The Journal of Bone and Joint Surgery, Vol 70, Issue 6 883-899, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
An electron microscopic study of early pathology in chondromalacia of the patella
O Ohno, J Naito, T Iguchi, H Ishikawa, K Hirohata and TD Cooke
Department of Orthopaedic Surgery, Kobe University School of Medicine, Japan.
For a study of the ultrastructural pathology of chondromalacia patellae, we
studied biopsy specimens that had been obtained at operation in twelve
young patients who had pain in the anterior aspect of the knee due to
mechanical derangement and also had the pathological changes in articular
cartilage that are characteristic of chondromalacia. The initial
pathological finding was swelling of the superficial matrix associated with
breakdown of the collagen fiber network, especially at matrix streaks in
the superficial and transitional zones. Fibrillated cartilage contained
surface fissures that penetrated the middle layers. Amorphous
electron-dense material was found covering the internal surfaces of the
fissures; this appeared to contain degraded components of the matrix. In
association with these changes, there were formation of nests of cells
(clusters of chondrocytes) and increased numbers of organelles in the
chondrocytes. A limited repair reaction also was observed in some
specimens; this was characterized by the migration of fibroblast-like cells
over the surface of the cartilage. The ultrastructural observations on
these specimens from patients who had chondromalacia were compatible with a
pathogenesis resulting from mechanical overload.
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