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Chondromalacia

Causes, Symptoms, Treatment Options, & Other Resources

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

Anterior Lateral Knee Pain

The knee joint is one of the most complex joints of the human body. The femur, the tibia, patella, and fibula all contribute to this joint. They are held together by a myriad of strong ligaments that stabilize and support the joint. Anterior lateral knee pain is pain that occurs in the anterior and the anterior lateral region of the knee joint. A person may experience this pain front and center, in the outer aspect of the knee, or diffusely throughout the joint. The cause of the pain is some pathology in the anterior and lateral aspect of the knee.

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Burning Pain on Outside of Knee When Kneeling

There are many possible causes of burning pain on the outside of the knee while kneeling. One possibility is that you may have patellofemoral syndrome, which is a condition that results in pain around the kneecap. This pain can be aggravated by activities such as kneeling or squatting. Other potential causes of this type of pain include iliotibial band syndrome, runners knee, and meniscal tears. If you are experiencing burning pain on the outside of your knee while kneeling, it is important to see a doctor for evaluation. Some of these conditions can be treated with conservative measures such as rest, ice, and physical therapy…

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Knee Hurts When I Bend It and Straighten It

Your knees bend countless times throughout the day. Running up the stairs, down the hall after kids, and getting into the car. You straighten the knee as you walk, descend stairs or get into and out of the car. Bending and straightening the knee are necessary for daily activities. Knee pain with bending or straightening may be a mild, transient irritation or may indicate a more significant problem. Learn more below and avoid further injury and dysfunction. Knee pain can vary significantly depending upon many factors including the actual source of the pain, the severity of the injury, general health, and level of activity…

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Knee Locking & Catching

Knees have the ability to bend forward and back, as well as rotate slightly. When a knee is unable to execute these actions, it impairs mobility and the capacity to complete daily chores such as sitting, standing, squatting, or kneeling. A locked knee occurs when a knee cannot be bent or straightened so it gets stuck or feels locked in a certain position for an extended period of time. There are two forms of locked knees: one that is due to inability to move because of an actually physical or mechanical restriction and there is one that feels locked due to the pain involved in moving it. When a person has their knee joint effectively frozen into place and cannot move, this is known as a true locked knee….

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Knee Making Crackling Sound

Crepitus is the medical term for this cracking or catching sensation. It can affect various regions of the body, but it is most common in the knee. It can happen due to air bubbles forming in bodily tissues (this is what happens most of the time), but it can also happen as a result of patellofemoral syndrome, damaged cartilage, osteoarthritis, or other conditions. Patients describe the sound of the popping with the following terms: popping, snapping, catching, clicking, crunching, cracking, crackling, creaking, grinding, grating, and Clunking. When Should You Be Concerned? When the crackling is accompanied by pain and/or the feeling of instability in the knee, that’s a good time to consult a physician. If the cracking is also associated….

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Knee Pain

Knee pain can be caused by many factors. Overuse injuries, direct trauma to the knee and arthritis are the most common causes of knee pain. Damage to the knee structures may cause swelling, scar tissue formation (fibrosis), and loss of function of the joint. Pain is often accompanied by difficulty walking, weakness, and instability. When the knee is overused, the thigh and shin bones (femur and tibia), cartilage, or tendons may experience stress. This leads to pain and discomfort as well as stiffness in the knee. Overuse injuries are common among athletes who participate in sports that involve running, jumping…

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Knee Swelling

Swelling of the knee, also known as water on the knee, is a condition in which fluid collects around the knee joint. Swelling can occur for a variety of reasons and affect patients of any age. Some swelling can be treated with over-the-counter medicines, but persistent and continuous swelling might result in tissue damage, bone softening, and cartilage deterioration. Over-the-counter medicines will assist relieve pain for individuals with a history of osteoarthritis and swelling following physical activity, such as exercise or running. During and after activity, the patient may apply compression sleeves to reduce the inflammation. Ice is another method…

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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

Knee Arthroscopy Surgery

Knee arthroscopy surgery is a very common procedure performed by orthopedic surgeons in an attempt to treat knee pain. Knee arthroscopic surgery is typically performed in an outpatient surgical facility where a small camera is inserted into the knee joint, which allows the surgeon an inside view of one’s knee to operate. It is used both to diagnose and treat a wide variety of knee problems. Utilizing arthroscopic surgery the surgeon can trim any “damaged” ligaments which are called knee ligament surgery.  Alternatively, if ‘damaged” meniscus is detected, it also is trimmed and or removed, which is called meniscus knee surgery.

