The hall mark of symptoms of chondromalacia is pain, which is more constant with grade IV chondromalacia and more intermittent with grade III chondromalacia. Moreover, grade I and II chondromalacia are usually symptom free. As a matter of fact, chondromalacia presents itself in the knee joint and in particular mainly under the knee cap. This painful syndrome is called “patella-femoral syndrome.”
However, chondromalacia is also often found in the tibio-femoral joint, where there is the medial and the lateral compartment (simply meaning that anatomically there is an equally important inside and outside part of the knee joint).
In addition, alignment problems of the knees are either in the shape of a “genu valgus” (knock-knee, where the knees are close together, but the appearance of the upper and lower legs look like an X from behind) or in the shape of a “genu varus” (bowleggedness , where the appearance from behind is like an O).
Alignment problems in the knee
It seems like in genu valgus the increased pressure onto the inside surfaces leads to a chondromalacia of the medial compartments on both knees. Most noteworthy, in bowleggedness the pressure on the outside parts of the knees leads to bilateral knee compartment chondromalacia. As a result, in this case the chondromalacia is located in the outside tibiofemoral joints.
If the pain leads to the patient resting more, there often is a corresponding muscle atrophy of the quadriceps muscle on one or both sides. Patello-femoral syndrome is more common among women, possibly because comparatively genu valgus is more common among women. With this in mind, grinding can be felt by the examiner when the knee cap (patella) is pushed against the lower end of the femur and the knee is flexed and extended alternatingly.
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 62.
2. EL Cain et al. Clin Sports Med 2001 Apr;20(2):321-342.
3. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.
3. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
4. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
5. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier