Patellar Chondromalacia – What a Pain In The Knee

Patellar Chondromalacia – What a Pain In The Knee

Patellar Chondromalacia, commonly referred to as Runner’s Knee, is a condition where the cartilage under your kneecap begins to deteriorate and soften. This is a common problem among younger, athletic individuals but adults with knee arthritis are at risk as well. Generally speaking, patellar chondromalacia results from overuse in sports. For some, taking a few days off can give the knee the recovery time it needs. For others, improper knee alignment is at the root of the problem and rest just isn’t enough to recover properly. As serious as it can be, most people affected by it don’t seek medical care, which makes it worse in the long run.

Causes of Patellar Chondromalacia

Your kneecap normally sits over the front of the knee joint. As you bend your knee, the back of the kneecap glides over the cartilage of your thigh bone or femur. The tendons and ligaments keep your knee bone attached. However, should any of these fail to work properly, the kneecap ends up rubbing against the thigh bone which deteriorates the patella and results in pain. Here are some common reasons why it might be happening to you:

  • poor alignment
  • weak hamstrings or quads
  • blows or trauma to the kneecap
  • repeated stress to the knee joints from activities like running or skiing
  • muscular imbalance between the abductors and adductors

Patellar Chondromalacia – What a Pain In The Knee 2

Symptoms of Patellar Chondromalacia

Common symptoms of this condition include a grinding sensation in the knee and knee pain in the inner portion of the knee cap. The grinding or cracking generally happens when you bend or extend your knee. The pain might worsen after sitting for a long period of time or during activities where a great deal of pressure is applied to your knees.

Patellar Chondromalacia Diagnosis & Treatment



If you are experiencing any of the symptoms above, visit your doctor to get a proper diagnosis. They will start by examining the affected knee and will most likely perform some different movement exercises to determine what is causing the issue. If they aren’t sure, they may request that you go for an x-ray, MRI or even an arthroscopic exam as an attempt to get more information.

The great thing about x-rays and MRIs, is that they can look at the joint and find radiological signs of arthritis. The x-rays and MRIs actually show things like joint space narrowing or formations indicative of the problem. MRIs can show signs of cracking or fraying along the cartilage underneath the patella. MRI scans generally tend to diagnose correctly 9/10 of the time.



Once they have enough information and have determined that it’s patellar chondromalacia, they will diagnose the condition on a grade of 1 to 4:

  • Grade 1 means there is indication of softening in the knee cartilage. X-ray results for a Grade 1 condition generally show a softening or swelling of the cartilage and focal areas might still have normal contouring;
  • Grade 2 indicates the start of tissue erosion. X-ray results for a Grade 2 condition tend to show blister-like swelling or fraying of the cartilage which extends all the way to the surface. There can be fragmentation and fissuring within different soft areas;
  • Grade 3 shows thinning of cartilage. For a Grade 3 condition, x-rays generally show partial fissuring and cartilage loss and there might be a cartilage loss with fibrillation which essentially means that the x-ray appears to have the same types of lines as crab meat;
  • Grade 4 indicates exposure of the bone with most of the cartilage deteriorated. (In these most severe of cases, bone is rubbing against bone, like when brake pads in a car wear down, and surgery might be recommended). In the x-ray results, the cartilage destruction might show exposed bone.

Patellar Chondromalacia – What a Pain In The Knee


The primary goal for any treatment and rehabilitation is to create a straighter pathway which your patella can follow when you’re quads contract. Once you have been properly diagnosed, your doctor may recommend one of the following options described below:

  • Rest – A large percentage of cases are generally grade 1 or 2. For these, the first thing that doctors recommend is to get some rest and to stop or (reduce) the amount of physical activities you do, to see if the situation improves itself.

  • Ice/Cold Therapy – A 2nd recommendation that you will most likely get is to ice the affected area. This is not a permanent solution, however icing or other cold therapy devices can provide much needed temporary relief. A popular option includes:

    Cold Therapy Knee Ice Wrap with Compression and Extra Ice Gel Pack - Essential Kit for Knee Pain...
    167 Reviews
    Cold Therapy Knee Ice Wrap with Compression and Extra Ice Gel Pack - Essential Kit for Knee Pain...
    • DESIGNED FOR THE KNEE - The gel packs and wrap were specifically designed to contour the knee area for a more focused treatment. Fits the left or right knee, up to 24 inches. (See sizing chart)
    • REDUCE KNEE PAIN AND SWELLING - Our cold therapy wrap helps to reduce swelling, inflammation and pain caused by Arthritis, Runner's Knee, tendinitis, bursitis, meniscus / ACL ligament tears, knee...
    • WHY COMPRESSION IS IMPORTANT - The added compression ensures that there is proper contact between the ice gel pack and the affected knee for a deeper treatment, compared to just using ice packs on...


  • Anti-inflammatories – In addition to icing, anti-inflammatory medications such as Advil or ibuprofen can be very helpful.
  • Muscle strengthening – Eventually, your doctor will suggest selective muscle strengthening exercises. The general idea is to strengthen certain muscles around your knee to help normalize patella tracking. In addition to this, cardiovascular conditioning may be recommended such as work with a stationary bike, swimming, etc. (If you decide to use a stationary bike, you should use low resistance with a high rpm mass.). Strengthening and stretching for the hamstring muscle groups and the quadriceps are critical for long-term rehabilitation.
  • Equipment analysis/changes – It is important to review all the equipment that you use in your physical activities to see if any of them could be aggravating the situation. The most common culprit being your running shoes. By changing your running shoes often, and making sure that you are using the type of running shoe specifically designed for your activity, you should be able to avoid or at least reduce the pain.
    Knee braces are also a great way to give extra support to the knee when it does not naturally occur. Occasionally using a brace with a patellar centering device might be required. In a more advanced cases surgical correction might be considered for the knee alignment. In cases of runner’s knee, braces worn during activities and during recovery can give extra support by keeping the knee aligned properly and reducing any unnecessary grinding away of the patella. For additional information on knee braces that help with Patellar Chondromalacia, visit



    Patellar chondromalacia (or Runner’s Knee) is not the end of the world, as long as you get it diagnosed and treated sooner rather than later. If any of the symptoms or information above resonates with you, then visit your doctor and get your knee pain diagnosed as soon as possible. Also check out our Blog for additional information on knee pain.


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