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NSAIDs

The other day I was evaluating a patient and reviewing the treatment options for their spine condition.  After discussing prior treatments, we got to the topic of medications taken for pain relief. She explained that she mainly utilized anti-inflammatory (NSAID) medications and then she told me to hold much she takes and has been for many years…..she takes close to 2 grams (2000 milligrams) on a daily basis which equated to about 9-10 capsules of medication per day.  I was shocked, considering she was pre-diabetic and with high blood pressure plus the kicker of it is that her PCP (primary care physician) is ok with this…

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PRP Knee Injections

PRP stands for Platelet-Rich Plasma. Platelets are blood cells that prevent bleeding. They contain important growth factors that aid in healing. Plasma is the light yellow liquid portion of our blood. So PRP is simply a concentration of a patient’s own platelets that are suspended in plasma and are used to accelerate healing. PRP is NOT stem cell therapy. Regrettably, blood contains few circulating stem cells. Rich sources of stem cells are bone marrow and fat. PRP is rich in growth factors. There are many different types of growth factors with different properties. VEGF is a very important one as it can increase the blood flow to an area.

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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.

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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

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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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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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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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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Mairin Jerome, MD

Mairin Jerome, MD

Dr. Mairin Jerome is a physiatrist with subspecialty fellowship training in Interventional Orthopedics and Regenerative Medicine. This subspecialty serves to fill the gap for patients who are interested in therapeutic options that lie between conservative treatment and surgery. Dr. Jerome uses regenerative medicine techniques, including prolotherapy and orthobiologics, via X-ray or ultrasound guidance to precisely deliver injections to areas of musculoskeletal injury or degeneration. Orthobiologics refers to tissue harvested typically from a person’s own body, such as platelets (platelet-rich plasma, PRP) or bone marrow, for use in treating painful musculoskeletal conditions. The goal is to stimulate the body’s healing mechanisms to improve pain, function, and decrease inflammation.

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Other Resources for Chondromalacia

Free Download: The Knee Owner’s Manual

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.

  • 6 Meniscus Tear Types – What They Are And How To Treat Them Properly

    Even a small meniscus tear can make walking difficult for you. If you are experiencing any of these symptoms, you may want to seek medical help as soon as possible, depending on the type of tear you have. Needless to say, a lot depends on understanding the meniscus tear types there are and what each … Continued


  • How To Heal A Torn Meniscus Naturally

    If you have, or suspect you have a torn meniscus, and you’re wondering how to heal a torn meniscus naturally, you’ve landed on the right post. You may be wondering: Do I need surgery? Can you heal a torn meniscus naturally? The short answer is: It depends. What Is a Meniscus? The meniscus is a … Continued


  • How to Avoid Knee Replacement: A Quickstart Guide

    Your knee pain initially was intermittent and mild.  Unfortunately, It is now constant and debilitating.  Your doctor recommends knee replacement surgery. What is the knee composed of?  What are the most common knee injuries?  What is knee replacement surgery? What are the different types of knee replacements?  What is knee replacement surgery success? What are … Continued


  • How to Read a Knee MRI for Meniscal Tear

    Dr. Chris Centeno discusses how to read a knee MRI for meniscal tears and what you need to know about such tears. Transcript Hi, this is Dr. Centeno. And I’d like to go over today How to Read Your Knee MRI: Focus on the Meniscus. I have a whole series of these and reading a … Continued


  • 7 Most Common Symptoms of a Loose Knee Replacement

    Walking became impossible.  Each step was associated with severe pain.  Knee replacement seemed like a good solution.  Unfortunately, months after the surgery problems exist.  Your doctor thinks you have a loose knee replacement.  What is a knee replacement?  What causes a knee replacement to become loose?  What are the 7 most common symptoms of a … Continued


  • How Likely Is a Second ACL Tear On the Same Knee?

    Anterior Cruciate Ligament Injuries and Treatments The ACL (anterior cruciate ligament) is an important knee stabilizing ligament. It prevents the tibia from moving too much frontward (anterior translation) and twisting too much (internal rotation).  It is under most stress with landing from a jump, or a planted foot with twisting, and this is how it … Continued


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