CHONDROMALACIA PATELLA (ANTERIOR KNEE PAIN)
Introduction:
The
most common location of knee pain in young adults is at the front of
the knee joint. The problem usually arises from patella (Knee cap
bone) and surrounding soft tissue.
Knee
cap (Patella) is a small bone which lies in front of lower end of
thigh bone (Femur). The back side of knee cap is lined by smooth
tissue called cartilage. This covering helps the patella to glide in
a groove on the lower end of thigh bone. The knee cap is held on the
top by thigh muscles (Quadriceps) and lower part is connected to the
shin bone by Patellar tendon. Function of knee cap is to aid knee
movement and stabilize knee joint while walking.
Causes:
There
are many theories suggesting softening and micro injuries to this
lining resulting in pain. It could be due to repetitive micro trauma
during falls, or vigorous unaccustomed exercises etc. Abnormal
position of knee cap over the knee joint with or without weak
ligaments may also damage the cartilage lining. As cartilage lining
gets softened and roughened it may cause pain and crepitus (clicks
and sounds) over the knee cap. Obesity makes the condition worse.
Complaints:
- Pain in front of knee.
- Pain on climbing up and down the steps or ramps.
- Sudden ‘catch’ over the knee cap while getting up from the ground.
- Dull aching pain after sitting for long time.
- Discomfort during squatting (Using Indian toilet) and sitting cross legged.
- Ocassional clicks and sounds over the knee cap.
- Swelling.
Diagnosis:
Orthopaedician
can make diagnosis based on your symptoms and examining the knee.
Grating sensation behind knee cap might give us some idea of the
roughness of patella when you tighten the knee cap muscles.
Some
times there may be a little swelling the joint.
Tests:
Blood
tests are normal.
X-rays
are not helpful as the problem is with cartilage lining which cannot
be seen on X-rays.
MRI
(Magnetic resonance Imaging) scans can detect changes in the
cartilage, but is used as last resort in unresponsive cases.
Arthroscopy:
It is possible to look inside the knee joint and back of the knee cap
with pencil shaped camera (Arthroscope) to confirm the diagnosis.
But arthroscopy is not done just for diagnosis and is only done if
there is any need for surgery.
Treatment:
This
condition generally improves over a period with some changes in the
life style. But in some patients, symptoms persist for several years.
Analgesics
(Pain Killers): Simple pain killers like Paracetomol and tramadol may
be sufficient in most of the cases. Sometimes anti inflammatory
medications (NSAIDS) may be necessary for a short period.
Nutritional
supplements to cartilage lining like Glucosamine, Chondroitin, MSM
and collagen peptides can be taken for 2 to 3 months which may
relieve the symptoms.
Injections:
In
some unresponsive cases Intra articualr Hyaluronic injections can
help. They act by providing lubrication between joint surfaces and
help to nourish cartilage lining of knee cap.
Physiotherapy:
Strengthening
the anterior thigh muscles (Quadriceps) and muscles around the knee
cap (VMO) helps to keep knee cap in right position.
Surgery:
Surgical
management is last resort in severe or unresponsive patients. It can
be performed with arthroscope (Key hole surgery). The principle is to
smoothen the rough surface of the back of knee cap. In some cases
where there are large defects in the cartilage, multiple drill holes
into the bone may help regrow some cartilage. Now a days we are
combining this procedure with stem cell treatment in selective cases.
Do's & Dont's:
Please
avoid any movement or position of which makes you feel the pain. It
is better to avoid kneeling, squatting or sitting cross legged. One
may go up and down the steps occasionally but avoid repeated stair
climbing. Pain may get worse with exercise bicycle and walking on a
treadmill with upward gradient (slope).
