should try losing some weight as soon as possible. Extra body weight will put extra pressure on your knees, normally leading to many health problems, including chondromalacia patella when it comes to the knees.

Losing weight is often not an easy thing to do, but a drastic change of the diet which will include healthy fruits and vegetables and a lot of fluids will give you the desired results.

Avoid snacks, canned and processed foods, fast foods, alcoholic beverages, sodas, etc. Also, physical activity is very important when it comes to losing weight.

Be active as much as possible and don’t spend your days sitting or lying down on a sofa in front of a TV. Instead, go for a walk, go to the gym or play a sport that you like. Soon you will notice the pounds melting.

Be patient and consistent. By losing those extra pounds you will do goods to your body, including your knees. Losing weight will help prevent chondromalacia patella.

Related posts:

References:
[01] Laprade J, Culham E, Brouwer B (1998) Comparison of five isometric exercises in the recruitment of the vastus medialis oblique in persons with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther 27: 197–204 doi: 10.2519/jospt.1998.27.3.197
[02] Kelvin T. L. Chew, MD Henry L. Lew, MD, PhD. Elaine Date, MD. Michael Fredericson, MD. Current Evidence and Clinical Applications of Therapeutic Knee Braces. doi: 10.1097/PHM.0b013e318114e416
[03] Lee Herrington and Abdullah Al-Sherhi, A controlled trial of weight-bearing versus non-weight-bearing exercises for patellofemoral pain.. doi: 10.2519/jospt.2007.2433
[04] Guy’s and St Thomas’ NHS Foundation Trust. Patello-femoral pain (PFP). Ref: https://www.guysandstthomas.nhs.uk/

Leave a Comment