Edward V. Craig, M.D: Nonsurgical: Chondromalacia Patella
Injuries and Conditions : Knee : Chondromalacia Patella : Treatment : Non-Surgical : Conservative Treatment of Chondromalacia Patella
 
Overview
Damage to cartilage on the undersurface of the kneecap will not typically require surgery for a full recovery. Chondromalacia patella may range from minor tears to severe wearing away of the cartilage beneath the kneecap. These differences in the severity of degeneration or erosion will affect the treatment decision, as will the degree of activity that the patient wishes to pursue after treatment.

Some patients, even with quite severe damage, may choose to not undergo surgery. Surgery is not usually required, as the condition frequently cannot be helped surgically. However, damaged cartilage cannot rebuild itself. Surgery attempts to remove the damaged cartilage and restore a smooth surface by creating a fibrous clot, the first stage required to build fibrous cartilage, in the area of the cartilage defect.

Rehabilitation Program
Rehabilitation exercises for non-surgically treated chondromalacia patella include:
  • Isometric Quad Sets.
  • Straight Leg Raises.
  • Isotonic Hip.
  • Isotonic Hamstring.

    •
    Medication and Medical Products
    Orthotics An orthotic insert fits inside a shoe and helps position the foot in an anatomically correct position while walking, running, or jumping. Frequently, abnormal foot motion and gait occurs as a result of over-pronation of the foot; most orthotics are used to treat this condition. Over-pronation is a tendency to roll the foot onto the inner edge, loading the inside of the foot and leaving the outer edge almost weightless. A professionally made orthotic insert will exactly contour to the bottom of the foot, and can compensate for over-pronation or other abnormal foot mechanics.

    One of two construction methods may be used to create an orthotic; one utilizes a plaster mold of the entire foot to make a moderately rigid insert, the other utilizes a foam impression of the bottom of the foot, creating a more flexible insert. In either case, the finished product must be tilted with small wedges, while other accommodations are made to protect sensitive areas of the foot. The choice of orthotics and design will vary according to the expected use, foot type, and body weight.

    Orthotics can be used to treat:

  • abnormal foot mechanics
  • patella dislocation or maltracking
  • patellar tendonitis
  • general knee pain
  • ankle instability


    • Knee: Compression Sleeves Knee compression sleeves give added support, increasing stability and helping to reduce swelling in an injured knee. Patients that have light sprains may be directed to use a compression sleeve during the early stages of rehabilitation. Other patients that have ongoing knee problems or chronic conditions may be recommended to use a sleeve on a daily basis. These sleeves are less restricting than most other knee supports and can be worn under loose fitting clothing.

    Knee compression sleeves can be used to treat:

  • Light swelling.
  • Light knee strains.
  • Chronic inflammation.
  • Degenerative joint disease.


    • Patella Supports


    Long-Term Expectations for Recovery
  • Patients with minor damage can expect to recover after a month of physical therapy.
  • Patients suffering severe damage will require much longer to rehabilitate. In these cases, some degree of pain or discomfort may remain during movements that place pressure on the underside of the kneecap.
  • Patients that have not achieved full recovery will need to reduce their level of physical intensity to prevent further degradation to the knee. In some cases this will mean completely refraining from activities that place particular stress on the knee.
  • Recovery is more dependent on the condition of the joint before and after injury and how the internal structures have repaired, not the number of days, weeks or months since the injury occurred.

    • Possible Complications and Risks
  • Re-injury to the cartilage of the patella is possible if physical therapy becomes too strenuous for the condition of the knee.
  • For patients with severe chondromalacia patella, physical therapy may not sufficiently recondition the knee joint for vigorous athletic activities.

    		•