First of all, treatment of chondromalacia for grade I and II chondromalacia consists of quadriceps strengthening and other exercises, as activity without overdoing it will strengthen the cartilage.
With regard to a patellofemoral syndrome this means that the patient needs to give up running running for a period of time. However, walking and swimming are appropriate exercises (Ref. 1). Also, the physician orders quadriceps exercises and physiotherapy treatments.
For grade III and IV chondromalacia it depends how the clinical condition of the patient is. If there is a lot of pain and there is some intermittent locking of the knee, it may well be that some loose bodies (basically sloughed off pieces of hyaline cartilage) are at times locking the knee.
Arthroscopy for grade III and IV chondromalacia
For grade III and IV chondromalacia it can be justified for the orthopedic surgeon to do an arthroscopy, assess the damage, shave off any irregularities and flush out any loose particles from the knee. This will likely give the patient at least 5 more good years without knee problems, until likely more degenerative changes happen, which might require orthopedic surgery again.
Ref. 2 reviews the various options for osteochondral injuries such as mosaic plasty, osteochondral transplantation and chondrocyte transplantation.
More difficult cases such as misalignments cases
Any of these procedures are very specialized procedures that are only done by experts in the field and often they are not applicable for the majority of cases. An orthopedic surgeon needs to assess alignment problems such as genu varus and genu valgus. The surgeon orthopedic surgeon will consider to do one of the offloading procedures such as wedge excisions to realign the bones. This allows the pressure gradients to change such that premature wear and tear is minimized. Weight control with the help of a sensible diet (Ref. 3) is also advisable.
References
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
6. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008
