Chondromalacia surgery is a surgical treatment for a condition called chondromalacia patella or “runner’s knee.” It is used as a treatment option when more conservative treatments for this condition fail and a surgeon believes a good outcome could be achieved with surgery. Historically, surgery was often strongly recommended, but research has suggested that it should only be used in cases where it is clearly indicated and patients are not responding to conservative treatment options.

Can Surgery Treat Chondromalacia ?

Treating Chondromalacia is declining in its popularities day by day due to good outcomes gained with conservative techniques without surgery and little benefit gained out of surgery. But when all other conservative methods of treatments fail to cure Chondromalacia, then surgery remains to be the only definitive treatment.

Success Rate Of Treatments: About less than 10% of patients complain of not getting relief even after a good period of rest and rehabilitation. But these have seen to have occurred mostly due to lack of proper guidance and not following the doctor’s guidelines strictly. If still the problem persists then surgery is the best option.

Is chondromalacia surgery dangerous?

Four methods of surgical treatment of chondromalacia patellae have been evaluated after periods ranging from two to thirty years (average seven years), to discover the success rate, complications and indications for each. A total of 140 operations had been performed in 98 patients. Overall, satisfactory results were achieved in 25 per cent after forty shavings of the patellar cartilage, 35 per cent after twenty cartilage excisions and drilling of the subchondral bone, 60 per cent after twenty medial transfers of the patellar tendon and 77 per cent after sixty patellectomies. Thirty-four primary patellectomies gave 82 per cent satisfactory results compared with 62 per cent after twenty-six patellectomies performed after a previously unsuccessful operation. The results were worst in patients below twenty years of age especially women and in those with Grade IV changes in the patellar cartilage. Weakness of the quadriceps after any procedure predisposed to an unsatisfactory result. Extensive late radiological degenerative changes in the knee were not seen. On the basis of the results in this report, patellar tendon transfer is recommended in adolescents and athletes with Grade I, II or III changes in the patellar cartilage. In adults over twenty years of age with Grade I and II changes cartilage excision and drilling is satisfactory. In adults with Grade III and adults or adolescents with Grade IV changes patellectomy is the treatment of choice.

In a retrospective review of 184 knees treated for surgically diagnosed chondromalacia of the patella, the average follow-up period was 3.9 years. The treatment rendered included trephine and drilling in 71 knees, facetectomy in 57 knees, shaving in 35 knees, and a combination procedure in 21 knees. Knees were graded as 2, 3, or 4, depending on the depth and severity of the lesion. The best results were in Grades 2 and 3 disease treated by trephine and drilling or facetectomy. Six patients required further patellar surgery during the follow-up period. The purpose of surgical treatment of the patellar articular surface is to relieve pain and preserve the mechanical advantage of the patella for normal knee function.

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You cannot stretch too much. You can however overstretch your muscle if you push the stretch too hard. Only stretch to the point of mild tension, NOT pain.

Don’t rock the stretch or use jerky movements.
Breathe normally, don’t hold your breath.
Hold all stretches for at least 10-20 seconds.
Always repeat your sequences of stretches at least once, twice is even better.

Chondromalacia Treatment: Exercises
Straight leg lifts can help strengthen the quadriceps muscles and improve chondromalacia of the knee. This can be performed with or without 2-5 lb. ankle weights.

Another useful exercise can be performed by placing a towel between the knees and squeezing the knees together for several seconds. This will build up the medial (inner) aspect of the quadriceps muscle and restore a more normal relationship between the patella (kneecap) and the knee joint.

These exercises, when repeated daily, can dramatically lessen the symptoms of chondromalacia patella. Avoiding stair and hill climbing will also decrease the progression of knee damage.

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These changes compare to the difference seen between a brand-new Teflon-coated frying pan, one that has been slightly scratched by a steel scrubber, and one where the Teflon surface has flaked off completely. As with a frying pan’s Teflon surface, the greater the destruction of the articular cartilage, the poorer the function of the joint.

Important considerations when evaluating chondromalacic changes in a joint are the state of the articular surface, the extent of the cartilage involvement and the location of the lesion. These all impact the degree of symptoms.

There are several classification systems used to grade the degree of articular cartilage damage. These usually describe the extent of fibrillation of articular surfaces, the degree of softness, the depth of involvement and sometimes the size of the lesion. Some of the systems combine surface appearance and the depth of involvement under a single category and others make no such distinction. There is some subjectivity in reporting but all classification systems attempt to be as objective as possible.

Generally, a Grade I lesion is a descriptive term for articular cartilage which is soft. Grade II lesions usually show some fissuring or disruption of the articular surface to various depths. Grade III lesions are more extensive with deeper fissuring and fibrillation which may extend to the underlying subchondral bone. Grade IV is a descriptive term used to describe that the articular cartilage is destroyed, leaving the subchondral bone exposed (eburnation). Grade IV is the most objective of the grades, and is the most consistent across the classification systems.

