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Chondromalacia patella should not be confused with simple patellar arthralgia ("achy kneecap syndrome", for lack of a better common name), which causes a dull, achy pain within the kneecap bone itself. This pain makes it difficult to keep one's knee flexed (bent) for prolonged periods, such as in movie theaters or airplanes. While this syndrome can co-exist with patellar chondromalacia, it can cause symptoms even when the articular cartilage behind the kneecap is perfectly firm and healthy. Patellar arthralgia, by itself, is usually recognizable as such by knee specialists. It is usually best treated with therapeutic exercise alone, emphasizing quadriceps muscle strengthening and stretching. Surgery rarely offers any benefit.

When knee pain is caused by structural softening and degeneration of the articular cartilage behind the kneecap (true chondromalacia), the patient's orthopedic surgeon should search for underlying mechanical causes such as natural patellar malalignment, a history of recurrent injury caused by unstable (loose) kneecaps and/or a history of prior, severe impact injury to the patella.

Surgeons should assess their patients with patellar pain by performing a careful physical examination, looking for patellar articular surface tenderness, crepitation, or problems such as patellar arthralgia, infrapatellar tendinitis, patellar instability, or malalignment caused by an excessively tight lateral retinaculum. The lateral retinaculum is a sheet of tough, ligament-like tissue connecting the lateral (outer) aspect of the patella to the lateral femur. It is usually thicker and better developed than its matched counterpart on the medial (inner) side of the knee, the medial patellar retinaculum. An excessively tight lateral retinaculum pulls the kneecap over toward the outside of the knee, creating excessive pressure between the lateral aspect of the patella and the lateral femur. This in turn may cause premature breakdown of the articular (joint surface) cartilage there. This type of malalignment syndrome is known as "ELPS" or excessive lateral pressure syndrome, and can usually be confirmed by special x-ray studies.


® 2007. The Knee and Shoulder Centers of New Jersey and Pennsylvania.