In most cases, chondropathia patellae is a cartilage disease of the knee with a favorable course. Surgical treatment measures are very rarely necessary.
What is chondropathia patellae?
Schematic diagram showing the difference between a healthy knee and chondropathia patellae. Click to enlarge. Chondropathia patellae is a disease of the cartilage (chondropathy) that affects the back of the kneecap (patella). If the knee is affected by chondropathia patellae, the articular cartilage usually shows degenerative impairments. Chondropathia patellae predominantly affects young women and girls. If chondropathia patellae is present in boys, it usually occurs during the life phase of puberty. In most cases, both knees of a person are affected by the disease when chondropathia patellae is present. Characteristic of chondropathia patellae is, among other things, pain in the affected knee, which is manifested, for example, when the affected person stands up after sitting for a long time, climbs down or up stairs, or runs downhill.
Causes
Chondropathia patellae is caused by changes in the posterior cartilage of the kneecap. However, such changes alone usually do not cause the pain associated with chondropathia patellae. The typical pain of chondropathia patellae often occurs when, in addition to the changes in the cartilage of the knee, there is frequent overloading of the knee (for example, due to frequent kneeling activities) or of the adjacent tendons (for example, due to sudden stopping movements of the knee, such as occur when running downhill). In addition to overuse, other factors can also cause chondropathia patellae: for example, malfunction of the ligaments at the knee joint, malposition of the kneecap or impairment of the thigh muscles. Injuries or accidents involving one or both knees can also lead to chondropathia patellae.
Symptoms, complaints, and signs
In most cases, chondropathia patellae results in a positive course of the disease and thus no permanent damage or complications. Treatment is not necessary in every case, as the disease heals on its own in many cases. Patients with chondropathia patellae suffer from severe pain in the knees. The pain occurs mainly in the area of the kneecap and can considerably restrict the daily life of the affected person and reduce the quality of life. The pain can be very severe, especially during exertion, and thus lead to restricted mobility. In some cases, patients are thus dependent on walking aids or on the help of other people in their lives. Pain can also occur at night, which can have a negative effect on the quality of sleep of the affected person and thus lead to irritability or other psychological complaints or depression. However, life expectancy remains unchanged in this case. In children, chondropathia patellae can also cause limitations or delays in growth and child development, although these can be quickly corrected. No other symptoms usually occur.
Diagnosis
To make a diagnosis of chondropathia patellae, an attending specialist usually first interviews the patient to obtain information about the individual symptoms and their progression. As part of a physical examination, it can then be checked, for example, whether a pressure pain typical of chondropathia patellae develops on the affected knee. Ligaments, tendons and adjacent muscles of the knee are also usually examined when chondropathia patellae is suspected. A diagnosis can be confirmed by procedures such as X-rays, magnetic resonance imaging or, less frequently, arthroscopy. In most cases, the course of chondropathia patellae is favorable: in many cases, it heals on its own after a few weeks.
Complications
Complications do not occur with chondropathia patellae in most cases. Usually, the condition heals quickly and no medical intervention is necessary. Chondropathia patellae causes the patient to experience severe pain in the knees.These occur primarily after exertion, but can also be noticeable in the form of pain at rest. Everyday life is severely restricted by the pain, so that the patient also suffers from restricted mobility. The pain at rest can also occur at night, leading to sleep disturbances and increased irritability. Other complaints usually do not occur. However, the pain can cause the affected person to become psychologically ill and suffer from depression. The treatment of chondropathia patellae is mostly done through therapies. In this process, various exercises are performed with the patient to relieve the discomfort and protect the joints. The patient must avoid heavy loads or sporting activities. Severe pain is treated with the help of painkillers. Only in very severe cases is surgical intervention necessary. Even after treatment, the patient’s everyday life is restricted by chondropathia patellae and he or she must avoid exertion. No further complications occur.
When should you see a doctor?
If there is pain in the kneecap and other typical signs of chondropathia patellae, a visit to the doctor is recommended. If the cartilage disease is not treated, further complaints such as pain at rest at night may develop – at the latest then a medical doctor should be consulted. With bad posture and muscle tension, it is best to go to a chiropractor or orthopedist. Patients who have already suffered from chondropathia patellae once should contact the responsible physician if symptoms recur. Recurring symptoms can lead to patellar osteoarthritis in the long term and must therefore be clarified. People who regularly perform kneeling activities or otherwise overload the tendons at the kneecap are particularly at risk. There is also an increased risk of cartilage disease in the case of existing malfunctions of the muscles and ligaments in the knee joint as well as malformations and malpositions of the kneecap. Anyone who belongs to these risk groups should have these complaints clarified quickly. Patients who suffer from pain in the kneecap after an accident should, at best, speak to the doctor in charge immediately.
