Chondromalacia

Chondromalacia translates to “cartilage that is bad.” Typically, this refers to cartilage in the knee or behind the Patella specifically, that is getting frayed, injured, or softened. If this occurs behind the kneecap, it is called Patella Chondromalacia. Download our e-book “The Knee Owner’s Manual” for more information about knee conditions.

Symptoms of Chondromalacia

Chondromalacia is the knee usually causes pain, typically around the kneecap or deep in the kneecap. You can also have some grinding sensations or crepitus which are sounds and noises coming from around the knee with certain motions. Typically, pain and grinding sensations are worse with bending the knee, especially for prolonged periods of time, kneeling on the knee, walking downstairs, or running downhill. Standing after prolonged sitting or an immobility period where the knee is bent can cause some discomfort as well. Some people may experience swelling, others may experience locking or catching in the knee, feeling the knee wants to give out, or a feeling of weakness.

Common Causes

• Chondromalacia can be due to an injury such as a fracture or dislocation of the kneecap.
• Risk factors for Chondromalacia of the knee can include being overweight, being a growing teenager, and specific biomechanical issues.
• Common biomechanical causes would be a weakness in the core muscles such as the multifidus, transverse abdominals, and glute muscle weakness. This weakness in turn causes excess internal rotation of the femur leading to lateral movement of the patella, so when the knee bends, the patella and the femur are out of alignment causing the kneecap to not fit into its natural groove. With this, you can get grinding sensations of the cartilage behind the kneecap with the femoral bone, and it can lead to the symptoms described above.
• Sometimes, the weakness in the core and the glutes can be due to an irritated nerve from low back such as a degenerative disc, radiculitis, sciatica, etc.

· When the kneecap is not tracking well and moving outside its natural groove, especially with bending, this is called Patellofemoral Syndrome.

Common Treatments for Chondromalacia

Nonsurgical treatment:

• Rest can be a first-line treatment.
• Icing or heating the knee.
• Anti-inflammatory medications such as ibuprofen or Aleve, or over-the-counter pain medicines such as Tylenol.
• Exercise therapy or specific physical therapy to strengthen the core, the glutes, the quadriceps muscles and specific therapies and exercises to allow the kneecap to track better, taking pressure off. This is highly recommended for everybody with Chondromalacia Patella.

Surgical Treatment:

• Arthroscopic surgery is sometimes recommended for this where cartilage is sometimes trimmed or shaved.
• Sometimes, a surgery called a Microfracture is performed if there is a specific defect in the cartilage.
• If there is a broken-off piece of cartilage, a loose body removal of that can be done as well.

Alternatives to Surgical Treatment:

• Precise image guided procedures using PRP or Bone Marrow Concentrate can often be alternatives to surgery for Chondromalacia
• PRP, which is Platelet Rich Plasma made from your own blood, contains your body’s own growth factors which act like a cup of espresso to the local cells. These precise image guided PRP injection procedures may also provide some cartilage protection, improve the joint fluid environment, and treat tendons and ligaments that may be injured around the kneecap contributing to the problem. Also, with a thorough examination, if there are low back issues, PRP can sometimes be used to address those as well.
• Bone Marrow Concentrate from your own body contains stem cells. Procedures using precise image guided injections of Bone Marrow Concentrate into the knee can be used in more severe cases to promote your body’s natural healing response to damaged cartilage, tendons and ligaments, improve the joint fluid environment and reduce pain.
• At the Centeno-Schultz Clinic, we treat these problems with regenerative interventional orthopedic procedures to help patients avoid surgery, avoid the risk of medications and drugs and get longer term benefit rather than temporary pain-relieving solutions.
  • Our methodology is to be holistic so we spend extra time with the patient getting a full history, physical exam, ultrasound evaluation and review of any imaging received beforehand or that we may recommend on our own to come up with a complete diagnosis and treatment plan.
  • Therapy is always an adjunct to treatment, as well as diet and nutrition to reduce inflammation, and we have recommended supplements that can also help to reduce inflammation.
  • Then, once a full evaluation and adjunctive therapies are used, we can precisely inject PRP or Bone Marrow Concentrate or other orthobiologics (substances that come from the body which help the body heal itself) to specific areas of the knee to help with Chondromalacia.

A Deeper Dive into Your Treatment Options

Recovering from Chondromalacia

Conclusion:

• Chondromalacia is gradual weakening and injury to the cartilage, typically referred to behind the kneecap.
• This is typically caused by biomechanical issues that can be made worse by excess weight, growing teenagers, and potential problems with the back of the hips.
• This can cause significant pain and reduction of desired activities.
• A full evaluation with history, exam, imaging is needed to come up with a complete treatment plan.
• At Centeno-Schultz Clinic, we focus regenertive interventional orthopedic procedures to promote yourown body’s ability to heal itself, to focus on longer-term benefits rather than masking symptoms with drugs or doing invasive surgeries that have many risks and potential complications. If you are considering treatment, please read more about our non-surgical treatment for knee pain.

If you or anyone you know has this issue and would like to see if they are a candidate for treatment, please contact us.

Doctors That Can Assist With Chondromalacia

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Other Resources for Chondromalacia

Free Download: The Knee Owner’s Manual

Download Now

This e-book by Dr. Chris Centeno examines the knee and its role in the human musculoskeletal system and the body as a whole. The Knee Owner’s Manual provides a series of tests and clearly defined exercises that you can perform on your own to assess and monitor your own knee health. It will allow you to look for trouble spots where your own body may be having difficulty with stability, articulation, symmetry, and neuromuscular function. You’ll be able to see how these deficits in other regions of the body relate to the knee.

The Knee Owner’s Manual also discusses how Regenexx is pioneering the development of interventional orthopedics, a new branch of medicine that employs regenerative biologic therapies such as adult bone marrow concentrate and platelet-rich plasma to help repair and strengthen damaged tissues in other areas of the body.

This is contrasted with invasive knee surgeries, which often remove important tissues or replace the entire knee itself when it becomes damaged. With hyperlinks to more detailed information, related studies, and commentary, this book condenses a vast amount of data, images, and resources into an enjoyable and informative read. This is the first edition of The Knee Owner’s Manual, a companion book to Orthopedics 2.0.