Chondromalacia Causes, Symptoms & Treatment Options

What Is Patellar Chondromalacia and How Is It Treated?

Patellar chondromalacia refers to the softening and deterioration of the articular cartilage on the undersurface of the kneecap (patella). In a healthy knee, the patella glides smoothly through a groove at the end of the thighbone (femur). When the cartilage begins to break down, that smooth motion is disrupted, leading to irritation, pain, and inflammation. The condition is graded on a scale of I to IV, with Grade I representing minor softening and Grade IV indicating a full-thickness loss of cartilage down to the bone.

Patellar Chondromalacia Causes

Chondromalacia develops when the kneecap is subjected to repeated abnormal stress or pressure over time. Common contributing factors include:

• Overuse from repetitive activities such as running, cycling, or jumping
• Kneecap misalignment or tracking problems
• Muscle imbalances, particularly weakness in the quadriceps or hip muscles
• Direct trauma to the kneecap
• Flat feet or other biomechanical issues that alter load distribution across the knee

Active young adults and athletes are among the most commonly affected, though chondromalacia can occur at any age.

Patellar Chondromalacia Symptoms

Common chondromalacia symptoms include:

• A dull, aching pain around or behind the kneecap
• Pain that worsens when going up or down stairs, squatting, or kneeling
• Discomfort after prolonged sitting with the knee bent, sometimes called the "theater sign"
• A grinding or grating sensation under the kneecap during movement
• Swelling or stiffness around the knee following activity

Chondromalacia Treatment Options

For most patients, chondromalacia responds well to conservative care. Physical therapy will be the main focus of your treatment to strengthen the quadriceps, hip abductors, and surrounding muscles to improve kneecap tracking and reduce stress on the joint. 

Some supplemental treatments to your therapy may include:

• Rest and activity modification to allow inflammation to settle
• Anti-inflammatory medications to manage pain and swelling
• Orthotics or bracing to address biomechanical contributors such as flat feet or poor alignment
• Corticosteroid injections for targeted pain relief
• Platelet-rich plasma (PRP) therapy as a supportive option to promote cartilage health and reduce ongoing inflammation

When conservative measures are insufficient, and there are other surgical lesions present, surgical options may be considered. 

Dr. Duany performs arthroscopic procedures including cartilage debridement and smoothing, as well as realignment procedures when kneecap tracking/tilt is a primary contributing factor. For patients with more significant cartilage defects, cartilage preservation procedures may also be an appropriate option to explore.