Chondromalacia patella. How to maintain the usual rhythm of life and reduce discomfort to a minimum

Cartilage tissue is destroyed imperceptibly, since the cartilage lining has no innervation - in other words, it does not hurt. Pain occurs when the cartilage deforms and thins and increases the load on the joints located near it. Chondromalacia of the knee joint is one of the types of damage to the cartilage pad - deformation of the posterior part of the kneecap. It is good if the disease is detected at the initial stage. Since the advanced stage of the deformity presents a sad picture of a through lesion, up to the exposure of the joint.

Chondromalacia of the patella in the clinic of Dr. Glazkov in Moscow

Chondromalacia of the patella at Dr. Glazkov's clinic in Moscow
The cartilage tissue covering the articular surfaces of the bones performs an important biological function. It reduces the load on the joint by providing shock absorption and also promotes less friction on the joint surfaces during active and passive movements.

Cartilage does not contain blood vessels; its cells (chondrocytes) are nourished by the diffusion of nutrients and oxygen from the synovial fluid filling the joint cavity. Tissue destruction occurs due to trophic disturbances against the background of changes in the composition and properties of the synovial fluid.

The degenerative-dystrophic process leads to disruption of the functional state of cartilage. Their surface becomes less smooth, which during movements contributes to even greater damage. Next, the tissues become inflamed and swell. The pathology is manifested by stagnation of blood with progression of pain.

Symptoms of the disease

Each type of knee chondropathy has its own specific signs, which often help diagnose the pathology at the first visit to the doctor. But there are general clinical manifestations that are similar to the symptoms of many musculoskeletal diseases:

• crunching, clicking, crackling when bending or straightening the knee;
• swelling, hyperemia due to blood vessels overflowing, increased local temperature;
• discomfort, and then pain when moving.

The teenager begins to noticeably limp and tries not to put full weight on his foot in order to minimize pain. It is also possible for the muscles to weaken with further atrophy, and the legs to shorten by several centimeters. With the accumulation of exudate in the joint cavity and the development of the inflammatory process, a deterioration in well-being occurs, including dyspeptic disorders. The psycho-emotional state of the patient changes. He becomes lethargic, apathetic, drowsy or, conversely, irritable and hot-tempered.

Causes

Chondromalacia of the patella of the knee joint is a pathological process, the development of which can be provoked by the influence of several etiological (causal) factors. Among them:

• Genetic predisposition.
• Congenital change in the anatomical relationship of the patella in relation to other structures.
• Knee injury, in which the impact of the damaging factor is directed directly to the kneecap (fall on the knee, mechanical shock).
• Increased loads on the knee that occur in athletes during systematic running, jumping, and squats.
• Reduced tone and strength of the quadriceps femoris muscle, which makes normal movement of the cup difficult.

The simultaneous impact of several factors leads to the development of more severe chondromalacia of the patella. How many cartilaginous structures are damaged and what degree of their destruction are determined by the type and strength of the damaging factor.

Effective Treatments

Chondropathy of the knee joint responds well to conservative therapy. Surgical intervention is usually indicated for developed complications, for example, severe bone deformation. Patients are recommended to wear orthoses that fix the joint structures, preventing their displacement or damage. In some cases, a plaster cast may be applied.

Knee brace.

Drug therapy

To eliminate pain, patients are prescribed non-steroidal anti-inflammatory drugs. In case of knee chondropathy, they are not very pronounced, so drugs in the form of tablets and ointments are used - Nimesulide, Celecoxib, Ketorol, Fastum, Voltaren. Since the pathology in most cases affects children and adolescents, the doctor calculates daily and single dosages taking into account age, weight, listed in the annotation of contraindications.

Physiotherapy

Pain in the knee joint of mild to moderate severity, characteristic of chondropathy, can be eliminated by physiotherapeutic procedures. Healing activities also stimulate blood supply to cartilage and bones, preventing the spread of the pathological process to healthy tissues. The following physiotherapy procedures have proven themselves to be particularly effective in the treatment of chondropathy:

• UHF therapy;
• magnetic therapy;
• laser therapy;
• shock wave therapy;
• galvanic currents.

UHF session.
It is practiced to apply applications with ozokerite or paraffin to the knee. Under the influence of heat, the regeneration of damaged structures, the removal of waste, toxins, and harmful salts are accelerated. At the rehabilitation stage, electrophoresis or ultraphonophoresis with chondroprotectors, B vitamins, and calcium chloride solution are used.

Physiotherapy

Since it is active sports training that often leads to the development of chondropathy, doctors recommend that patients reduce physical activity. During therapy, you should prefer swimming, physical therapy, and gymnastics. Daily exercises help strengthen the muscle-tendon system of the knee without putting stress on the bones and cartilage.

