As part of your treatment your Physical Therapist may use a hands-on technique to mobilize your kneecap and improve its flexibility if it is stiff. In cases where the patella does not move well, improved movement can assist in decreasing the resistance that the VMO needs to work against and make tracking of the patella easier to control.
Taping the kneecap may also help you to do exercises and activities with less pain. Your Physical Therapist may even teach your how to tape your own knee so you can do it for sporting activities that you are still engaging in.
Taping over a longer time frame will cause irritation to the skin and can be cumbersome, therefore if the taping helps, a brace, which performs a similar function, may be suggested. Braces used for chondromalacia patella are made of soft fabric, such as cloth or neoprene, and work to encourage proper alignment of the patella as it glides down the knee. There are small buttress pads in the brace that sit on the side of the patella to keep it lined up within the groove of the femur.
Patients commonly report less pain and improved function with both taping and bracing. As mentioned above, proper alignment of your entire lower extremity is paramount to decreasing the overall stress that is placed on the patella and knee in general.
In addition to strengthening, stretching, hands-on treatment, and taping, foot orthotics may be useful to assist with alignment. Strengthening of the muscles of the shin and foot can help with the foot alignment, but often this is not enough to fully correct the problem, and foot orthotics are required.
Alignment of the foot in turn then encourages proper alignment up the lower extremity chain. Your Physical Therapist can advise you on whether orthotics would be useful for you, and also on where to purchase them. A critical part of our treatment for chondromalacia patella at Sports Rehabilitation Unlimited includes specific education on returning to full physical activity.
Bending and straightening the knee occurs often even in everyday activities such as walking or stair climbing so a patella that is recovering from injury can easily be aggravated.
Returning you back to normal physical activity at a graduated pace is crucial to avoid repetitive pain or a chronic injury. Your Physical Therapist will advise you on the acceptable level of activity at each stage of your rehabilitation process and assist you in returning to your activities as quickly but as safely as possible. With a well-planned rehabilitation program and adherence to suggested levels of rest and activity modification, most people respond very well to the treatment we provide for chondromalacia patella at Sports Rehabilitation Unlimited.
If, however, your knee pain is not responding to the treatment then we may suggest that you consult an orthopaedic surgeon as surgery may be necessary in your case to resolve your pain. If nonsurgical treatment fails to improve your condition, surgery may be suggested. The procedure used for patellofemoral problems varies. In severe cases a combination of one or more of the following procedures may be necessary. Arthroscopy is sometimes useful in the treatment of patellofemoral problems of the knee.
Looking directly at the articular cartilage surfaces of the patella and the femoral groove is the most accurate way of determining how much wear and tear there is in these areas. Your surgeon can also watch as the patella moves through the groove, and may be able to decide whether or not the patella is moving normally. If there are areas of articular cartilage damage behind the patella that are creating a rough surface, special tools can be used by the surgeon to smooth the surface and reduce your pain.
In more advanced cases of patellar arthritis, surgeons may operate to repair or restore the damaged cartilage. The type of surgery needed to repair articular cartilage is based on the size, type, and location of the damage. Along with surgical treatment to fix the cartilage, other procedures may also be done to help align the patella so less pressure is placed on the healing cartilage.
If your patella problems appear to be caused by a misalignment problem, a procedure called a lateral release may be suggested. This procedure is done to allow the patella to shift back to a more normal position and relieve pressure on the articular cartilage. In this operation, the tight ligaments on the outside lateral side of the patella are cut, or released, to allow the patella to slide more towards the center of the femoral groove.
These ligaments eventually heal with scar tissue that fills in the gap created by the surgery, but they no longer pull the patella to the outside as strongly as prior to the surgery. This helps to balance the pull from the quadriceps muscles and equalize the pressure on the articular cartilage behind the patella. In some cases of severe patellar misalignment, a lateral release alone may not be enough.
For problems of repeated patellar dislocations, the tendons on the inside edge of the knee the medial side may have to be tightened as well. If the misalignment is severe, the bony attachment of the patellar tendon may also have to be shifted to a new spot on the tibia shin bone.
Remember that the patellar tendon attaches the patella to the tibia just below the knee. By moving a section of bone where the patellar tendon attaches to the tibia, surgeons can change the way the tendon pulls the patella through the femoral groove. The surgeon removes a section of bone where the patellar tendon attaches on the tibia. This section of bone is then reattached on the tibia closer to the other knee. Usually, the bone is reattached onto the tibia using screws.
