Chondromalacia of the medial femoral condyle, grade 4. Chondromalacia of the knee joint - what is it and how to treat it? Symptoms of chondromalacia patella

The femur is the largest tubular bone in the body. Its distal end expands and passes into two condyles - medial and lateral, which are provided with articular surfaces with chondral, necessary for articulation with the tibia and patella, forming the knee joint. The latter is a place for intense physical activity and frequent injuries. As a result of this, both the bone components of the joint and its cartilaginous layers suffer. A common occurrence is the connection (including the internal and external condyles), which will be discussed in this article.

The destruction of chondral tissue in the knee is called chondromalacia. The joint sometimes remains intact. In some cases, it occurs against the background of osteoarthritis and arthritis.

Classification

In order to assess damage to cartilage tissue in traumatological practice, there is an appropriate classification, which is based on the degree of cartilage destruction. It is mainly used in practical orthopedics:

• 1st degree. The cartilaginous layer is at the initial stage of softening and in a state of edema.
• 2nd degree. The chondral tissue cracks, and the cartilaginous plane separates into isolated fibers. At this stage, only a small area of ​​cartilage is affected - up to 12.5 mm.
• 3rd degree. Cracking and intensive layer-by-layer separation into fibers are observed. The affected area already exceeds 12.5 mm.
• 4th degree. Destruction reaches bone formation, and a significant cartilaginous defect develops.

Symptomatic picture

The clinical picture consists of the following manifestations:

1. Pain syndrome. It can be aching or acute in nature, similar to spasms. In some cases, the articular joint hurts exclusively on the front surface (in the case of involvement of the patella) or on the side (depending on the lesion of the lateral or medial condyle), and sometimes the entire plane of the knee.
2. A feeling of crunching when performing motor acts (while going up or down the stairs).
3. Joint blockade. They are called “soft” due to the erased clinic.
4. Slight limitation of mobility. Often the amplitude of motor acts remains in full, however, at the III-IV stage. may be slightly limited.
5. Swelling of the knee joint. Develops due to the possible presence of an inflammatory process.
6. Instability in the joint. In some variants, it is subjectively described as slipping. It is observed in 30% of cases.

Diagnosis

The main way to confirm the diagnosis is arthroscopy, which is an examination of the joint cavity through an endoscope, and MRI, and it is also possible to make a diagnosis based on X-ray data.

Therapeutic measures

Therapeutic measures are already necessary even with the initial degree of the destructive process, since after the latter the process of damage to the bone component begins, which leads to deforming osteoarthritis of the knee joint.

Often the destruction is accompanied by an inflammatory process in the inner synovial membrane).

Fluid sometimes accumulates in the cavity, which leads to aggravation of the process.

The treatment complex consists of conservative and surgical techniques.

Conservative treatment

This therapy is effective in the initial stages of the disease (grades I and II). In this case, physiotherapeutic procedures are used in combination with medications.

1. Physiotherapy and exercise therapy. It is recommended to limit physical activity on the arterial joint. During exercise therapy, it is recommended to pay attention to exercises to strengthen the 4th femoris muscle. Physiotherapy includes magnetotherapy, ultrasound and laser therapy.
2. Drug treatment. The basic pharmaceuticals are NVSP (diclofenac, nimesulide and their analogues). They help relieve the inflammatory process in the area of ​​the knee joints, which relieves pain. Treatment courses with these drugs can be both long and short in order to quickly relieve the symptomatic picture. In this case, it is necessary to take into account the side effects of these drugs.

Chondroprotectors based on chondroitin and glucosamine are also used. In some cases, drug therapy is combined with hyaluronic acid. The administration in this case is exclusively intra-articular and is carried out over a long period.

Surgery

At stages IV and III of chondral destruction, surgical intervention is mainly indicated.

A preliminary assessment of the degree of cartilage damage is required. This is done during diagnostic arthroscopy, which also allows you to determine the tactics of the surgical procedure.

Postoperative period

Its duration depends on the type of surgical procedure. During endoscopic surgery, the patient spends no more than 7 days in the hospital, after which outpatient treatment is provided.

Full physical exercise is allowed from 3-4 weeks. The limb is not immobilized. With complete dissection of the articular joint, the postoperative period is significantly lengthened.

In the case of osteochondral plastic surgery, it is necessary to apply a plaster cast to the lower limb for a period of up to a month, and moderate physical activity is allowed only after six weeks.

After any surgical intervention, rehabilitation procedures are prescribed in the form of physiotherapeutic procedures, exercise therapy and swimming in a pool.

