What Is It?

The joints in your body are cushioned with a type of connective tissue called articular cartilage. This tough, rubbery tissue covers the ends of bones inside a joint. As the joint moves, the cartilage helps to cushion the bones. It also allows the ends of the bones to glide smoothly against one another.

In chondromalacia, the cartilage inside a joint softens and breaks down. When this happens, the cartilage loses its ability to cushion and protect the ends of the bones as the joint moves. As a result, the ends of the bones can rub together, causing joint pain.

Although chondromalacia can affect any joint, the most common location is inside the knee, where it usually begins as a small area of painful, softened cartilage behind the kneecap (patella). Eventually, this area can become larger, and the softened cartilage can crack or shred into a mass of fibers. In severe cases, the damaged cartilage can wear away completely, down to the undersurface of the kneecap. If this happens, the exposed kneecap’s bony surface can grind painfully against other knee bones. Also, bits of cartilage can float inside the joint space, further irritating the lining of the joint and producing fluid inside the joint (called a joint effusion).

Many different types of joint injuries and joint disorders can lead to chondromalacia. In the knee joint, the most common causes involve injury, overuse of the knee, and poor alignment of the muscles and bones around the knee joint. These causes include:

• Trauma, especially a fracture (break) or dislocation of the kneecap
• A mechanical imbalance of the muscles around the knee
• Overuse (repeated bending or twisting) of the knee joint, especially during sports
• Abnormal alignment of the muscles or bones near the knee joint
• Injury to a meniscus (C-shaped cartilage inside the knee joint)
• Rheumatoid arthritis or osteoarthritis
• An infection in the knee joint
• Repeated episodes of bleeding inside the knee joint
• Repeated injections of steroid drugs into the knee

Chondromalacia of the knee affects young adults more than any other age group. It is especially common in runners, joggers, skiers, soccer players, cyclists and other athletes who repeatedly stress their knees. Also, workers who spend a lot of time kneeling — particularly carpet layers, tile setters and floor layers — have an increased risk of developing this joint problem.

The most common symptom of chondromalacia is a dull, aching pain in the front of your knee, behind your kneecap. This pain can worsen when you go up or down stairs. It also can flare up after you have been sitting in one position for a long time. For example, your knee may be painful and stiff when you stand up after watching a movie or after a long trip in a car or plane.

Chondromalacia also can make your knee joint “catch” (movement suddenly is limited) or “give way” (buckle unexpectedly). These symptoms tend to occur during repeated knee bending, especially when you go down stairs. In some cases, the painful knee also can appear puffy or swollen.

Chondromalacia can cause a creaky sound or grinding sensation when you move your knee. However, creaking sounds during bending do not always mean that cartilage is damaged.

Your doctor will review your medical history. In particular, he or she will want to know whether you have ever:

• Fractured your kneecap or any other bone in the knee joint
• Sprained your knee or injured your knee’s meniscus (the disk-shaped, shock-absorbing cartilage inside the knee)
• Had knee surgery
• Had bleeding or an infection inside your knee joint
• Been diagnosed with arthritis in your knee

Your doctor also will ask you about the type of work you do and your recreational and sports activities.

Then your doctor will examine both of your knees to compare your painful knee with your normal one. He or she will check your painful knee for swelling, deformity, tenderness and fluid in the joint. Your doctor also will look at the position of your kneecap and the alignment of your knee joint. In addition, he or she will bend and straighten your knee gently to check for creaking sounds and grinding sensations.

After examining your knees, your doctor may order knee X-rays. Although standard knee X-rays do not always detect chondromalacia, they can identify other causes of knee pain. If your symptoms are severe or unusual, your doctor also may order a computed tomography (CT) or magnetic resonance imaging (MRI) scan of your knee.

In some cases, your doctor may want to examine your knee through a type of surgery called arthroscopy. In fact, surgery may be the only way to be certain that the problem is chondromalacia. In arthroscopy, a tubelike instrument is inserted into your knee through a small incision to allow the doctor to inspect the inside of the joint and, if necessary, to correct problems.

Since articular cartilage heals poorly, chondromalacia usually is a permanent problem. However, nonsurgical treatments often can relieve knee pain within a few months. If nonsurgical treatment fails, your doctor can do surgery to remove the area of damaged cartilage. Once this is done, most patients find that their symptoms improve.

You can reduce your risk of chondromalacia by preventing knee injuries and overuse of your knee joints. To do this:

• Warm up and stretch before you participate in athletic activities.
• Do exercises to strengthen the leg muscles around your knee, especially the muscles in your thigh called the quadriceps.
• Increase the intensity of your training program gradually. Never push yourself too hard, too fast.
• Wear comfortable, supportive shoes that fit your feet and your sport. Problems with foot alignment can increase your risk of knee injuries. Ask your doctor about shoe inserts that can correct the problem.
• If you ski, or if you play football or soccer, ask your doctor or trainer about specific equipment that can help to reduce your risk of knee injuries.
• If you often kneel on hard surfaces when you work, wear protective knee pads.

Your doctor probably will recommend nonsurgical treatments first. These include:

• Applying ice after exercise and as needed for pain or swelling
• Taking a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin and others), to relieve your knee pain and ease any swelling; or other pain relievers, such as acetaminophen (Tylenol), which also may provide benefit
• Starting an exercise program to strengthen the muscles around your knee
• Avoiding high-impact exercises
• Avoiding all kneeling and squatting
• Using knee tape, a brace or a special patellar-tracking sleeve, to correct or maintain the proper alignment of your kneecap

If nonsurgical treatments fail, or if you have severe symptoms, your doctor may do arthroscopy to check the cartilage inside your knee. If the cartilage is softened or shredded, damaged layers can be removed during the surgery, leaving healthy cartilage intact. If necessary, your doctor also can correct the alignment of your kneecap or other knee structures to help to reduce wear and tear on your knee cartilage.

Contact your doctor if you have knee pain that doesn’t go away, or if your knee catches, gives way or looks swollen and puffy.

Simple nonsurgical treatments can relieve knee pain in most people with chondromalacia.

If nonsurgical treatment fails, and surgery is done, studies show that most patients are satisfied with the results. Once the damaged cartilage is removed surgically, knee pain usually decreases and the knee functions better.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.