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Condition/Disorder Synonyms

  • 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

ICD-9-CM Codes

  • 733.92 Chondromalacia

  • 717.7 Chondromalacia of patella

ICD-10-CM Codes

  • M22.40 Chondromalacia patellae, unspecified knee

  • M94.20 Chondromalacia, unspecified site

Preferred Practice Pattern1

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

Key Features

Description

  • 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

Essentials of Diagnosis

  • 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

General Considerations

  • Patellofemoral joint dysfunction includes

    • Decreased quadriceps flexibility

    • Hypermobile patella

    • Altered vastus medialis oblique (VMO) response

    • Diminished quadriceps explosive strength7

Demographics

  • 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

Clinical Findings

Signs and Symptoms

  • Quadriceps weakness

  • Patella maltracking

  • Anterior knee pain with deep squatting, descending stairs, prolonged sitting7

Functional Implications

  • Decreased sitting tolerance

  • Difficulty descending stairs

  • Decreased ability to squat

Possible Contributing Causes

  • 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

Differential Diagnosis

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