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Therapy in the final stages of chondromalacia Chondromalacia of the patella and knee - manifestations

Chondromalacia of the patella and knee joint is a common disease among athletes and people leading an active lifestyle. In pathology, damage occurs to the hyaline cartilage covering the articular surfaces of these structures. Over time, the cartilage becomes thinner, and in severe cases, it is completely worn down to bone tissue.

To understand the essence of the disease, it is necessary to study the basic anatomy of the knee joint:

• Three bones are involved in its formation - tibia, femur and patella;
• The articular surfaces are perfectly smooth and covered with soft hyaline cartilage, which ensures their smooth gliding. Its wear is prevented by a special synovial fluid that is constantly produced;

Interesting!

The role of the patella is very important - thanks to it, the tendon of the quadriceps femoris muscle is thrown over the joint. During extension of the leg, it slides along the articular elements of adjacent bones.

Chondromalacia of the knee is often confused with a disease such as chondromatosis, in which the synovial membrane of the joint degenerates into cartilaginous tissue. Chondromatosis rarely causes severe pain. Only with the growth of bone elements instead of synovium. You should also know the difference between chondromalacia and osteochondropathy - this pathology is characterized by the destruction of spongy bone with the formation of microfractures.

Let's take a closer look at chondromalacia of the knee joint - what it is, diagnostic methods and treatment principles.

Etiology

The main reasons for the development of chondromalacia are:

• Acute injuries of the knee joint;
• Congenital deformities of the joints of the lower limb;
• Imbalance of thigh muscle tone;
• Constant stress on the knees during sports and during work;
• Fractures and cracks of bone elements included in the joint;
• Dislocations and subluxations of the knees.

According to foreign clinicians, there are risk groups for developing chondromalacia of the knee joint:

• Gender – in women, pathology develops more often than in men, since their muscles are less developed. This results in greater lateral deviation of the patella during ankle extension;
• Age – chondromalacia is detected in all age periods, but more often develops in children or adolescents. During active bone growth, a redistribution of muscle mass and changes in the structure of cartilage tissue occur;
• People suffering from arthritis - with inflammation in the joint, swelling develops, which promotes friction of the cartilage against adjacent tissues, increasing injury with the subsequent development of chondromalacia of the articular cartilage;
• Flat feet - with this disease, the knee joint experiences more stress than normal;
• Active sports that put stress on the knees;
• Injuries suffered.

How does pathology develop?

In a healthy person, during extension of the leg, the kneecap slides relative to the condyles of the femur; the rubbing elements of these formations are covered with smooth hyaline cartilage. The development of pathology begins under the influence of causal factors that lead to deviation of the patella to the side - its sliding occurs relative to the bone tissue. Gradually, the hyaline coating on it becomes thinner and deformed, and every movement in the knee causes pain. This is how chondromalacia of the patella develops.

Sometimes damage to the cartilage covering of the femur occurs and pathology occurs on their surface:

• Chondromalacia of the lateral condyle develops when the tibia deviates to the side, which leads to increased stress and wear of the cartilage;
• Due to certain factors, all articular elements are involved in the pathology and the medial condyle of the femur may be damaged.

Classification

According to ICD 10 code, this pathology corresponds to nomenclature 94.2 - “Chondromalacia”. Based on the degree of damage, there are four degrees of the disease:

• I – during this period, the first signs of chondromalacia of the cartilage surfaces appear. Clinical manifestations are mild or absent;
• II – cartilage delaminations appear, small cracks form, damage to which leads to severe pain;
• III – irreversible destruction of cartilage, some areas of damage reach bone tissue;
• IV – the appearance of large zones of destruction, physiological restoration of the articular elements is impossible.

Clinical picture

The kneecap is most often affected because it experiences intense pressure when the quadriceps muscle contracts. The stages of chondromalacia of the patella do not differ from the classic manifestations of pathology. Common symptoms are:

• Pain in the joint, manifested at rest;
• Discomfort increases with physical activity and while standing on the sore leg;
• Symptoms may gradually worsen or disappear depending on weather conditions;
• During movement, a characteristic crunching sound is heard in the knee.

Interesting!

Extraneous sounds indicate that small growths or deformations are forming on the hyaline cartilage of the joint.

