Chondromalacia Patella: Causes and Treatment of Anterior Knee Pain

Symptoms

• Dull pain at the front of the knee, around or beneath the kneecap
• More difficulty descending stairs than ascending
• Pain on standing up after prolonged sitting
• Discomfort with squatting, kneeling and sitting cross-legged
• A grinding or clicking sensation with movement

Causes

The problem usually lies not in a single structure but in the balance of load around the knee:

• Relative weakness of the inner portion of the quadriceps
• Weak hip muscles, allowing the knee to collapse inward and increasing pressure on the kneecap
• Angular differences along the hip–knee–ankle axis
• A sudden increase in loading: running or squatting exercises resumed too quickly
• Tightness of the hamstrings and outer thigh structures
• Previous kneecap dislocation or direct trauma

It is particularly common in young women, runners and those who sit at a desk for long periods.

Diagnosis and Treatment

Diagnosis is largely clinical: the site of pain, the movements that aggravate it, muscle strength and flexibility are assessed. X-rays show the position of the kneecap within its groove; MRI is not needed in every patient.

Treatment centres on exercise and load management: strengthening the quadriceps below the pain threshold, strengthening the hip muscles (the most commonly overlooked component), stretching, temporary reduction of deep squatting and stair descent, weight control and a gradual return to loading. Surgery is considered in a small proportion of patients when adequate conservative treatment fails or when there is significant cartilage damage or recurrent dislocation.