Symptoms and causes of patella chondropathy

By Cristiano Antonino Last updated Feb 16, 2023

When we talk about patellar chondropathy, we often refer to the pathology that affects the anterior region of the knee, therefore we are talking about anterior knee pain

The term chondropathy indicates a damage to the cartilage which, in this case, is associated with both the patella and the femur where the patella slides in the flexion-extension movement.

There are different degrees of chondropathy, as well as different causes and treatments

It is up to the orthopedic specialist to identify the problem and direct the patient to the therapeutic path that best suits her needs.

The different degrees of chondropathy

As mentioned, there are different degrees of chondropathy, from the least serious to the most serious: we go from grade 0 or I chondropathies, i.e. knees that only have an inflammatory disease of the cartilage, up to gradually more important pathologies up to grade IV , resulting in patellofemoral arthrosis.

The causes of patellofemoral syndrome

Chondropathy has several causes.

It is a frequent pathology, both in young people and in less young people, so much so that more than chondropathy, a diagnosis of patellofemoral syndrome is made, which results in chondropathy, but, being precisely identified as a syndrome, this is conditioned by several factors which can be:

morphological articulation, therefore joints that do not have a precise shape, dysplasias;
functional, i.e. linked to how and how much our kneecap works.

Patellofemoral dysplasia

Patellofemoral dysplasia is a morphological alteration (of the shape) of the joint between the femur and the patella.

The latter can be too flat, off-center (lateralized), too high, excessively inclined.

This affects the movement of the kneecap itself within the joint, resulting in the abnormal wear of the cartilage.

This can also be associated with impaired foot support which, if not corrected, can aggravate the disease.

Diseases of the muscular system

Then there are pathologies related to the muscular system.

How many, perhaps following prolonged immobilization or simply because there has been a long time without physical activity due to Covid, develop painful symptoms of the knee?

If a person returns to physical activity with an unsuitable muscle situation, an imbalance in the patellar femur joint can occur.

This is risky because it can result in a functional pathology of the patella, characterized by pain related to the sliding of the patella within the joint.

Factors influencing patellofemoral pathology and pain symptom

Being a syndrome, and being influenced by various factors, first of all it is necessary to resolve the factors predisposing to patellofemoral chondropathy.

Between these:

foot support;
musculature;
relationship between extensor and flexor muscles with relative muscle strengthening.

Usually the medial (internal) muscle of the thigh is the one affected by the syndrome, for this reason it is necessary to strengthen it, taking care to lengthen the opposing muscle.

Obviously, this must be done without causing pain, because a patient who is in pain and starts doing the wrong exercises can significantly worsen the clinical picture.

Therefore, as mentioned, the main symptom of patellar chondropathy is pain at different degrees, linked to the different types of chondral damage that we are facing.

Almost all patellofemoral pathology must make use of a good contribution from the muscles and any treatment you want to set up, without good muscle tone, is doomed to failure.

The pain focuses mainly in the front of the knee and sometimes radiates to the thigh and can lead to worsening of some activities: jumping, sprinting, leaps, walking downhill, climbing stairs, squatting positions.

This is why it is important to find the most suitable exercises and activities for this phase.

Direct traumas are also responsible for the syndrome and painful symptoms.

Just think of the classic trauma from a direct fall on the patella which does not lead to the breaking of the patella itself, but to a contusion of the cartilage between the femur and the patella which can first become inflamed and then develop a chondropathy linked to the femoral-patellar conflict.

The diagnosis of patellofemoral chondropathy

The diagnostic suspicion is substantially clinical: the expert knee surgeon is able to make the diagnosis thanks to the description of the symptoms by the patient which is quite significant and repetitive.

Then it is necessary to find a confirmation also in the clinical examination of the patient, with specific tests on the patellofemoral joint and subsequently, almost always, to typify the extent and severity of the pathology, there is the need to resort to instrumental tests such as X-rays and MRIs that study in a specific and functional way how the kneecap moves within the joint.

During the examination, the muscles are contracted in order to see if the kneecap assumes altered position during the phase of muscle contraction.

Be careful not to confuse chondropathy and patellar instability

The treatment of patellofemoral syndrome is established on the basis of what emerges from the clinical and instrumental examination.

When we talk about pathology from patellofemoral chondropathy, it is absolutely necessary to differentiate it from another pathology, patellar instability, which involves completely different treatments.

The first is, in fact, a painful pathology that can give flexor failures (the knee bends suddenly due to the pain felt).

Patellar instability, on the other hand, is a pathology in which the patella comes out of its position and luxates or sub-luxates and is almost always of surgical competence.

Once we understand that we are suffering from a painful pathology, we must absolutely correct the muscles and resolve all the predisposing factors.

The different treatments of chondropathy based on the degree of pain

There are very effective physical therapies that are linked precisely to pain reduction, such as instrumental physiotherapy (tecar therapy, laser therapy often used).

Foot support is often to be corrected with a suitable orthotic for this reason it is important to understand what are the causes that led to the appearance of pain.

When the chondropathy is not particularly serious, erosive or does not reach degrees of full-blown arthrosis, it is also possible to resort to regenerative medicine always in association with physiotherapy, based on the type of pathology.

In this case, the clinician has joint infiltrative therapy available with growth factors (PRP or mesenchymal stem cells) or hyaluronic acid, with different indications depending on the situation.

Finally, surgical therapy is used to treat anterior knee pain, when all conservative therapies prove unsuccessful.

When the pathology is localized, an arthroscopic surgical treatment can be indicated, able to evaluate the extent of the damage and find the correct surgical approach which can be both cartilage transplantation and techniques to stimulate the healing of the cartilage damage.

It is also possible to carry out arthroscopic interventions associated with open surgery, to release (relaxation) of 1 of the 2 alar ligaments that guide the movement of the patella, partially improving the position and sliding of the patella.

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