CHONDROMALACIA PATELLAE AND PHYSIOTHERAPY

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.