Features January 2018 Issue

Knee Pain: Front and Center

Pain in the front of the knee may arise from a common condition that sometimes, but not always, causes symptoms.

Do you have pain in the front of your knee and feel a grinding sensation when you bend your knee? If so, you may have chondromalacia patella. This is the breakdown of articular cartilage on the underside of the kneecap (patella). Articular cartilage is a tough, elastic tissue that covers the ends of bones in the most mobile joints in the body, including the knees. It allows for smooth, pain-free movement.

“Chondromalacia occurs on a spectrum, ranging from little fissures and softening to deep cracks and wearing down to the bone,” says Cleveland Clinic orthopaedic surgeon Jack Andrish, MD.

Patellofemoral Joint

The part of the knee between the kneecap and the thigh bone (femur) is called the patellofemoral joint. This joint has the thickest articular cartilage in the body. The knee joint supports a lot of weight, and the thick cartilage helps to absorb and distribute that pressure evenly.

Chondromalacia frequently occurs with age. Most adults have it to some degree. As the cartilage breaks down, there is less cushioning between the kneecap and the joint. Sometimes this causes symptoms.

“Articular cartilage is vulnerable to breaking down, and it doesn’t heal, so any injury is permanent,” says Dr. Andrish. If you are overweight, have had a knee injury, play soccer, run, ride a bicycle or exercise often, you may develop pain in the front of your knee, which can be related to chondromalacia patella.


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The thick cartilage under the kneecap can wear down with age.

In more advanced cases, gaps in damaged cartilage may lead to bone rubbing against bone. This can cause pain or a grinding sensation around the kneecap when the knee is bent. So you’ll feel pain when going down stairs, walking downhill, getting up from a chair, running, squatting, hiking or kneeling.

Link to Knee Osteoarthritis

Regarding chondromalacia and osteoarthritis, “one doesn’t cause the other,” says Dr. Andrish. “There may be an association or they may be linked, but there is no cause and effect.” You can start off with chondromalacia, and as the cartilage damage progresses you can develop osteoarthritis in that knee. “It’s a spectrum,” Dr. Andrish explains.

It is possible to have osteoarthritis that is confined to the patellofemoral joint, which would cause pain in the front of the knee similar to the pain associated with chondromalacia. The challenge is determining where the pain is coming from. “If we know the source of the pain, we are better able to be more specific in the treatment,” says Dr. Andrish.

Treatment for a Lifetime

“Treatment for chondromalacia is not accomplished in just a few months,” says Dr. Andrish. A physical therapist will instruct and guide a plan for rehabilitation. But to reduce the pain and be more comfortable, you will need to follow a treatment plan for the rest of your life. Fortunately, the treatment for chondromalacia will also benefit osteoarthritis of the knee.

The three-part treatment plan includes exercises to strengthen and stretch the thigh muscles (quadriceps) and hip, low-impact aerobic exercise, and maintaining a healthy weight.

“The trick with someone who has arthritis or chondromalacia is finding an aerobic exercise that doesn’t hurt or make the knee swell,” says Dr. Andrish. He recommends walking, swimming, riding a stationary bike, or using an elliptical machine.

It is important to find an exercise plan that works for you and is something that you can easily do at home or in a gym. “More often than not, we don’t resort to surgery because people can be helped by following the exercise program,” he says.†

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