Clinical manifestations of pathology as the disease progresses:

• Chondromalacia of the knee joint 1st degree. Latent period – patients are not bothered by any serious complaints, and small clicks or crunches in the joint after dynamic loads do not attract attention. Pain can only occur with certain movements, when strong pressure is applied to the softened cartilage tissue;
• Chondromalacia grade 2 is characterized by increased pain after physical activity that puts stress on the knees (squats, quickly climbing stairs). On external examination, the appearance of swelling and redness is noted;
• Chondromalacia 3rd degree. During this period, irreversible disorders occur, manifested by a corresponding clinical picture. Pathology can occur in two forms. Acute – swelling and redness of soft tissues, the appearance of pain at rest, which limits mobility. The patient is unable to perform a squat. Chronic - in this form, the pain is weak, aching, and intensifies with physical activity or when climbing stairs. Extraneous movements in the joint periodically occur;
• Chondromalacia grade 4 is an advanced stage of the disease. It is difficult for the patient to move independently; externally, the knees are swollen and red. Any movement of the legs or touching the affected area causes pain.

Complications

The most serious consequence of the disease is the destruction of the knee joint, a gradual impairment of mobility followed by its absence and the development of disability. The gradual progression of the pathology leads to the formation of chronic subluxations and the development of instability of the knee joint.

Diagnostics

The main rule for successful treatment of chondromalacia of the knee joint is the rapid identification of pathology. If you suspect this disease, you should consult an orthopedist. The doctor will ask you about your complaints, conduct an external examination and prescribe instrumental research methods.

With chondromalacia, already from stage 2, swelling of the knees, impaired movement, and sometimes redness of the affected area are noted.

An X-ray examination is prescribed to determine indirect signs of chondromalacia. The photographs show a decrease in the joint space - a very important point that indicates the erasure of hyaline cartilage. If the kneecap is damaged, it may be displaced in a direct projection.

Magnetic resonance imaging - indicated to determine the integrity of soft tissues, as well as signs of inflammation. MRI perfectly visualizes cartilage deformations and the presence of complications.

Arthroscopy - penetration into the joint using an arthroscope, on which a small camera is placed to take pictures. The method is painless and is performed under local anesthesia. Allows you to make a final diagnosis.

Is it possible to play sports

Chondromalacia of the knee is a serious disease that leads to abrasion and destruction of hyaline cartilage, a decrease in the joint space, and the development of deformities with subsequent instability in the joint. Accordingly, the greater the load on the knees, the more their surfaces wear out. Therefore, sports such as football, jumping, running and weightlifting are strictly prohibited. It is recommended to replace them with swimming, cycling, and pull-ups.

Squats with chondromalacia are prohibited, especially with a barbell. Neglecting these rules may lead to disability.

Treatment

Therapy for this pathology takes a comprehensive approach depending on the progression of the disease. At the initial stages, articular lesions are reversible and minor, so only conservative therapy is indicated. In later stages, anesthesia of the affected area is required, as well as surgical intervention.

Treatment of chondromalacia 1st degree

At the initial stage of pathology, the following is prescribed:

• Taking chondroprotectors (Arthra, Teraflex) to restore joint tissue, as well as increase the production of synovial fluid;
• A complex of physical therapy to improve blood flow, strengthen cartilage and ligaments;
• Massage of the affected area ensures normalization of blood circulation and accelerates the healing process;
• Changing physical activity from dynamic to static loads to unload the knees (replace running with swimming, football with an exercise bike);
• Mandatory wearing of fixing bandages, orthoses, bandages is necessary to fix the joint in a physiological position, as well as to evenly distribute the vertical load on its tissues;
• The use of physiotherapeutic treatment - the most popular at this stage are warming procedures that improve blood circulation.

Therapy at stages 2-3-4

Treatment of chondromalacia of the patella of the 2nd degree requires more serious actions - there is a need to relieve inflammation, and if there are deformities, an operation to remove them. Main therapeutic measures:

• Drug treatment – ​​taking painkillers. Nonsteroidal anti-inflammatory drugs (Ibuprofen, Naproxen, Voltaren), and if they are ineffective, corticosteroids (Prednisolone, Hydrocortisone). For severe pain - intra-articular injections of hyaluronic acid to ensure the production of synovial fluid and relieve inflammatory manifestations;
• Some physiotherapeutic methods - the most popular is medicinal electrophoresis with the use of anti-inflammatory drugs. Shock wave therapy, which increases cartilage regeneration, will also be useful;
• Surgical treatment is indicated for pronounced structural changes in joint tissue. The surgical approach includes several types of manipulations: removal of deformed areas, smoothing of cartilaginous surfaces, excision of the thigh muscles to correct the position of the patella, and implantation.

At stage 4 of chondromalacia, several of the above operations are usually performed.

Traditional methods of treatment

Chondromalacia of the knee joint cannot be cured with the recipes of traditional healers, but it is possible to relieve the symptoms of inflammation and get temporary relief. Can be used as an addition to conservative therapy.

