Chondromalacia, retropatellar pain

Young, teenager patients often complaint of anterior knee pain, that is caused by the softening of the cartilage (chondromalacia), as the structure of the cartilage and its nutrition is affected, and/or the tracking of the kneecap is abnormal

This quite frequently occurring syndrome still does not have a clear scientific explanation. A young, active sportsmen/woman complaining of a dull retropatellar pain on one or both legs might only need a slight modification in the training plan. Chronic anterior knee pain is, however, still quite often worrying many young patients (mostly females). Continuing the sports activity does not necessarily mean that they would do any severe damage to their joints, but may become more painful. In most of the cases plain pain management proves to be sufficient and no surgery is needed. Patients, however, have to be referred to a specialist to make sure no other symptom is present provoking the pain. Pain below the kneecap, clicking, popping, locking or shooting pain may indicate a wholly different symptom.

It is quite helpful if the patient would summarize the duration of the symptoms, how it is related with any physical activity, sports, shoe wear, or the treadmill used for training, whether there is any provoking movement. A plain physical examination is usually sufficient to decide if there is any accompanying abnormality in the knee joint.

Usual examinations:

 ·        Assessment of the axis of the extremities

·        Checking stability, range of motion

·        Assessing retro patellar sensitivity

·        Measuring muscle strength of the limb

·        Assessment of the major joints, as hip, knee, ankle

·        Taking x-ray if appropriate 

Susceptibility

Knee has a fairly complicated anatomy, allowing wide range of motion along with massive resistance against loads, but is very sensitive to any changes in the axis of the lower limb. Even the slight patella mal-tracking would cause severe pain behind the kneecap.

Many other factors will contribute in teenagers:

 ·        Cross legs, hyperrotation in the hip joints

·        Tight muscles in the thigh

·        Physical exertion, or inappropriate training techniques

·        Severe collision or fall on the knee  In the abovementioned cases specialist (orthopedic surgeon) is to be visited. 

Prevention is highly recommended:

 ·        Proper shoe wear

·        Stretching exercises before any serious physical activities

·        Avoiding pain provoking exercises

·        Decreasing the distance of running on both training and race

Complaints

Pain develops gradually, often crepitation is present, even subtle clicking noise may occur, especially on the stairs, or following long sitting period. Pain may increase with cyclic knee bending exercises, like jumping, squatting, running, etc.  If pain is present for an extended period the muscles of the thigh may get atrophic, and it may occasionally seem to give way.  

Options for treatment

Rest, ice, physiotherapy are the main measures, and anti inflammatory drugs (e.g., diclofenac, ibuprofen, etc.,) and certain dietary supplements (glucosamine, chondrioitin sulfate) may be prescribed temporarily.

Ice: ice wrapped up in a towel may be appropriate in acute pain to treat inflammation and swelling of the joint.

Rest: until the damaged tissues recover full restriction of painful sport activity may be advised. All training exercises must be reconsidered and avoided if provokes pain. The exercises must fully follow the proper description.  In case of any overweight loss of a few pounds may be very beneficial. Patella fixing rubber band or brace is quite helpful sometimes.

Rehabilitation: once all pain is gone one may need an appropriate rehabilitation training program to restore the original strength, coordination, and range of motion in the affected knee. Most appropriate if the training is performed under physiotherapist’s supervision (eg. water aerobic, cycling) and a slow gradual return to sport activity.