This procedure shifts the patella to the medial side. Once the surgery heals, the patella should track better within the center of the groove, spreading the pressure equally on the articular cartilage behind the patella.
Arthroscopic procedures to shave the patella or a simple lateral release can usually be done on an outpatient basis, meaning you can leave the hospital the same day.
If your problem requires the more involved surgical procedure where bone must be cut to move the patellar tendon attachment, you may need to spend one or two nights in the hospital.
Patients undergoing a patellar shaving usually begin rehabilitation at Sports Rehabilitation Unlimited right away. More involved surgeries for patellar realignment or restorative procedures for the articular cartilage may require a delay before starting at Sports Rehabilitation Unlimited just to give the tissues a short time to begin the healing process before they are stressed.
Rehabilitation will be slower with a realignment or restorative procedure as the bone and cartilage needs more time to heal before too much strain can be put on the knee. Your first few appointments at Sports Rehabilitation Unlimited will focus on helping to control the pain and swelling from the surgery. Icing the knee frequently will assist with the inflammation and relieve a great deal of the pain. Massage, particularly for the quadriceps muscle, may also be helpful in the early stages after surgery.
One of the first exercises your Physical Therapist will prescribe will be some gentle range of motion exercises for your knee to gradually regain full movement. This should be done within a pain free range of motion, however, movement will be encouraged even if it causes a slight bit of discomfort as the movement itself can greatly assist with dispersing any inflammation as well as improving the overall level of pain.
A stationary bicycle can be very useful in the initial stages of gaining range of motion in the knee, so if able, you will be encouraged to use one.
Even if you are unable to fully rotate the pedals, the back and forth motion on the bike is an excellent method of slowly encouraging the knee to regain its full range of motion.
Your Physical Therapist will begin to add some gentle strengthening exercises as well for your knee. Initially these may only involve isometric exercises, where you tighten and hold the quadriceps muscle without actually moving the knee itself.
Gradually though, the strengthening exercises will be advanced and will address any deficits in strength that your Physical Therapist has identified as contributing factors to the initial development of your chondromalacia patella. As you recover from the direct effects of the surgery, your Physical Therapist will begin to add in exercises to your program similar to that listed under non-surgical rehabilitation. Flexibility of the knee and hip will be addressed, as well as the strength, and the overall alignment of these joints during your rehabilitation exercises and everyday activities.
Eccentric exercises will be added as soon as they are appropriate, and exercises specific to the sport you enjoy will also be incorporated as soon as it is safe to do so. When you are well under way with your rehabilitation, regular visits to Sports Rehabilitation Unlimited will end. Your Physical Therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.
Generally rehabilitation at Sports Rehabilitation Unlimited after surgery for chondromalacia patella goes extremely well and clients can return without difficulties to the activities they enjoy participating in. If however, your pain is lasting longer that your therapist thinks it should or you are not progressing as rapidly as we would expect, we will ask you to follow up with your surgeon to ensure that there are no complicating factors impeding your rehabilitation.
Chondromalacia Patella Patient Guide Share this page. This guide will help you understand: what parts of the knee are affected how this condition develops how health care professionals diagnose the condition what treatment options are available what Sports Rehabilitation Unlimited's approach to rehabilitation is.
What is the patella, and what does it do? What causes this problem? What does chondromalacia patella feel like? How do health care professionals diagnose the problem? What treatment options are available? Nonsurgical Rehabilitation and Treatment Non-operative treatment is the usual treatment for this problem. Arthroscopic Method Arthroscopy is sometimes useful in the treatment of patellofemoral problems of the knee.
Lateral Release If your patella problems appear to be caused by a misalignment problem, a procedure called a lateral release may be suggested. Ligament Tightening Procedure In some cases of severe patellar misalignment, a lateral release alone may not be enough. Bony Realignment If the misalignment is severe, the bony attachment of the patellar tendon may also have to be shifted to a new spot on the tibia shin bone.
Eccentric exercises will be added as soon as they are appropriate, and exercises specific to the sport you enjoy will also be incorporated as soon as it is safe to do so When you are well under way with your rehabilitation, regular visits to Sports Rehabilitation Unlimited will end. Request An In-Clinic Appointment. Request A Telehealth Appointment. Newsletter Sign-up. Sign Up for Newsletter. Before considering acupuncture to manage chondromalacia, talk to your healthcare provider to see if it is a safe option to manage the condition's symptoms.
Prolotherapy , also known as proliferation or regenerative injection therapy, is an injection-based CAM therapy used to treat musculoskeletal pain.