The most popular home methods:

• Applying ice to reduce pain and inflammation;
• Compress from burdock, cinquefoil or chestnut root in alcohol;
• The analgesic effect can be achieved by applying fresh cabbage leaves, grated potatoes or beets to the knees;
• Applying fresh lemon juice to the skin of the knees;
• For general strengthening of the body, it is recommended to drink herbal teas based on chicory, ginger or lingonberries.

Clinicians strongly discourage self-diagnosis and treatment only according to prescriptions from traditional healers. Chondromalacia of the knee can lead to serious complications. And timely treatment guarantees a favorable prognosis.

Knee pain and discomfort when walking occur equally often in both young and elderly people. Pain always indicates a problem in that area. The cause of discomfort can be a large number of ailments. One of the insidious diseases is chondromalacia of the knee joint. To make an accurate diagnosis and effective treatment, it is necessary to seek help from a specialist as soon as the first symptoms appear.

Chondromalacia of the knee joint- called the destruction of the cartilage of the articular surface of the popliteus. When there is excessive load on the cartilage lining, its integrity is violated. The severity of the damage depends on the degree of the disease.

The cartilage tissue may soften a little, and in difficult cases, the depleted cartilage exposes the knee joint, which leads to a through-and-through defect. Degenerative changes occur from external environmental influences and internal disorders in the body.

The disease progresses severely, as evidenced by pain and discomfort when moving. The severity of the disease depends on the degree of destruction of the knee joint.

Chondromalacia of the knee mainly affects people who regularly expose the knee joint to stress. Athletes, hockey players, football players and other athletes, regularly overloading the joint, unnoticed by themselves and others, always suffer from similar problems in the future.

When a load is placed on the knee joint, the cartilage becomes deformed, and over time, the bone tissue softens and the knee joint becomes completely exposed.

Elderly people are no less susceptible to the disease; their tissues wear out, and even long walking leads to severe stress on the knee. The disease in older people is often accompanied by deformation of other parts of the bone skeleton and many concomitant diseases.

At the same time, it becomes more difficult to establish a diagnosis and treatment usually takes a long time.

TO main reasons Chondromalacia of the knee joint includes:

— Acute injury;

— Regular dislocations and injuries of the knee;

— Fractures and injuries of adjacent bones;

— Regular load on the joint;

— Imbalance of muscle tone;

— Deformation of joint development from birth;

The result of rickets at any age and abnormal development of the joint and adjacent cartilage.

Symptoms and degrees of chondromalacia of the knee

Symptoms of the disease appear depending on the severity.

There is an Outerbridge system, according to which the disease is divided into four degrees of complexity:

• Grade 1 is the beginning of deformation; soft seals appear on the surface of the joint, which do not cause pain, but are characterized by discomfort in the affected area.

There is no swelling in the knee area, as inflammation is just beginning to develop. On palpation, especially when pressing, pain appears.

• Grade 2 is characterized by the appearance of a gap in the cartilage and a depression of up to 1 cm.

The pain occurs with sudden movements and does not go away for some time at rest. Swelling and redness appear in the affected area, especially if the disease is a consequence of injury.

• Grade 3 is manifested by a crack of 1 cm with a gap to the bone.

The pain in this case does not cease to bother you in any condition. The acute form passes with obvious signs of inflammation, the chronic form is accompanied by severe pain and crunching when moving.

• Grade 4 is the most advanced, with complete deformation leading to open and unprotected exposure of the subchondral bone of the knee joint.

When the disease is advanced, there is no motor activity due to severe pain and disruption of the integrity of the joint.

With each day the disease progresses, the pain in the knee intensifies, in addition, as the lumen increases, the pain syndrome becomes more pronounced.

The main symptoms of chondromalacia of the knee include:

• Pain in the affected area during movement and at rest;
• Discomfort and increased pain when bending and straightening the knee;
• The pain increases gradually and may bother you from time to time for a year or more;
• Crunching in the knee when moving the leg;
• Pain when putting weight on the affected leg;
• Painful sensations during prolonged rest.

Treatment methods for chondromalacia of the knee joint

There are two main ways to restore a damaged joint - conservative treatment and surgery.

Treatment of chondromalacia begins with conservative treatment methods. The treatment regimen depends on the severity and condition of the patient.

Treatment is aimed at pain relief and relieving inflammation, this is done with the help of local analgesics and non-steroidal anti-inflammatory drugs. In advanced cases, sodium hyoluronate preparations are injected into the joint cavity to accelerate tissue regeneration.