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Quadriceps Strengthening
Quad Strengthening Contractions:
Sit in chair. Extend legs, heels to floor. Keep knees straight (or as straight as possible if you have arthritis.) Tighten thigh muscles. Hold for count of 10. Relax for count of 3. Do 10 repetitions. You can do this several times throughout the day. You can build up to 2 or 3 sets of 10 repetitions at a time.

Quad Strengthening Leg lifts:
Lie flat on back. Bend left knee at 90-degree angle, keeping foot flat on floor. Keeping the right leg straight, slowly lift it to the height of the left knee. Hold for a count of 3. Repeat 10 times. Switch sides. Work up to 10 sets of 10 over several weeks.

Safety Tip:
Leg lifts: Lifting both legs at the same time causes excessive stress on your lower back so
only lift one leg at a time; the opposite leg should be kept slightly bent with foot on floor.

Quad Strengthening Short-Arc Leg Extensions:
Sit or lie on floor. Place a rolled up towel under your thigh for support. Keep you leg straight and raise your foot about six inches off the floor. Hold for 5 seconds. Slowly lower your foot, bending your knee. Do 10 repetitions. Switch sides.

Quad Strengthening Knee Dips:
Stand with knees slightly flexed. Point your toes straight ahead.
Make sure your kneecaps are also pointed straight ahead.
Lift one leg up and balance on the other leg. Slowly lower yourself up and down ONLY a few inches. Keep the knee of the leg you are balancing on slightly flexed. Your knees must remain pointing straight forward. Do not let them turn inward. Stand straight, do not lean you body to one side. Do 10 dips. Switch sides.
If you feel pain in your knees, start with fewer dips.

Quad Strengthening Partial Squats:
Double leg partial squat: Stand. Keep Back Upright. Knees pointing straight ahead – inline with feet and hips. Slowly lower yourself. Don’t bend your knees beyond a 90-degree angle, if 90 degrees is too difficult bend even less.

Safety Tip: Make sure your knees do not extend beyond your toes when doing partial squats. Keeping your weight behind your knees reduces the pressure on the knee joint during the squat. Bending the knees beyond 90 degrees (a right angle) places excessive strain on the knee.

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Method A：
Straight leg lifts can help strengthen the quadriceps muscles and improve chondromalacia of the knee. This can be performed with or without 2-5 lb. ankle weights.
Another useful exercise can be performed by placing a towel between the knees and squeezing the knees together for several seconds. This will build up the medial (inner) aspect of the quadriceps muscle and restore a more normal relationship between the patella (kneecap) and the knee joint.
These exercises, when repeated daily, can dramatically lessen the symptoms of chondromalacia patella. Avoiding stair and hill climbing will also decrease the progression of knee damage.

Method B：
Consider these exercises:
1. Sit on a bed, keep your leg flat and straight out. Bend your toes towards your head as much as possible and hold this position for ten seconds. Release. Repeat ten times.
2. Sit on a bed, keep your leg flat and straight out. Bend your toes towards your head. Raise your leg off the bed six inches and hold it. Keep this position for ten seconds and release. Repeat ten times.
3. Hang your legs over the side of the bed, raise the lower part of your leg so your leg is straight out and hold for ten seconds. Release. Repeat ten times.
4. Sit and swing your leg over the side of the bed or chair to maintain knee mobility. Do this for about 1-2 minutes.
5. Sit in a chair, place your foot under the bottom edge of a desk or bed with the leg almost straight. Slowly, lift the leg from the top up as though trying to lift the desk or bed off the ground. Your thigh muscles will tighten and become fatigued. Hold for 10 seconds then relax. Repeat 20 times and then do the same with the other leg. Repeat this exercise three times a day for three or more weeks.
6. Hamstring Lengthening Exercises: While sitting in a chair, put your leg straight out in front of you with your heel resting on the ground. Rest both hands on your knee and while keeping your leg straight, slowly slide your hands down the front of the knee towards the foot until you feel a tightening and slight pain in your hamstrings (tendons behind the knee). Hold for 10 seconds, then relax. Repeat 20 times with both legs and perform the exercise three times a day for three weeks. Your hamstrings will loosen and you will be able to move your hands further down your shin towards your foot.
You will need to restrict your athletic exercise and do the above exercises for a month to get an improvement. You may then gradually return to your normal exercise. The pain may recur. You should then follow the above exercises again.
Other exercises for chondromalacia focus on the hip (gluteal exercises) and flexibility exercises. An exercise that directly put force through the knee, especially the knee extension exercise may be painful.
If you find the above exercises too painful, then try the one below.
Lateral “monster walk.” This requires a 20-inch piece of thick theraband or tubing tied in a circle and wrapped around both ankles. The patient will stand with the feet shoulder-width apart (never let the feet get any closer than that) and walk sideways across the floor against the resistance of the band. The knees should be slightly bent; the buttocks should be down and back. Stress should be felt in the quadriceps and in the gluteal (butt) muscles. Repeat 10 steps in each direction, 2-3 times.

