Chondromalacia of the patella
Abstract
Introduction: Chondromalacia is one of the conditions that cause anterior knee pain syndrome. It involves the softening of the articular cartilage of the patella.
Objective: To update knowledge on the most important aspects of chondromalacia of the patella.
Methods: The search and analysis of information was carried out over 89 days (February 1st, 2025, to April 30th, 2025) using the keywords anterior knee pain, chondromalacia, and chondromalacia of the patella. A bibliographic review was conducted based on the information obtained. A total of 275 articles published in the PubMed, Hinari, SciELO, ResearchGate, EBSCO, Scopus, Medscape, and Medline databases were reviewed using the EndNote search engine and reference manager. Thirty selected citations were used for the review, 29 of which were published within the last five years.
Results: The three causes of chondromalacia patella are discussed. The pillars of diagnosis are referenced and divided into clinical, imaging, and arthroscopic approaches. Two clinical maneuvers that are useful for diagnosing this condition are described. The main conservative and surgical treatment modalities, as well as the main complications, are outlined.
Conclusions: Patellar chondromalacia is a condition that falls under the umbrella of anterior knee pain syndrome. It involves anatomical and muscular factors, as well as situations that occur directly on the patella. Diagnosis is based on clinical, imaging, and arthroscopic findings. Conservative treatment is the most common approach, and surgical procedures are usually performed using arthroscopy.
Downloads
References
1. Ostojic M, Hakam HT, Lovrekovic B, Ramadanov N, Prill R. Treatment of anterior knee pain due to chondromalacia patellae with platelet-rich plasma and hyaluronic acid in young and middle-aged adults, a cohort study. Arch Orthop Trauma Surg [Internet]. 2024 [citado 26 Feb 2025]; 144(9):3969-3976. Disponible en: https://pubmed.ncbi.nlm.nih.gov/38780774/
2. Alharbi AH, Seyam MK, Alanazi A, Almansour A, Hasan S. Influence of pain, risk factors, and functional ability on physical activity levels in women with anterior knee pain: a cross-sectional study. Medicina (Kaunas) [Internet]. 2024 [citado 26 Feb 2025 2025];60(9):1467. Disponible en: https://doi.org/10.3390/medicina60091467
3. Cai Y, Deng Y, Ou L, Guo Y, Guo Y. Clinical trial of manual therapy in the treatment of chondromalacia patellae. Medicine (Baltimore) [Internet]. 2023 [citado 26 Feb 2025];102(24): e33945. Disponible en: https://doi.org/10.1097/MD.0000000000033945
4. Demir M, Sahan MH. Evaluation of the relationship between trochlear and patellar morphology and patellar chondromalacia with magnetic resonance imaging. Acta Orthop Belg [Internet]. 2023 [citado 26 Feb 2025];89(3):409-416. Disponible en: https://doi.org/10.52628/89.3.11782
5. Chamorro-Moriana G, Espuny-Ruiz F, Ridao-Fernández C, Magni E. Clinical value of questionnaires & physical tests for patellofemoral pain: validity, reliability and predictive capacity. PLoS One [Internet]. 2024 [citado 26 Feb 2025];19(4):e0302215. Disponible en: https://doi.org/10.1371/journal.pone.0302215
6. Kizilgöz V, Kantarci M, Aydin S. Association between the subcutaneous fat thickness of the knee and chondromalacia patella: a magnetic resonance imaging-based study. J Int Med Res [Internet]. 2023 [citado 26 Feb 2025];51(6). Disponible en: https://doi.org/10.1177/03000605231183581
7. Jones RH, Lijesen E, Green DW. What's up with patella alta? Curr Opin Pediatr [Internet]. 2025 [citado 26 Feb 2025];37(1):82-87. Disponible en: https://doi.org/10.1097/MOP.0000000000001428
8. Kaur R, Dahuja A, Kaur C, Singh J, Singh P, Shyam R. Correlation between chondromalacia patella and patellofemoral factors in middle-age population: a clinical, functional, and radiological analysis. Indian J Radiol Imaging [Internet]. 2021 [citado 26 Feb 2025];31(2):252-258. Disponible en: https://doi.org/10.1055/s-0041-1734361