After the swelling is removed, restorative therapy is carried out to restore joint mobility and restore muscle tissue. While taking medications, the motor activity of the leg is stopped, the leg is fixed with a splint or elastic bandage without tightening. This helps to quickly relieve swelling and relieve pain. After the inflammatory process is relieved, the knee begins to be developed using simple therapeutic exercises. Therapeutic exercise helps restore muscle tone and strengthen bone tissue.

To keep the joint in a stable position, especially after an injury or complex dislocation, special knee pads are placed on the knee.

The process of regeneration of bone tissue and cartilage is a long and complex process, so you should not expect a quick recovery. But if there is no positive dynamics over the course of several months or the patient’s condition worsens, it remains to resort to surgical intervention.

Exists several methods of surgical treatment of chondromalacia First of all, arthroscopy is performed, which is less invasive and allows you to inspect the joint, assess the degree of damage and partially align the deformed areas.

During arthroscopy, local lavage is also performed near the articular surface and bursa; this helps remove local inflammation, but there is a risk of it occurring again.

Lavage and removal of growths are relevant only for the first two degrees of severity. In the third and fourth stages, joint plastic surgery is performed, restoring the correct anatomical location of the components of the knee joint.

In case of complications and concomitant diseases, patellectomy and surface contouring are performed.

With full access, cartilage tissue that cannot be restored is removed, and the gap exposing the bone is closed with an implant. When chondromalacia is associated with improper positioning of the bone articulation, the correct position is surgically restored and the articular joints are fixed.

Since the knee joint cannot be completely immobilized, using a new technique, bone marrow stem cells are introduced into the joint cavity, which trigger the process of natural regeneration. The ability to recover decreases over the years, so this method is used for patients under 30 years of age.

For the older generation, an implant is used, taken from a healthy area and transplanted onto a surface cleared of dead tissue.

This method also has contraindications:

• History of osteoarthritis;
• Previous interventions, in particular meniscus removal;
• Joint instability due to previous injuries.

In addition to contraindications to healthy tissue transplantation, there is a risk of complications at the donor site. The operation is quite complex and requires considerable skill and precision in movements from the doctor. The surface for transplantation must be completely disinfected to avoid future inflammation and recurrent chondromalacia.

An implant for transplantation is almost always used from one person; in rare cases, someone else can become a donor, but in this case there is a high risk of rejection of the implant by the immune system and the occurrence of irreversible consequences.

Prognosis for recovery

Even a specialist cannot give accurate forecasts for recovery. A progressive process, like a chronic disease, is quite difficult to stop. How the body behaves and how it responds to treatment depends on physiological characteristics. One thing is certain: the earlier the disease is detected, the greater the chances of a positive result.

Chondromalacia can be cured completely if you consult a specialist in time and follow all his instructions. It’s not worth expecting a quick result; the recovery process is long and difficult. After medicinal aphids and surgical treatment, there will be difficult and long-term rehabilitation, which is the main way to restore mobility and performance of the knee joint.

Prevention

The disease can be avoided if you adhere to a number of rules:

1. When performing strength loads and playing sports, always do a warm-up to warm up the muscles and elasticity of the ligaments, this will help prevent injuries and reduce the load on the cartilage tissue.

2. Regular exercises aimed at strengthening and toning muscle tissue to maintain the stability of the knee joint.

3. Prevent sudden loads on the legs; when performing exercises, distribute the load over the entire body and increase the tension gradually.

4. Avoid sudden weight gain; excess weight is always dangerous for joints; gaining excess weight only increases the volume of soft tissues.

5. Comfortable shoes are extremely important not only for the knee joint, but also for the legs in general. Special insoles are able to evenly distribute the load and prevent unnecessary stress.

6. If any pain or discomfort occurs, you should seek help from a specialist.

Timely examination and treatment of any injuries can prevent the development of complications and illnesses such as chondromalacia.

Chondromalacia patella is diagnosed when the articular cartilage of the lower portion of the kneecap wears or softens. The deviation is popularly known as. This pathological process leads to frequent inflammatory reactions in the condyle area. Chondromalacia of the 1st degree may not be observed by a person for a long time, since no characteristic symptoms are felt. Subsequent softening causes constant pain in the patient, which intensifies with prolonged walking or playing sports.

The patella cartilage is often damaged in people in their 20s who are actively involved in sports.

Why is it developing?

