IMP.

IN ORTHOPAEDICS SHORTS BY MPMEP

CHONDROMALACIA PATELLAE

It is a degenerative condition of the knee affecting the

cartilage of patella in an otherwise fit person. There
occurs fibrillation, fissuring, erosion and softening of
the articular cartilage of patella. It gives rise to following
symptoms
1. Pain arising from the posterior aspect of patella.
Exercise programme to be progressed to PRE as
pain is reduced, encouraging functional activities
except squatting.
2. The pain worsens with strong quadriceps con-
tractions in actions 1like descending stairs or getting up
from squatting or from chair.
3. There is an associated symptom of the knece
giving way" or "locking'".be tried.
4. The ROM at the knee is usually full.
5. There may be slight effusion and quadriceps
atrophy.
6. Compression of the patella against femoral con
dyles causes pain.
7. Radiographs show osteoporosis, Antero-po
erior striping is visible on "skyline view
The etiology is unknown; however, mild repeated
trauma, inflammatory or metabolic joint disease may
precipitate the condition.
Adolescents and young adults (age group years) are
commonly affected, the incidence is However more
common in females.
Treatment
(a) Conservative
lt is effective in mild cases.
1.Initially ,if too painful the knee is immobilised in A POP
cast.
2. The exercise programme, then, includes:
Gentle isometnc quadriceps contractions
Assisted SLR.
Strong hip, ankle and foot movements.
Ambulation with shoe raise on the normal side,
so as to facilitate movement of the affected leg
encased in a cast.
When treated without a plaster cast:1. Avoid strenuous
actívities.
2. Isometrics to quadriceps with the knee in slight
flexion to avoid patellar movement, within the
limits of pain.
3.Assisted SLR without hyperextension at the knee.
4.Relaxed passive or active knee swinging to main-
tain full ROM of both flexion and extension.
rise to the following symptoms:
5. Deep thermotherapy modality like pulsed short
wave diathermy or ultrasonics may be given as an
adjunct for pain relief.
Ambulation has to be properly controlled to avoid
excessive hyperextension of the knee; gemu recur
vatum has been reported as one of the common
features following chondromalacia patella.
(b)lnjection therapy. Corticosteroid injections could
urgery. Surgery is indicated only when the conservative
treatment fails to provide relief.
i) Arthrotomy:This procedure has been reported to be
effectivein very early cases of chondromalacia patellae.
The affected area of articular cartilage age is removed by
shaving and smoothening.
i) Patellectomy:It is indicated even fragmentation and
fissuring affects an area of more than 1.3 cm
in diameter, or erosion of the articular carilage
and subchondral bone occurs.

Physiotherapy following surgery

A POP cylinder cast is applied after shaving of the art
The physiotherapy regime is the same as described
for conservativemanagement with plaster cast. The only
difference being that the vigorous exercises are
encouraged.
..............................................................................................
............................ by meenakshiputraeashwarprasad
19@gmail.com