9. Halabi MH, Alturkistani BA, Abuhadi RH, Garout AN, Almuqbil FB, Alshehri MS. The efficacy of hip and knee muscles strengthening versus knee muscle strengthening alone in managing patellofemoral pain syndrome: A systematic review and meta-analysis. Musculoskeletal Care [Internet]. 2025 [citado 26 Feb 2025];23(1): e70059. Disponible en: https://doi.org/10.1002/msc.70059
10. Retzky JS, Gross PW, Doyle SM, Strickland SM. High rates of abnormal patellofemoral morphology in adolescents with anterior knee pain: a retrospective review. HSS J [Internet]. 2024 [citado 26 Feb 2025];20(3):351-358. Disponible en: https://doi.org/10.1177/15563316241231805
11. Dursun M, Ozsahin M, Altun G. Prevalence of chondromalacia patella according to patella type and patellofemoral geometry: a retrospective study. Sao Paulo Med J [Internet]. 2022 [citado 26 Feb 2025];140(6):755-761. Disponible en: https://doi.org/10.1590/1516-3180.2021.0206.R2.10012022
12. Özel D. The relationship between early-onset chondromalacia and the position of the patella. Acta Radiol [Internet]. 2020 [citado 26 Feb 2025];61(3):370-375. Disponible en: https://doi.org/10.1177/0284185119861901
13. Öztürk C, Güngör Ö. Relationship between patellofemoral joint morphology and chondromalacia patella. Acta Radiol [Internet]. 2024 [citado 26 Feb 2025];65(1):62-67. Disponible en: https://doi.org/10.1177/02841851231169725
14. Mostafaee N, Pashaei-Marandi M, Negahban H, Pirayeh N, Saki Malehi A, Ebrahimzadeh MH. Examining the diagnostic accuracy of common physical examination and functional tests in the diagnosis of patellofemoral pain syndrome among patients with anterior knee pain. Physiother Theory Pract [Internet]. 2024 [citado 26 Feb 2025];40(4):843-855. Disponible en: https://doi.org/10.1080/09593985.2022.2158053
15. Nielsen MG, Lyng KD, Holden S, Johansen SK, Winters M, Rathleff MS. Item generation for a new patient-reported outcome measure: The non-traumatic anterior knee pain (AKP)-YOUTH scale. Musculoskelet Sci Pract [Internet]. 2024 [citado 26 Feb 2025]; 73:103151. Disponible en: https://doi.org/10.1016/j.msksp.2024.103151
16. Sieron D, Jablonska I, Niemiec P, Lukoszek D, Szyluk K, Platzek I; et al. Correlation of patellofemoral chondromalacia and body mass index (BMI) in relation to sex and age analysis of 1.5T and 3.0T magnetic resonance (MR) images using the Outerbridge scale. Med Sci Monit [Internet]. 2022 [citado 26 Feb 2025];28:e937246. Disponible en: https://doi.org/10.12659/MSM.937246
17. Cho J, Yi J, Song Y, Kim YU. Assessment of patellar cartilage cross-sectional area in patients with lower grade chondromalacia patella. Medicine (Baltimore) [Internet]. 2023 [citado 26 Feb 2025];102(33): e34307. Disponible en: https://doi.org/10.1097/MD.0000000000034307
18. Rethman KK, Mansfield CJ, Moeller J, De Oliveira Silva D, Stephens JA, Di Stasi S; et al. Kinesiophobia is associated with poor function and modifiable through interventions in people with patellofemoral pain: a systematic review with individual participant data correlation meta-analysis. Phys Ther [Internet]. 2023 [citado 26 Feb 2025];103(9). Disponible en: https://doi.org/10.1093/ptj/pzad074
19. Saral I, Agirman M, Basat H, Surucu S, Mahirogullari M, Cakar E. A comparison of isokinetic muscle strength in patients with chondromalacia patella: a cross-sectional study. Eur Rev Med Pharmacol Sci [Internet]. 2022 [citado 26 Feb 2025];26(21):7771-7778. Disponible en: https://doi.org/10.26355/eurrev_202211_30126
20. Kim KC, Wakeman B, Wissman R. Functional imaging of the knee-A comprehensive review. J Knee Surg [Internet]. 2024 [citado 26 Feb 2025];37(8):593-601. Disponible en: https://doi.org/10.1055/a-2216-5186
21. Shetty ND, Dhande RP, Parihar P, Bora N, Shelar SS. The role of magnetic resonance imaging in the evaluation of knee pain. Cureus [Internet]. 2024 [citado 26 Feb 2025];16(7):e65898. Disponible en: https://doi.org/10.7759/cureus.65898