Chondromalacia of the articular surfaces manifests itself in childhood and adulthood. The disease is associated with exposure to various negative factors. The deviation occurs due to constant friction of the patella on the joint of the femur. Damage to the kneecap is associated with the following disorders:

• Incorrectly selected shoes for sports. In this case, there is a negative effect on the area of ​​the knee and hip joint.
• Strengthening exercises, in particular running.
• Deformed structures of the lower extremities. Acquired or congenital pathology leads to chondromalacia of the medial condyle.
• Lateroposition of the patella. With pathology, the structure shifts from the middle position to the outer part of the knee.
• Obesity. The presence of excess weight provokes increased pressure on the area of ​​the tibia and ankle joint. Due to constant stress on the legs, cartilage and ligaments quickly wear out.
• Weakened elastic abilities of the muscles and regular dislocations. Pathological conditions negatively affect the patella, leading to chondromalacia.
• Leg injuries. If a person does not use special fixators and protective equipment during sports activities, then damage to the medial facet and other structures of the knee occurs.
• Arthrosis and other joint disorders in the patella area.

Degrees of chondromalacia patella

Already from the second stage of the disease, with sudden movement a person feels pain in the knee area.

Chondromalacia of the knee joint goes through 4 stages, each of which manifests itself with characteristic symptoms. For a long time, the clinical picture of the pathology is not observed. Pathological manifestations are observed, as a rule, at stage 2 of the disease. The table shows the stages of the disease and the characteristic features of each:

Stage	Slot size	Peculiarities
I	Absent	The deformation process begins
		A small seal forms on the upper part of the patella, which does not cause an attack of pain.
		No swelling of the knee joint
II	No more than 1 cm	Sudden movements cause severe pain that does not go away in a calm state
		Severe swelling in the damaged area
III	More than 10 mm with clearance to the bone	The pain becomes permanent
		Chronic inflammatory response
		Crunching and clicking noise when moving
IV		Unprotected exposure of the subchondral bone of the knee joint

If grade 3 chondromalacia of the patella is not treated in time, the disease becomes chronic and irreversible processes occur. In this case, it is extremely difficult to restore motor function even surgically.

Main symptoms

If the disease progresses, the person's kneecap swells.

At first, a person is bothered by superficial pain, which occurs exclusively during physical activity. As the disease progresses, the joints of the hip and knee are damaged. The patient feels pain attacks even at rest. In the future, chondromalacia leads to the development of the following symptoms:

• clicking sounds during physical activity;
• inflammatory process in the area of ​​the patella and internal condyle;
• swelling of the kneecap;
• local increase in temperature;
• redness of the skin in the affected area.

How is diagnosis carried out?

A person may not immediately suspect that the articular surface of the patella has weakened and softened. In the early stages of the disease, no clinical signs appear. Only the attending physician can establish an accurate diagnosis after conducting a comprehensive examination. In case of chondromalacia, consult an orthopedist, traumatologist, or rheumatologist. The doctor examines the damaged patella and collects a detailed medical history. The patient is required to undergo the following instrumental examinations:

• CT and MRI;
• ultrasound diagnostics;
• arthroscopy;
• radiography.

Treatment: basic methods

The painful joint must be secured with an elastic bandage.

Chondromalacia of the patella in children and adults requires complex therapy. It is important to reduce the load and avoid overstraining not only the knees, but also the wrists and other joints of the body. It is also necessary to secure the movable joint with an elastic bandage and other fasteners. Conservative treatment of chondromalacia includes the use of medications presented in the table:

Medicines are not effective in grade 4 chondromalacia. At a severe stage, drugs are used as an adjuvant measure to surgical therapy.

Surgical intervention

Usually the problem is solved through surgery.

Surgery is the main way to get rid of chondromalacia. Lateral release and other types of interventions are also prescribed for impaired function of the lower limb. Surgery is performed in several ways:

• Tunneling. A light surgical intervention in which the surgeon creates special channels in the bone tissues adjacent to the patella. The technique reduces pressure on the patella and restores microcirculation, supplying the tissues with oxygen. One day after the operation, you can walk independently.
• Chondroplasty. It is possible to effectively restore the tissue of the patella. During manipulation, damaged areas are replaced with prostheses. After surgery, the patient is no longer bothered by pain and the leg moves normally.
• Microfracture. The procedure is aimed at natural stimulation of the production of cartilage tissue. Surgical intervention is used for grade 3-4 chondromalacia, when the pathological process has reached the bone.
• Chondrocyte transplantation. Surgery is performed when there is extensive damage to cartilage tissue. An arthroscopy technique is used, in which healthy tissue cells are obtained and created in the laboratory. They are then returned to the affected area, after which the regeneration process occurs.

