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Chondromalacia patella is a broad diagnosis referring to anterior knee pain, usually of a non-traumatic, chronic entity. Specifically, chrondomalacia patella refers to the “softening” of cartilage at the patella-femoral joint in the knee. In essence, behind a patient’s kneecap has suffered erosion. However, this diagnosis has recently been used more to encompass numerous different conditions that all present with pain in the front of the knee, surrounding the kneecap. Some of these conditions include patella-femoral pain syndrome (PFPS), patella instability, housemaid’s knee (pre-patellar bursitis) and patellar tendinitis (Jumper’s Knee). However, Jumper’s knee occurs below the kneecap.
Patella-femoral pain syndrome (PFPS), has been gaining prevalence over the past 20-25 years in the world of Orthopedics and Sports Medicine. Put simply, PFPS is a condition caused by poor alignment and tracking, or movement, of the patella as it relates to the femur. Ideally, our patella is meant to travel, or “track”, in a nearly straight line, in a North-South manner, as we bend and straighten the knee. This injury presents itself when the ability of the patella to track smoothly is impeded. In some cases, this is caused by osteoarthritis or cartilaginous damage to the underside of the patella, where it contacts the femoral joint. While not rare, this is not the most common cause of this injury. In the majority of cases, PFPS is caused by malalignment and poor stability at joints either proximally or distally to the knee. Speaking in broad terms, weakness and instability at the hip joint, usually in the glute musculature is a major precipitating factor due to its influence in alignment of the lower extremity. Another common issue in most cases is tightness and soft tissue restrictions within the gastrocnemius muscle, altering mechanics at the ankle joint and thus changing alignment at the knee.
Patella instability is a classification of anterior knee pain due to hypermobility of the patella. This condition is characterized by excessive motion of the kneecap in relation to its position at the femur due to global or local ligamentous laxity. Usually, this diagnosis is preceded by acute episodes of instability, such as when the patella dislocates or subluxes outside of the confines of its normal joint space. This condition is far more common in females than males, particularly those of the pubescent and pre-pubescent age ranges. It is also more often seen in recreational activities that place an emphasis on flexibility, such as gymnastics, ballet, and cheerleading. Commonly, this condition presents with knee pain, weakness, instability, and fear or apprehension of re-injury.
Prepatellar Bursitis, or also known as Housemaid’s Knee is a condition where the bursa sacs of fluid in the front of the kneecap become inflamed. Generally caused by repetitive kneeling on the knee, infection, a direct fall onto the kneecap, gout or rheumatoid arthritis, this condition manifests with marked swelling on the front of the kneecap and pain. Often seen in carpet fitters and roofers, the goal of treatment is to reduce the inflammation in the bursa sac. Typically, NSAID”s are utilized and physical therapy may include measures to reduce inflammation, help the patient pick out padding if direct contact with the kneecap is used in an occupation, regain range of motion, and function.
Patella tendinitis, commonly known as “Jumper’s Knee”, is an inflammatory condition impacting the patella tendon, which connects the quadriceps to its distal attachment at the top of the tibia. This injury is generally recognized as an overuse injury, characterized as a soft tissue injury due to prolonged repetitive strain and loading. Most often, this injury is seen in both recreational and competitive athletes participating in sports that require repetitive loading of the knee in a bent position. Those sports would include, but are not limited to, basketball, soccer, football, and track and field. Normally, patient’s will present with anterior knee pain, moderate to severe tenderness to palpation, localized swelling, limitations in range of motion and flexibility, and painful quadriceps activation.
As always, the above is just a brief overview of each of those conditions, and patients should be seen by a licensed healthcare professional to insure accurate diagnosis and treatment plan. Speaking generally, each of the above diagnoses respond well to conservative treatment, and patient’s suffering from these conditions are excellent candidates for skilled physical therapy intervention. At Furnace Brook PT, our therapists specialize in the treatment of Orthopedic and Sports Medicine injuries. We will take the time to appropriately diagnose your condition, and formulate an individualized plan of care to get you back on your feet. Treatment for the above injuries may include, but is not limited to:
- Alleviating pain, stopping inflammation, and reducing swelling – varying hands on techniques, such as soft tissue mobilization, joint mobilizations, Kinesiotaping, cupping, and stretching, have been shown effective at modulating symptoms. Other physical agents such as ultrasound, electrical stimulation, iontophoresis, and cryotherapy are also at our disposal to combat pain.
- Restoring strength, improving alignment, enhancing stability – addressing these factors is a key aspect for maximal rehabilitation. It is important to address deficits not just at the knee, but also at the foot / ankle, hip, and trunk to achieve success.
- Graded return to activity – Gradually introducing strenuous activity in an incremental manner is essential to prevent a re-occurrence of symptoms. Aquatic therapy, available on-site at Furnace Brook PT, can be an excellent instrument to help achieve this goal, by allowing patients to return to running and jumping while placing minimal strain on the knee joint.