CHONDROMALACIA PATELLAE
This is a diagnosis used to denote retro-patellar pain in
patiants who have no other obvious cause for the pain and are too young to be
in the osteoarthritis age group. There is degeneration of the articcular
cartilage of the patella, particularly on the medialside.
AETIOLOGY
Age group:16-30years.
Sex: females are
affected more than males.
Cause:this is unknown but sometimes can be related to an
episode of trauma, change of footwear or change of lifestyle (e.g. leaving
school nad going to work).
PATHOLOGICAL
The articular cartilage softens, and fissures and erosions
appear. tags of cartilage and fibrous tissue are formed on the margins of the
fissures (smillie,1978). There is some doubt as to whether these changes cause
the pain because they have been seen in the cartilage of patients undergoing
operation or investigation (orthroscopy) for other
reasons (e.g. meniscus problems are fractured patella).
CLINICAL FEATURES
Pain-deep aching in nature, behind the patella, aggravated
by going up or down stairs or sporting activities involving weight-bearing knee
flexion.
Crepitus-compression and passive movement of the patella
elicits a grating sound and sensation of roughness to the exasminer.
Locking-occasionally a locking sensation may be felt behind
the patella which does not slide easily over the femoral condyles.
MUSCLE WEAKNESS
When the condition is unilateral, the quadriceps is weaker
than on the other side. In bilateral cases the quandriceps may be weaker than
the expected norm for the age, built than lifestyle of the patient. The vastus
medialis is often wasted.
POSTURE
The patella or patellae may be directed midially
STRAPPING OR
BANDAGING
Strapping is applied, bearing in mind the
hypothesis that the medial side of the patella needs to be compressed; 2-3
bands are generally enough. These are applied from the lateral side of the
patella is if to pull it medially, and then the strap ia carriade on to the
medial side of the patella and up to the medial side of the famour. Fixing
sraps are required to stop the main bands rolling down. This may be applied for
the patiens who wants to compete in a sporting competition. It may be left in
situ for 3-4 days and then reviewed.
Bandaging – A firm elastic bandage may be applied, again to
produce compression on the patella. This may suit the patient better than
strapping because he can be taught to apply it himself and the skin is less
traumatized . bandaging is not, however, a substitute for the strapping which can
apply a more precise force.
QUADRICEPS STRENTHENING
If the vastus madialis is weaker than the other three
components it may be appropriate to apply a muscle stimulating current such as
faradism is applied to boost the vastus madialis contraction.
PNF may be used in the flexion-adduction pattern of the leg,
modified to include knee extension. If the patient sits with the knees flexed
over the end of the plainth the physiotherapist can apply resistens to the
foot, which is dorsiflexed and inverted, as well as to the quadriceps as the
knee is straightned. The physiotherapist’s other hand palpates the vastus
madialis and she can instruct the patient to make the muscle work.
Once this has been successful, the patient should practise
sitting with the ankles crossed and pushing the underneath ankle up against the
resistance of the top one. He can be taught to feel the vastus madialis working
and should practise this for 5 minutes every day.
SHORT-WAVE DIATHERMY
Theoretically, if a co-planar technique is applied so that
the field can increase the circulation to the synovium, nutrition to the
cartilage will be improved. This is the worth considering when the patient’s
pain is esily proviked, ut should not feature in the treatment programme more
than five or six times.
LONG TERM
This condition usually develos insidiously and therefore
takes some time to clear. The patient should therefore be treted until pain is
diminished and the quadriceps is working fully. Then a review programme should
be implemented, for example at 3-4 week
intervals for up to 4 months.
If there is steady deterioration of function, an ortho
paedic surgeon may contemplate scrapping the cartilage or changing the
machanics of the quadriceps mechanism.
