How can I relieve knee pain from chondromalacia?

DEAR DOCTOR K:

I saw my doctor because of aching pain in my knee, which sometimes buckles unexpectedly. He says I have chondromalacia. What is this, and what can I do to relieve the pain?

DEAR READER:

The joints in your body are cushioned by cartilage. This tough, rubbery tissue covers and protects the ends of bones inside a joint, allowing them to glide smoothly against one another as the joint moves.

With chondromalacia, the cartilage inside a joint softens and breaks down. The ends of the bones can rub together, causing pain. Chondromalacia can affect any joint, but the most common location is inside the knee, see the illustration on the right.

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Chondromalacia usually begins as a small area of softened cartilage behind the kneecap.

The part of the knee that is affected most often is the kneecap (also known as the patella). The kneecap is a little oval-shaped bone with an undersurface covered by cartilage.

As chondromalacia causes more cartilage to soften, it can crack or shred into a mass of fibers. Bits of cartilage can float inside the joint, irritating the cells that line it and provoking them to produce fluid. In severe cases, the cartilage can wear away completely. That causes pain of the kneecap, in the front of the knee, around the side or even behind the knee.

Chondromalacia of the knee is usually related to injury, overuse, and poorly aligned muscles and bones around the knee joint. It is especially common in runners, joggers, skiers, soccer players, cyclists and other athletes who repeatedly stress their knees. Workers who spend a lot of time kneeling are also more likely to develop this problem.

The most common symptom is a dull, aching pain in front of the knee, behind the kneecap. The condition also can make your knee joint “catch”: You suddenly have trouble moving it past a certain point, or it may buckle unexpectedly.

Nonsurgical treatments often relieve knee pain within a few months. Your doctor may recommend:

  • Applying ice for pain or swelling.
  • Taking acetaminophen (Tylenol) to relieve pain.
  • Taking a nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil, Motrin, others), to ease pain and swelling.
  • Starting exercises to strengthen the muscles around your knee. (A physical therapist can design an exercise program for you.)
  • Avoiding kneeling, squatting and high-impact exercises.
  • Using knee tape, a brace or a special sleeve to keep your kneecap aligned properly.
  • Wearing inserts called orthotics inside your shoes to keep your foot in proper position ¬†neither turned in or out too much ¬†when you bear weight on that foot, and the knee above it.

If nonsurgical treatments fail, or if you have severe symptoms, your doctor may recommend arthroscopy. This surgical procedure uses miniature instruments inserted through small incisions to repair joint problems. Damaged cartilage can be removed during the surgery. If necessary, your doctor also can correct the alignment of knee structures to help to reduce wear and tear.