Recovery period

After conservative and surgical treatment, a patient who has been diagnosed with chondromalacia of the knee joint must undergo mandatory rehabilitation. Such measures are necessary to prevent relapse and restore motor activity. During the recovery period, it is necessary to strengthen the ligamentous apparatus of the patella and adjacent muscles. For this purpose, the following physiotherapy procedures are prescribed:

To restore the functions of the joint, the patient may be prescribed mud therapy procedures.

• electrophoresis;
• phonophoresis;
• UHF therapy;
• mud therapy;
• ultrasound therapy.

It is important to perform special gymnastic exercises prescribed to each patient with chondromalacia individually. Light tasks that do not overload the patella are performed first. In the future, the intensity and number of approaches increases. Exercises on simulators are added, performed under the supervision of a rehabilitation specialist. During rehabilitation, the patient must take medications of various effects.

Massage procedures and kinesitherapy are effective in recovery after treatment of chondromalacia of the patella.

It is possible to prevent chondromalacia of the patella by choosing the right shoes during sports activities. It is equally important to warm up and stretch thoroughly before exercise. It is worth eating right and watching out for excess weight, which puts increased stress on the kneecaps. Women are not recommended to wear high heels and wedges for long periods of time. If arthrosis and other disorders in the knee joint develop, it is necessary to consult a doctor and receive timely treatment.

Chondromalacia of the patella is a disease caused by degenerative changes in cartilage tissue. This condition is accompanied by loss of elasticity. The cartilage becomes less elastic and gradually collapses. As the structure of the knee joint changes, pain appears. They are provoked by increased stress placed on the underlying bone.

Reasons for development

You need to imagine where exactly the changes are happening. Cartilage itself does not have innervation; therefore, the symptoms of the disease appear when excess load is placed on the bone. Cartilage tissue has a smooth surface and is elastic, which allows the joint to actively move. This is a kind of connecting layer between the femur, tibia and kneecap.

Chondromalacia begins to develop from degenerative processes of the cartilage of the posterior surface of the patellas. Depletion of cartilage tissue can also occur in other areas of the femoral-patellar joint. To prevent this from happening, it is recommended to begin treatment for kneecap cartilage in a timely manner. Degenerative processes can be stopped using complex therapy. However, if the factors contributing to the development of this pathological condition are not eliminated, after some time you will have to face this disease again.

If chondromalacia of the patella is diagnosed, the causes of this pathology may be the following:

1. Increased physical stress on the joints. Professional athletes in running and jumping usually find themselves in such conditions. Changes in cartilage tissue begin with regular intensive work of the joints of the lower extremities in flexion and extension.
2. Anatomical features. Women are more prone to the development of degenerative processes in the structure of the tissues of the knee joints than men.
3. Pathologies diagnosed at birth. Displacement of the kneecap is the most common.
4. Muscle hypotonia (quadriceps). In this case, movement of the joint may become difficult due to weakness in the tissues that support the kneecap.
5. Muscle imbalance. In this condition, chondromalacia of the knee develops due to differences in load levels. The muscles of the outer thigh are much more developed than the inner thigh.
6. Injury that led to disruption of the integrity of cartilage tissue. This risk is present if the exercises are performed incorrectly.
7. Repeated deformation of the patella cartilage can also provoke the disease.
8. Age-related changes. In older people, the pathology develops against the background of arthritis. In most cases, the degenerative condition of cartilage is diagnosed in young people and adolescents.

Degrees of the disease

Chondromalacia develops gradually. In this case, the degenerative process goes through 4 stages. Each of them is accompanied by different symptoms, which is due to the deterioration of the patient’s condition. Degrees of chondromalacia:

1. First. In patients with grade 1 joint pathology, thickening of some areas of cartilage tissue appears. They are soft to the touch. In addition, swellings form on the cartilage. At this stage of development of the pathology, the first signs appear - pain, but so far they are not intense. In this case, on the recommendation of the attending physician, the joint cavity is washed.
2. Second. If treatment was not carried out at stage 1 of the knee joint pathology, degenerative processes will continue to develop. In patients with grade 2 pathology, significant depressions and gaps up to 1 cm in size appear in the cartilage tissue. Such deformations lead to severe pain, which is often chronic. The second degree of the disease is diagnosed more often in athletes who ignore the discomfort that appears at the initial stage of development of degenerative processes. In this case, a resection procedure may be recommended - a surgical intervention in which damaged areas of cartilage are excised with special scissors. After this, washing the joint is indicated, as in the first stage of the disease.
3. Third. In this case, the cartilage tissue is more deformed. In patients with grade 3 joint pathology, cracks and depressions larger than 1 cm in size appear in the connective tissues. Sometimes the cartilage is deformed so severely that the bone is exposed. If the question of how to treat grade 3 pathology is being decided, it should be taken into account that the resection procedure in this case is ineffective. Joint plastic surgery is often required, in which pathologically altered tissues are replaced with healthy ones.
4. Fourth. This is the most serious stage in the development of degenerative processes. In patients with grade 4 pathology, exposure of the subchondral bone is noted.

