Chondromalacia patellae, or patellar pain syndrome, is a degenerative lesion that affects the cartilage on the articular surface of the patella.
The incidence of this injury in adolescents and young adults responds to stimuli of overload and overpressure in the knee, while in older people degenerative diseases such as osteoarthritis are responsible for the wear and tear of the articular cartilage. In both cases in greater in women than in men.
Main symptoms
Pain in the front of the knee, typically related to physical activity and worse when going up and down stairs or when running on hard surfaces. This pain also increases after a prolonged knee flexion (when driving, at the movies, bending over ...). In these cases the pain is accompanied by a feeling of stiffness and difficulty in extending the knee.
During flexion-extension movements of the knee, rubbing and clicking of the patella on the femur frequently occurs.
We can also appreciate quadriceps weakness, especially the vastus medialis
Shortening of the posterior muscle chain, which will contribute to abnormal femoro-patellar biomechanics, in the hamstrings, triceps sural, fascia lata ...
The main tools to detect a patellofemoral syndrome are exploratory tests such as Zohlen's, Smillie's and Farbank's Apprehension, which will be used to detect abnormalities in the patellar cartilage and also imaging tests, such as X-rays or MRI .
Causes
The causes of patellar chondropathy can be mechanical (misalignment), post-traumatic (patella fractures, chondral contusion, etc.), inflammatory, degenerative, post-immobilization, overtraining, etc. Ultimately, the cause of this injury is multifactorial, it is believed that the overuse of the joints can cause accelerated wear, the patella rubbing against the lower end of the femur when the knee moves.
Likewise, other factors can negatively influence cartilage wear:
Overweight
Use of inappropriate footwear
Muscle atrophy or weakness
Shortening of the muscles of the back of the thigh
Knees in X (valgus)
Structural abnormalities of the patella
Uneven legs in length
Exaggerated curve in the spine
Alterations in the biomechanics of gait and running
Treatment
In the acute phase, the treatment will be anti-inflammatory and analgesic with the use of manual techniques, such as osteopathy, myofascial release, massage therapy, gentle stretching ... and electrotherapy techniques such as magnetotherapy, TENS currents.
In a second phase, treatment will focus on muscle enhancement, improvement of the biomechanics of the patella and muscle flexibility, through the use of Global Postural Reeducation RPG®, proprioception training or the McConnell Method, among others.
In short, consider that it is important to carry out a global examination of the patient, assessing the patient in his entire structure, knowing his postural, work, sports, eating habits ... to know the exact cause of the injury and correct it.
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