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Sports Medicine

Chondromalacia

09/13/2000

Question:

I was diagnosed with Chondromalacia 7 years ago. I was put in aggressive Physical Therapy for a year nothing changed. I am an avid volleyball, softball player, as well as a dancer. They have put me in braces taped me and I even took a year off from all sports. I am having sever pain and can hardly walk. My doctor doesnt want to do surgery and wants to try to keep treating me conservitavely. Is there any way I can convince him to do the surgery without falling down a flight of stairs first? and Is there anything I can do to help myself in the meantime? Thanks.

Answer:

You are an avid volleyball player, and also play softball and dance. You were diagnosed with chondromalacia 7 years ago, and despite one year of aggressive Physical Therapy, including bracing and taping, and taking a year off sports, your symptoms have remained so severe that you can hardly walk. You want your doctor to perform surgery, but continued nonsurgical treatment has been recommended.

The term "chondromalacia" means softening of cartilage, so the only true way of making this diagnosis is during surgery. Since you`ve not had surgery, this diagnosis may or may not be correct. You didn`t mention whether or not you have undergone X-rays, but those would certainly be necessary to help clarify your diagnosis. If you`ve had X-rays but have not undergone an MRI (magnetic resonance imaging) scan, MRI is an additional diagnostic test which would clarify whether or not the diagnosis of "chondromalacia" remains a possibility. A better term is patellofemoral pain, which refers to pain in the front part of the knee, involving the patella or kneecap. You didn`t mention whether your symptoms involve one or both knees - if it`s just one knee, the cause may be easier to determine. But even if both knees have pain, there may be anatomic or structural predisposing factors making it more likely for you to have these symptoms, especially since you enjoy jumping, cutting, pivoting, running, and quick stop-and-start activities, all of which tend to aggravate patellofemoral pain. Such structural features would include flat or hyperpronated feet. You didn`t mention whether the taping and bracing you underwent involved just your knees, or also your feet. If your feet haven`t been evaluated, they should be.

Surgical procedures for patellofemoral pain usually involve realigning the patella, and are usually regarded as a last resort, only when all nonsurgical treatment options have been exhausted, unless: 1) there`s a loose cartilage fragment present, or 2) there`s a degenerative portion in the tendon below the patella... both these conditions would usually show up on an MRI, and are more likely to benefit from surgical intervention. You may wish to ask your doctor exactly why is surgery being advised against... it could be because the likelihood of your benefiting from surgery is uncertain. If so, perhaps the details can be further discussed.

Short of surgery, there are a number of different knee braces for patellofemoral pain, some of which would work better than others for a particular person, so, trying several types of knee braces may be necessary. Nonsteroidal anti-inflammatory drugs such as Ibuprofen and Naproxen over the counter, as well as a large number of prescription medications in this category, often provide some degree of relief, which, again, varies with the individual. There are a number of exercise approaches to patellofemoral pain, including very specific strengthening and stretching exercises, tailored for each individual`s needs, so hopefully your extensive P.T. has incorporated all available options from this standpoint.

Of great importance at present is a cross-training exercise program to maintain your conditioning/fitness level as much as possible, through such activities as swimming or water exercise, ski machines, possibly cycling, etc., as long as your symptoms don`t become further aggravated in the process.

I truly hope you find some of this information to be of benefit.

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Response by:

The Ohio State University Brian L Bowyer, MD
Associate Professor of Clinical PM&R
The OSU Sports Medicine Center
Department of Physical Medicine and Rehabilitation
College of Medicine
The Ohio State University
Brian L Bowyer, MD