It is allowed to perform isometric exercises to maintain strength and muscle mass. Physical therapy doctors, after studying the diagnostic results, often allow training with a barbell or dumbbells, but not in a standing position. But jogging is strictly prohibited. Subsequently, after complete recovery, the teenager can return to running, football, and basketball.

Surgery

The ineffectiveness of conservative therapy over several months becomes an indication for surgical intervention. Arthroscopic surgeries performed in a minimally invasive manner make it possible to restore damaged bones and cartilage, while avoiding severe damage to connective tissue structures. The surgeon inserts instruments through small punctures or cuts in the skin above the knee. Manipulations are carried out with miniature arthroscopic instruments, and the progress of the operation is visualized on the monitor.

After minimally invasive surgery, the patient remains in the department for a short time under the supervision of medical staff. A few days later he is discharged for further rehabilitation. At the recovery stage, massage, physiotherapeutic procedures, and exercise therapy are indicated.

Folk remedies

It is not advisable to use products made according to traditional medicine recipes in the treatment of chondropathy. Firstly, they do not contain ingredients that can prevent deformation of cartilage and bone tissue. Secondly, folk remedies contain components that often provoke the development of local or systemic allergic reactions. Thirdly, most medicinal plants are prohibited for use in the treatment of children and adolescents.

Chondromalacia of the patella - degrees and types

Chondromalacia of the patella - degrees and types

• Stage 1 – small local thickenings of cartilage develop in the form of swellings.
• Stage 2 – cracks and depressions appear on the surface, the dimensions of which do not exceed 1 cm.
• Stage 3 – cracks and depressions exceed 1 cm in size, they can penetrate through the entire thickness of the cartilage to the surface of the bone.
• Stage 4 is the most severe degree of damage, in which the surface of the bone is almost completely exposed.

Diagnostics

To confirm the diagnosis and assess the condition of the articular cartilage, the orthopedic traumatologist, after examination, prescribes the following studies:

• Magnetic resonance imaging. This study is more accurate than x-rays and allows for a more detailed examination of the joint.
• Arthroscopy is an endoscopic examination in which the doctor inserts special equipment with a miniature video camera into the joint through a puncture. This is the most accurate technique that allows you to examine the articular cartilage in detail.

The modern equipment of the multidisciplinary CELT clinic allows for high-quality comprehensive diagnostics.

Classification by localization and prevalence

Depending on the prevalence of the pathological process, chondromalacia of the patellar facet is distinguished (thickening of the cartilaginous surface, repeating the shape of the knee joint), which is divided into 2 types:

• Chondromalacia of the medial facet of the patella - damage primarily affects the thickening of the cartilage of the patella, localized on the inner (medial) side.
• Chondromalacia of the lateral facet of the patella - the cartilaginous thickening located on the outer (lateral) surface of the patella is predominantly damaged.
• Combined lesion affecting all structures of the cartilaginous surface of the cup.

Also, pathological destruction of cartilage tissue can be isolated or affect other structures of the knee. The most common sites are chondromalacia of the patella and tibial condyle.

Chondromalacia patella - symptoms

Chondromalacia patella - symptoms

• Acute, severe pain that intensifies with increasing load on the knee (climbing or descending stairs, running, squats, kneeling).
• Chronic constant pain at rest. It is less pronounced than when performing movements in the knee.
• Characteristic clicks and crunches that occur when performing active or passive movements in the joint.
• Limitation of range of motion in the knee.
• Swelling and redness of the skin in the area of ​​the kneecap, indicating the development of an inflammatory reaction.

Chondromalacia of the medial condyles and patella has pronounced clinical symptoms. In general, clinical manifestations tend to gradually progress over a fairly long period of time. As degenerative-dystrophic processes progress, as well as against the background of an inflammatory reaction, the intensity of symptoms increases significantly.

When to see a doctor

If complex therapy begins at the initial stage of any chondropathy, it does not last long and always leads to a complete recovery of the patient. Therefore, it is necessary to consult a doctor for medical help at the first signs of damage to the knee joint.

Parents should be wary if their child complains of pain more frequently after sports training or long walking. Swelling of the knee, redness of the skin, and even a slight limp are also signals to see a doctor.

chondromalacia patella

Chondromalacia of the patella
After the diagnosis of chondromalacia of the patella has been established, a comprehensive treatment is prescribed by the doctor. It includes conservative drug therapy (use of anti-inflammatory drugs and chondroprotectors), physiotherapy and surgery. The choice of volume and direction of therapeutic measures depends on the severity and localization of the pathological process.

Prevention measures

Since the causes of the development of chondropathy have not yet been established, there are no specific measures for its prevention. Doctors recommend avoiding traumatic situations, excessive physical exertion, and not standing on your feet for long periods of time. Fried, smoked, and fatty foods should be excluded from the diet. The daily menu should include fresh vegetables and fruits, lean meat, cottage cheese, kefir, and Varenets. This will normalize body weight and replenish vitamins and microelements.