22. Sirik M, Uludag A. Assessment of the relationship between patellar volume and chondromalacia patellae using knee magnetic resonance imaging. North Clin Istanb [Internet]. 2019 [citado 26 Feb 2025];7(3):280-283. Disponible en: https://doi.org/10.14744/nci.2019.65882
23.Mederake M, Scheibe V, Dalheimer P, Schüll D, Marina D, Hofmann UK. Reliability and accuracy of the Outerbridge classification in staging of cartilage defects. Orthop Surg [Internet]. 2024 [citado 26 Feb 2025];16(5):1187-1195. Disponible en: https://doi.org/10.1111/os.14016
24. Smith RDJ, Hanrahan M, Gerber A, Tanaka MJ. Patellofemoral disorders in soccer players. Sports Med Arthrosc Rev [Internet]. 2024 [citado 26 Feb 2025];32(3):146-155. Disponible en: https://doi.org/10.1097/JSA.0000000000000390
25. Young JL, Snodgrass SJ, Cleland JA, Rhon DI. Usual medical care for patellofemoral pain does not usually involve much care: 2-year follow-up in the military health system. J Orthop Sports Phys Ther [Internet]. 2021 [citado 26 Feb 2025];51(6):305-313. Disponible en: https://doi.org/10.2519/jospt.2021.10076
26. Kim T, Kim JK, Lee HS, Kim DK. Patella-patellar tendon angle in relation to the medial patellar plica syndrome, chondromalacia patella, and infrapatellar fat pad syndrome. PLoS One [Internet]. 2022 [citado 26 Feb 2025];17(3): e0265331. Disponible en: https://doi.org/10.1371/journal.pone.0265331
27. Katz NB, Tsitsilianos N, Nowak AS, Douglas SR, Tenforde AS, Borg-Stein J. Advanced non-operative interventions for anterior knee pain. Curr Rev Musculoskelet Med [Internet]. 2024 [citado 26 Feb 2025];17(12):589-615. Disponible en: https://doi.org/10.1007/s12178-024-09930-x
28. Vasconcelos GS, Nunes GS, Munhoz RF, da Silva MECB, Pisani GK, Luz BC; et al. Is strength and power training targeting hip and knee muscles superior to strength training in individuals with patellofemoral pain? Proof of concept study. Sci Rep [Internet]. 2024 [citado 26 Feb 2025];14(1):27450. Disponible en:
https://doi.org/10.1038/s41598-024-78074-2
29. Zheng W, Li H, Hu K, Li L, Bei M. Chondromalacia patellae: current options and emerging cell therapies. Stem Cell Res Ther [Internet]. 2021 [citado 26 Feb 2025]; 12(1):412. Disponible en: https://doi.org/10.1186/s13287-021-02478-4
30. Wong YM, Suzuki S, Odagiri K. The micro-current stimulation of knee acupoints in management of chondromalacia patella: a case report. J Phys Ther Sci [Internet]. 2020 [citado 26 Feb 2025];32(11):772-774. Disponible en: https://doi.org/10.1589/jpts.32.772
Published
How to Cite
Issue
Section
License
Copyright (c) 1970 Alejandro Alvarez López
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright: Camagüey Medical Archive Magazine, offers immediately after being indexed in the SciELO Project; Open access to the full text of the articles under the principle of making available and free the research to promote the exchange of global knowledge and contribute to a greater extension, publication, evaluation and extensive use of the articles that can be used without purpose As long as reference is made to the primary source.
Conflicts of interest: authors must declare in a mandatory manner the presence or not of conflicts of interest in relation to the investigation presented.
(Download Statement of potential conflicts of interest)
The Revista Archivo Médico de Camagüey is under a License Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 International (CC BY 4.0).
This license allows others to distribute, to mix, to adjust and to build from its work, even for commercial purposes, as long as it is recognized the authorship of the original creation. This is the most helpful license offered. Recommended for maximum dissemination and use of licensed materials. The full license can be found at: https://creativecommons.org/licenses/
22 julio 2025