Question about Chondromalacia and exercise:
I am a computer contractor in my 30s and recently had health insurance for a brief period of time- about a year and a half ago. I was experiencing pains in my knees when walking. I had an MRI. I was quite dismayed when the doctor told me then I appeared to have chondromalacia and some thinning cartelege, as well as an unexplained miniscus tear. I have since lost coverage and cannot afford to go back. How and why I got chondromalacia I have no idea, but I do not do strenuous sports.
After taking glucosamine and changing to better shoes, the knee pain went away and really hasn’t returned since. The tear, if it hasn’t healed, appears to cause me no trouble. However I have been concerened about cartelege and wear on my joints. I do hear some slight clicking/squelching when doing squats or straightening knees, and have read on websites that this could mean degrading carteledge, softening, wear, etc. Some warn about ignoring such signs, and give horror stories of ‘bone on bone’ after ignoring them for years.
My question is, I would like to exercise with weights, but I am concerned that exercises such as the leg lift, leg curl, etc will further ‘wear down’ the carteledge in my knees. Does the cartelege in your joints really behave like road tires, meaning such increased activity will wear them down prematurely? Am I dooming myself to ruined knees by such exercises?Thanks much!

Answer:
Although I don’t have expertise in the area of knees, I’ll try to address a few points you make on other general issues.
My one concern is the fact that you don’t have health insurance and you went to a doctor and got a diagnosis. My fear is that since there is a written record of a health issue, any insurance you pick up might consider this a pre-existing condition and will make it harder for you to get coverage. A pre-existing condition clause normally does not cover diagnosed conditions that are less than five years old. So you need to be very careful when looking into health coverage and be sure you are covered.
It might be that the pain you were experiencing was from the meniscus tear and that may have healed and that’s why you are pain free. thing that concerns me is that you are still experiencing clicking and and squelching noises and that you had been diagnosed with thinning of the cartiledge. If I were you I would not exercise with weights, that can exacerbate any condition you might have and if your meniscus tear has not completely healed you may tear it again.
You really need to get in touch with a competent physical therapist in order to see if there is any exercise you can do that will strengthen the muscles and not do damage to your cartlidge or the meniscus.
I can’t say for sure what you can and can’t do, only your doctor can tell you that. My main concern is your health coverage. My gut reaction is that if you are not in any pain, you should do very little weight lifting and try to stay healthy until the pre-existing clause of any health insurance has expired. Then get health insurance, and address any issues you may have at that time.
If you don’t do that, and for some reason, do damage to your knees you won’t be covered because of the diagnosis.
Hope this helped.

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Signs and symptoms of patellofemoral pain include:
A dull, achy pain in the front of your knee
Increased pain when you walk up or down stairs (the most common symptom)
Pain in your knee when kneeling or squatting
Knee pain after sitting for long periods of time
A grating or grinding sensation when you extend your knee
Knee stiffness
Pain around the knee. The pain is usually located at the front of the knee, around or behind the knee cap. The pain is typically worse when going up or down stairs. It may be brought on by sitting (with the knees bent) for long periods.
A grating or grinding feeling or noise when the knee moves knee (‘crepitus’).
Rarely, some fluid swelling (‘effusion’) of the knee joint.

What is the treatment for chondromalacia?
Avoid strenuous use of the knee – until the pain eases. Symptoms usually improve in time if the knee is not over used.
Painkillers – paracetamol or anti-inflammatory painkillers such as ibuprofen may be advised to ease the pain.
Physiotherapy – improving the strength of the muscles around the knee will ease the stress on the knee. Also, specific exercises may help correct problems with alignment and muscle balance around the knee. For example, you may be taught to do exercises which strengthen the inner side of the quadriceps muscle.
Taping of the patella – is a possible treatment which can reduce pain. This is where adhesive tape is applied over the patella, to alter the alignment or the way the patella moves. Some people find this helpful. Some physiotherapists can offer patellar taping treatment.

Surgery
Surgery is not usually necessary, but may be advised if the above treatments have not helped.

Arthroscopic surgery is the usual operation. A tiny flexible camera is inserted into the knee. The surgeon sees the inside of the knee joint and the cartilage, and may then operate through the camera tube, using very fine instruments. Possible surgical treatments are:

Tight ligaments on the side of the patella may be cut to allow the patella to align better and move more smoothly.
Smoothing or ‘shaving’ the cartilage behind the patella.
Rarely, if all other options do not help, the patella can be removed (the knee can still function without it).

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