Symptoms

Based on a number of signs, one can suspect the development of a degenerative process in the structure of the knee joint. Symptoms of chondromalacia patella are few. Some of them appear infrequently under the influence of a number of factors: varying degrees of intensity of deformation of cartilage tissue, the general condition of the patient’s body and the type of his activity. The symptoms are as follows:

1. Pain syndrome. In the early stages of the development of the pathology, mild pain is noted and occurs periodically. As the situation worsens, the discomfort in the joint increases. The pain becomes intense and appears after physical exertion.
2. Swelling. This is one of the signs of chondromalacia, but it does not always occur. Most often, edema develops after physical exertion on the lower extremities.
3. Atypical. If previously the patient periodically experienced specific sounds when bending the knee joint and this was associated with physiological characteristics, then there is no reason to worry. In the case when the crunch appears as a result of exposure to excess loads, this may be a cause for concern against the background of other symptoms: swelling, pain.

Factors that contribute to discomfort in the patella area: gymnastics (certain exercises, such as squats), running, climbing stairs, the need to frequently kneel, and playing sports that place increased stress on the joints of the lower extremities. Pain may occur when sitting for a long time (in an airplane, car, office). Excess weight also provokes the development of chondromalacia.

Diagnosis and prognosis

The doctor conducts an external examination; by palpation, swelling and swelling of the tissues can be detected. The main diagnostic methods for knee joint pathology:

• radiography, and the procedure is carried out in the axial projection (legs bend at the knees at an angle of 45°);
• using CT and MRI, changes in the position of the patella (tilt or subluxation) are detected;
• arthroscopy of the knee joint - is prescribed in cases where there are signs of the development of arthrosis; this procedure makes it possible to determine the severity of the pathological condition.

The prognosis for this disease is positive. If you start treatment in a timely manner, you can gradually restore elasticity to cartilage tissue, strength and endurance to muscles. If the recommendations are followed, the cartilage is restored to its original state.

Patients who play sports can actually regain their dexterity and speed of movement.

Therapeutic measures

Based on the diagnostic results, the severity of the disease is determined. In most cases, good results can be achieved with conservative treatment. It includes a number of activities:

• taking painkillers and non-steroidal anti-inflammatory drugs, which can help stop the development of pathological processes and relieve discomfort;
• therapeutic physical education (PT), in this case it is important to do the exercises correctly so as not to aggravate the condition of the knee joint.

During exercise therapy, a specialist performs gymnastics aimed at strengthening muscles. Moreover, it is important that the exercises are not dynamic, but static in nature. For chondromalacia of the patella, it is recommended to use a bandage that fixes the joint. This measure will remove excess load from the cartilage tissue and the kneecap. The bandage fixes the joint in the correct position, which eliminates the formation of subluxation.

While the knee is recovering, stop training and remove any physical activity. In cases where conservative treatment does not produce the desired results, the situation is corrected by surgical intervention. The choice of procedure is determined by the condition of the damaged cartilage tissue. In addition, you can relieve symptoms of this pathology using traditional methods:

1. Cold is applied to the inflamed joint; prolonged exposure to low temperatures will ensure the outflow of blood from the affected tissues.
2. Treating the knee joint with lemon juice. Thanks to this, it becomes possible to reduce pain.
3. Onion broth. It is prepared from 2 onions and 1 liter of water. The onion is peeled, finely chopped, then the components are combined and boiled. You should drink the medicine three times a day, 200 g each. The duration of taking the decoction is 1 week.
4. Sunflower oil. You only need 1 tbsp. l. The oil is heated and rubbed into the knee joint.
5. If swelling develops, apply fresh one. This should be done before bedtime. The swelling will go away overnight. It is recommended to fix the sheet on the leg with a bandage.
6. Propolis can be rubbed into the knee joint. For this purpose prepare 1 tbsp. l. substances. It is rubbed in a circular motion without putting pressure on the affected area.

You should not rely only on folk recipes. With their help, it is impossible to completely cure chondromalacia of the patella.

Home remedies help relieve discomfort, swelling, pain, but do not solve the problem of developing pathology.

In cases where it is not possible to completely eliminate factors that contribute to the appearance of degenerative processes in the structure of the cartilage, difficulties arise in the future when moving the knee joint: it is problematic to climb stairs, squat, or play sports.