The goal of these injections is to stimulate a natural healing response in soft tissues or joints affected by pain. These injections contain irritants like dextrose, glycerine, lidocaine, or phenol to increase inflammation temporarily. That inflammatory response should increase blood flow to stimulate new growth and healing of the damaged tissues.
According to a study reported in in the journal Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders , prolotherapy can improve chondromalacia symptoms and physical function. The researchers felt prolotherapy could provide long-term improvement that reduces the need for pain medications. They added that prolotherapy should be considered a first-line conservative least invasive therapy for chondromalacia.
Your healthcare provider may order additional tests to further investigate the problem, such as magnetic resonance imaging MRI or X-ray.
If the MRI shows you have a focal small area of cartilage damage beneath the patella, surgery may be recommended. If the lesion has certain characteristics on the MRI, surgery can be used to clean out the affected area so there are no loose flaps of cartilage that may cause pain. If the lesion is in a particular location, healthcare providers can sometimes replace it with a healthy piece of cartilage, either from another part of the knee or from a donor.
Arthroscopic surgery starts with examining the joint to look for the misalignment of the knee and then correct it. This surgery involves using a small camera inserted into the joint with a small incision so that the surgeon can see inside the knee. Some people have chondromalacia because their patella is misaligned. This means the patella does not sit in its groove correctly.
One common procedure to address this is a lateral release. A lateral release is usually done with a combination of arthroscopic and open techniques.
This involves cutting some of the tight ligaments pulling the patella to release tension and allow for proper movement and position. Most people with chondromalacia make a full recovery. That recovery might occur as early as one month, or it could take years, depending on the severity of the condition. In mild to moderate cases, you can manage chondromalacia with rest, ice, and stretching.
Chondromalacia rarely requires long-term treatment, but chronic knee pain might be caused by another condition, like osteoarthritis. You might need further or more advanced treatments to manage the knee joint's pain, swelling, and stiffness. Dealing with chronic inflammation? An anti-inflammatory diet can help. Our free recipe guide shows you the best foods to fight inflammation. Get yours today!
Chondromalacia patellae: a review. Research Journal of Pharmacy and Technology. Cleveland Clinic. Knee pain chondromalacia patella. Updated October 6, Harvard Medical School. Exercise for stronger knees and hips.
Updated June Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons - a scoping review. Obes Rev. Updated April 15, Goldstein JL, Cryer B. Gastrointestinal injury associated with NSAID use: a case study and review of risk factors and preventative strategies. Drug Healthc Patient Saf. Updated March 28, Updated January 3, Use of exogenous hyaluronic acid for the treatment of patellar chondropathy- a six-month randomized controlled trial.
Rev Bras Ortop Sao Paulo. National Center for Complementary and Integrative Health. Updated July Johns Hopkins Medicine. What is acupuncture? Acupuncture versus non-steroidal anti-inflammatory drugs for treatment of chondromalacia patellae: a systematic review and meta-analysis of randomized controlled trials.
Complementary Medicine Research ; ;23 6 — Prolotherapy in primary care practice. Prim Care. Outcomes of prolotherapy in chondromalacia patella patients: improvements in pain level and function. Wilkerson R. Usually, a provisional diagnosis of chondromalacia patellae is made from your symptoms plus a doctor's examination of the knee.
This will be a working diagnosis rather than a definite one, because the cartilage cannot be seen without further tests see below. In this situation, where there is no proof of chondromalacia, some doctors call the pain patellofemoral pain syndrome or anterior knee pain.
This does not matter, as the treatment will be the same at this point see below. Often, no tests are needed, as treatment can be started on the basis of a working diagnosis of chondromalacia. Tests may be used in some situations, either to confirm the diagnosis or to rule out other causes. For example, if the diagnosis is not clear, or if symptoms do not improve after treatment. Tests which may be used are:.
Surgery is not usually necessary but it may be advised if the above treatments have not helped. Arthroscopic surgery is the usual operation. A tiny flexible camera is inserted into the knee. The surgeon sees the inside of the knee joint and the cartilage, and may then operate through the camera tube, using very fine instruments.
Possible surgical treatments are as follows:. The outlook prognosis is good. Most people get better with simple treatments such as physiotherapy. Chondromalacia does not seem to be linked to arthritis later in life. J Sport Rehabil. Epub May 6. Cochrane Database Syst Rev. Arch Bone Jt Surg. Epub Mar Hi folks,I had my right knee replaced 18 days ago.
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