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  • Chondromalacia
  • Chondropathy
  • Anterior knee pain
  • Patellofemoral dysfunction
  • Patellofemoral stress syndrome
  • Patellofemoral lateral tracking
  • Patellofemoral pain syndrome (PFPS)
  • Patellofemoral arthralgia
  • Patellofemoral compression syndrome
  • Lateral patellar compression syndrome
  • Excessive lateral pressure syndrome
  • Patellar misalignment syndrome
  • Patellalgia

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  • 733.92 Chondromalacia
  • 717.7 Chondromalacia of patella

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  • M22.40 Chondromalacia patellae, unspecified knee
  • M94.20 Chondromalacia, unspecified site

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  • Pattern 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation

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Description

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  • Chondromalacia: softening of cartilage on articular surface of patella at the patellofemoral joint
  • Retropatellar knee pain with patellar cartilage damage2
  • Insidious onset typically defined by pain in the retropatellar or peripatellar region3
  • Also known as patellofemoral pain syndrome (PFPS), “anterior knee pain syndrome”2
    • PFPS applies to patients with retropatellar pain and no cartilage damage; chondromalacia applies to patients with patellar damage2
  • Structures most likely to generate patellofemoral pain: anterior synovium, infrapatellar fat pad, subchondral bone, medial or lateral retinaculum4,5

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Essentials of Diagnosis

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  • Insidious onset aggravated by repetitive impact6
  • Decreased hip stability due to muscular weakness, especially gluteus medius, may affect patellofemoral joint7,8
  • Q-Angle greater than 20 degrees generally considered a structural abnormality, can put patient at risk for excessive lateral-patellar forces7
  • Intermittent pain and swelling6
  • Greater pronated foot posture in relaxed stance3

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General Considerations

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  • Patellofemoral joint dysfunction includes
    • Decreased quadriceps flexibility
    • Hypermobile patella
    • Altered vastus medialis oblique (VMO) response
    • Diminished quadriceps explosive strength7

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Demographics

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  • Chondral lesions more common, more severe in patients aged 30 years and older, and those who sustained ACL injury > 5 years prior6
  • Frequently occurs among physically active populations, aged 18 to 40 years9
  • Higher incidence in women than in men9

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Signs and Symptoms

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  • Quadriceps weakness
  • Patella maltracking
  • Anterior knee pain with deep squatting, descending stairs, prolonged sitting7

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Functional Implications

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  • Decreased sitting tolerance
  • Difficulty descending stairs
  • Decreased ability to squat

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Possible Contributing Causes

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  • Presence of excessively pronated foot posture is then hypothesized intrinsic risk factor3
    • Restrictions of first metatarsophalangeal joint (MTPJ) and ankle dorsiflexion reported to increase and prolong rearfoot eversion, respectively3
    • Greater foot mobility and greater pronated foot posture during static stance3
  • PFPS results from increased or altered patellofemoral joint loading secondary to poor patellar tracking3
  • Anterior knee pain within 3 months of beginning tennis lessons7
  • Tight lateral knee structures: Iliotibial band, lateral knee capsule
  • Weak knee extensors: Quadriceps

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Differential Diagnosis

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  • Patellofemoral arthritis, subluxation, instability6
  • Plica Syndrome6
  • Anterior knee pain6
    • Patellar subluxation, dislocation
    • Tibial apophysitis (Osgood-Schlatter’s lesion)
    • Jumper's knee (patellar tendonitis)
    • Posterior cruciate ligament (PCL) injury7
  • Referred pain to low back, sacroiliac joint, ...

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