Patella Chondromalacia

Patella Chondromalacia is a softening of the articular cartilage of the patella, and is generally a result of trauma, or degenerative changes within the knee. This condition is commonly associated with patella femoral compression syndrome, and other knee injuries.

Understanding what causes chondromalacia, signs and symptoms, and treatment options can help you recover, and return to play faster.

What is Patella Chondromalacia?

Chrondromalacia is the term used to describe a degeneration of articular cartilage. Remember, articular cartilage is a hard, very slick type of cartilage that covers the ends of bones where they articulate, or touch, other bones. Usually found within the joints of the body, articular cartilage helps to reduce friction during movement. Patella chondromalacia refers to the articular cartilage on the undersurface of the patella.
Chondromalacia can be classified in 4 grades or stages. Grade I involves the softening of the articular cartilage. As the cartilage softens, it often takes on a rough appearance, much like very fine sandpaper. As the cartilage is normally very smooth and slick, this can lower the effectiveness of the cartilage, and increase the friction between the two bones.
Grade II chondromalacia involves a roughening of the cartilage. It begins to take on a very rough surface, and very small amounts of the cartilage are eroding away. Popping within the joint becomes common, and there may be mild pain associated with activities.

Grade III chondromalacia occurs when small pieces of the articular cartilage begin to break away. There may be holes in the articular cartilage, and the overall thickness is no longer uniform. This is usually accompanied by significant amounts of pain, popping, and possibly swelling.

Grade IV chondromalacia involves fissures or cracks in the cartilage that reveal the underlying bone. There may be large holes within the cartilage, and the exposure of the subchondral bone leads to severe pain and discomfort. There may also be loose pieces of articular cartilage floating within the joint.


This condition often begins slowly, as an ache or occasional sharp pain within the knee. The pain usually originates from the underside of the kneecap. Popping may occur, although it may not be painful. Contraction of the quadriceps muscles pull the patella into the femoral groove, and this compression causes a grinding sensation at the patella. There may be small amounts of swelling around the kneecap, and it may be tender to the touch. As the injury gets worse, pain will increase, and may hinder your athletic activities. Running and jumping will usually be the primary activities that increase pain. Deep sqautting may also be painful.

What Causes Patella Chondromalacia?

Patella chondromalacia does not occur on its own, and is not as common with traumatic knee injuries. The most common cause is patella femoral syndrome. With this injury, the normal mechanics of the patella are disrupted by various factors, and a degeneration of the cartilage occurs because it is unable to recieve the normal amounts of nutrients.

Traumaic knee injuries can also be a cause, however this is not as common as normal wear and tear on the knee. During a traumatic knee injury, there may be significant forces compressing the patella into the femoral groove, which leads to damage to the cartilage. As time passes, this damaged area becomes soft, and starts to erode away, leading to patella chondromalacia.


The most effective treatment is to determine the biomechanical factors that are causing the problem, and to address them. Patella femoral syndrome can be caused by many different factors, including flexibility, anatomical structure, muscular strength and balance, and biomechanics at the foot and ankle. By addressing these factors, you can restore the normal mechanics of the patella, and stop further damage to the cartilage. R.I.C.E. is also helpful in treating the pain and discomfort associated with this injury.

The only way to directly treat this injury is through surgical intervention. Arthroscopic surgery to "clean up" the articular cartilage may be necessary in some cases. The procedure involves a smoothing out of the cartilage and removal of any loose debris. Because patella chondromalacia is a result of other injuries, surgery just for this condition is not very common.


Patella chondromalacia is not a specific sports injury, but rather a result of other injuries, especially patella femoral syndrome. To treat this condition, the underlying causes must be identified and addressed. Resolution of biomechanical, flexibility, and strength issues is the most effective non-surgical treatment. As always, rest, ice, compression, and elevation are very beneficial in treating this condition.

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