CHONDROMALACIA PATELLAE

¹ Department of Orthopaedic Surgery, State University of Iowa School of Medicine, Iowa City

Chondromalacia of the patella can be a disabling disease in a young, otherwise healthy individual. A summary of the clinical symptoms shows that in a patient in his early twenties, with a history of chronic knee discomfort which does not respond to conservative treatment, and which includes weakness, tendency to locking, occasional swelling of the knee, and pain especially on the medial side of the joint, the diagnosis of chondromalacia of the patella must be strongly considered. If patellar crepitation or grating is present, this diagnosis can be made with a greater degree of certainty. In young individuals, a positive diagnosis of chondromalacia of the patella can only be made at time of operation. In older individuals, a positive diagnosis can be made, based entirely on the described clinical signs and symptoms.

All of the cases in Group I were characterized by the absence of swelling at preoperative examination. At best, this symptom is of dubious diagnostic value. A certain amount of fluid can be present without a noticeable change in form of the joint. In 50 per cent. of the remaining groups, this sign was also absent. The presence of osteophytes will help in the diagnosis of osteo-arthritis; otherwise, none of the symptoms distinguish Group I from the other groups or the other groups from each other.

There were no specific signs or any combination of signs that could be attributed to the existence of free bodies or a torn meniscus in the joint. Usually, the relatively increased intensity of the described complaints will indicate the possible presence of these conditions.

In regard to the surgical treatment, it was found that patellaplasty or chondrectomy, combined with some form of covering for the articular surface, gave consistently poor results and could not be considered of any value in the treatment of this disease. This was obvious as far back as 1933, when the last patellaplasty was performed in this Clinic.

The surgery of choice is either the partial chondrectomy or the patellectomy. Chondrectomy gave good results in 75 per cent. of all the cases in which it was performed. The excision of the patella gave good results in all cases except one, where a primary synovitis was present. When synovitis is present with chondromalacia of the patella, synovectomy is not required, since this condition usually clears up after excision of the patella. The age of the patient has little influence on the choice of surgical treatment. Often the decision as to the type of operation to be performed will have to be made after the knee joint has been exposed, and the degree of degeneration has been determined. Chondrectomy should be reserved only for those cases in which the patellar cartilage and surrounding soft tissue are mildly or moderately involved. In all cases in which there is a severe involvement of the synovial tissue, the patellectomy will give best results. Any free bodies and torn menisci that might be present should, naturally, be removed.

The youngest patient in whom a patellectomy was performed was thirteen years of age; the oldest patient was thirty-six. In all cases, the functional results were good. The follow-up period ranged from five months to two and one-half years, with an average of fourteen months.

In conclusion, chondromalacia of the patella is a relatively frequent condition in both young and old. In all patients who do not respond to conservative treatment, surgery will produce definite and lasting relief from subjective symptoms.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				R.N. Villar Patellofemoral pain and the infrapatellar brace: A military view Am. J. Sports Med., September 1, 1985; 13(5): 313 - 315. [Abstract] [PDF]