Treatment and therapy
In the majority of cases, chondropathia patellae can be sufficiently treated with the help of conservative (nonsurgical) treatment methods. The treatment of chondropathia patellae focuses primarily on physiotherapeutic (physiotherapeutic) measures aimed at strengthening the anterior thigh muscles, among other things. In addition, physicians recommend that the affected knee joint be sufficiently spared in the case of chondropathia patellae. This can be achieved, for example, by applying stabilizing bandages and avoiding movements that put too much strain on the knees (such as knee bends). If the pain associated with chondropathia patellae is very severe, painkilling medication may be necessary in rare cases. This can be done, for example, with the aid of tablets. Only in rare cases does chondropathia patellae require surgical intervention. If chondropathia patellae has been successfully treated, experts say that it can make sense not to put too much strain on the affected knee for a longer period of time; hobby athletes can switch to compensatory sports such as cycling or swimming, for example, which are easier on the knee joints. In women, after suffering from chondropathia patellae, temporarily avoiding shoes with high heels can be useful.
Outlook and prognosis
The outlook for recovery is good in chondropathia patellae. The symptoms regenerate in most patients within a short time after the knee is unloaded. Complete remission is possible after a few weeks. Consequential symptoms are not to be expected in normal cases. The path of healing is shortened as soon as a few tips are followed. Due to the natural self-healing powers, recovery is possible in many cases even without medical treatment. With medical treatment, the healing path is additionally shortened. The prognosis is also improved if the patient wears healthy footwear and observes sufficient rest as well as a grace period. Recurrence of chondropathia patellae is possible at any time. Nevertheless, by taking precautions, the patient can actively influence it and prevent its recurrence.With the right precautions, there is a possibility that a permanent cure will occur. Sufficient fitness, avoidance of excess weight and a healthy lifestyle are important for this. As soon as the affected person optimizes his lifestyle, he usually remains cured. In rare cases, the symptoms may worsen. If the knee is subjected to continuous stress or recurrent heavy use, the pain persists. This may result in muscle discomfort or skeletal system malalignment.
Prevention
Direct prevention of chondropathia patellae is possible only to a very limited extent. However, the risk of developing chondropathia patellae can be reduced by avoiding overuse of the knees early on. Active athletes who already experience mild knee pain are recommended as a possible preventive measure against chondropathia patellae, for example, to stabilize the affected joint, to take it easy on it, and to avoid sports with a high risk of falling.
Aftercare
The healing process in chondropathia patellae can be positively influenced by consistent aftercare. Nevertheless, a regeneration phase of up to six months is to be expected with conservative therapy. As part of the follow-up treatment, the doctor recommends targeted physiotherapy. After receiving detailed instruction from a professional, patients can also perform the exercises at home. During the build-up phase, overloading of the knee should be avoided. This means that intensive sports and climbing stairs are taboo for a certain period of time. Depending on the severity of the condition, the doctor prescribes anti-inflammatories. Patients may also wear knee joint bandages to avoid incorrect stresses. Electrotherapy and also strengthening exercises may cause increased discomfort for a short time. Patients should not be put off by this, but should stick with the program to the end. In general, the regeneration process is quite positive. This also applies to the period after surgical treatment. Here it is important that patients elevate their leg as often as possible and start activities only slowly. This starts with careful walking, slow swimming and cycling. Too much knee bending during sports activities and also in the household should be avoided at the beginning.
Here’s what you can do yourself
Chondropathia patellae is a disease of the cartilage of the kneecap, which sometimes manifests itself very painfully. Those affected are often children and young girls and women. The cartilage on the inside of the kneecap, which is up to seven millimeters thick, is supplied by the synovial fluid in the knee joint. This requires, among other things, that the kneecap is subjected to a certain contact pressure within certain tolerances by the muscles and ligaments, and that it is subjected to sliding movements with alternating loads due to movements of the knee. Oblique loading due to poor posture or muscle atrophy of the most important leg extensor, the quadriceps femoris muscle, can lead to painful damage to the knee cartilage. In contrast to the past, when mainly rest was prescribed, today targeted gymnastics is recommended, which the affected persons can perform themselves. Great importance is attached to building up the leg muscles; above all, the extensor muscles on the thigh should be able to provide the kneecap with the “right” contact pressure and supply it with nutrients via the synovia through the natural knee movement. This means that targeted physiotherapy and physiotherapy as self-help measures are of great importance in order to be pain-free again as soon as possible. In addition to the individually composed movement exercises, muscle building is of similarly high importance. Recommendations for absolute sparing of the knee are generally not effective according to modern findings.
