Photo: Chondromalacja IV stopnia w stawie rzepkowo-udowym

Chondromalacia is a progressive disease of the cartilage where the articular surfaces of the joint undergo damage and degeneration. It is a common condition that can eventually lead to joint osteoarthritis, an advanced degenerative disease. Chondromalacia can affect most joints, but it is most commonly observed in the knee joint.
The causes of chondromalacia can vary, but they are often associated with chronic improper loading of the knee joint or structural damage within the joint, such as meniscal injuries. Risk factors include previous knee injuries, anatomical abnormalities, improper lower limb alignment, overweight or obesity, abnormal movement patterns, and frequent and intense loading of the knee joint, especially in sports.
The International Cartilage Repair Society (ICRS) grading system is used to assess the severity of chondromalacia and describes four grades:

• Grade I – Softening of the cartilage without visible defects.
• Grade II – Cartilage damage with small defects less than 1.5 cm in diameter involving up to 50% of the cartilage thickness.
• Grade III – Cartilage damage with larger defects larger than 1.5 cm in diameter involving more than 50% of the cartilage thickness.
• Grade IV – Advanced cartilage damage with large defects revealing the subchondral bone layer.

Chondromalacia can involve one of the three compartments of the knee joint, such as isolated chondromalacia of the patellofemoral joint or the medial compartment, which is associated with abnormal biomechanics or axis deviation. We can also observe chondromalacia in all compartments of the knee, most commonly associated with meniscal injuries or chronic joint instability.

Accompanying symptoms of chondromalacia of the knee joint surfaces may include:

• Pain in the knee joint, especially during movement
• Swelling of the joint
• Cracking, popping sounds
• Stiffness and limited range of motion in the knee joint
• Joint inflammation with chronic effusions

The diagnosis of chondromalacia of the knee joint surfaces includes a physical examination where the doctor assesses symptoms and conducts range of motion tests and a series of clinical assessments. Additionally, imaging studies such as X-rays and magnetic resonance imaging (MRI) are used to evaluate the condition of the articular cartilage. High-quality MRI scans are necessary for accurate evaluation of the cartilage. Currently, 3T MRIs are the standard, which allow for a precise assessment of the joint surface.

Non-surgical treatment options for chondromalacia may include:

• Pharmacological treatment – non-steroidal anti-inflammatory drugs
• Physical therapy to strengthen muscles, improve joint stability, and reduce inflammation and pain
• Physical modalities such as cryotherapy or neuromuscular electrical stimulation
• Working on correct movement patterns during walking
• Viscosupplementation, which involves injecting a hyaluronic acid preparation to reduce pain and improve knee joint function
• Platelet-rich plasma (PRP) injections, alone or with an anti-inflammatory agent, which have regenerative effects on the cartilage and reduce inflammation in the joint.

Surgical treatment for chondromalacia of the knee joint surfaces may be necessary in advanced cases. Methods of repairing the joint surface include:

• Microfracture – creating small holes in the subchondral bone layer, which stimulates the formation of a fibrocartilage scar that fills the defect.
• Autologous cartilage transplantation – taking healthy cartilage fragments from another part of the knee and grafting them onto the damaged surface – OATS (osteochondral autograft transplantation)
• Autocart – taking cartilage fragments during debridement, preparing them appropriately, and patching them into the damaged area.
• Biotechnology – using special collagen membranes that serve as a scaffold for cell growth to create “new” cartilage in the damaged area.
• An important aspect is unloading the affected knee compartment by improving the structure and biomechanics, for example, of the patellofemoral joint, as well as using a limb realignment procedure such as a femoral or tibial osteotomy.
• In cases of extensive joint surface damage in advanced degenerative disease, the final surgical option is joint surface replacement, called unicompartmental or total knee arthroplasty.

After surgery, it is important to follow postoperative recommendations, such as avoiding weight-bearing on the knee joint, undergoing rehabilitation, using Continuous Passive Motion (CPM), or sometimes wearing an orthosis. Follow-up imaging with MRI and regular check-up appointments are crucial for monitoring healing and determining the rehabilitation strategy for a return to full function.

At MIRAI, the following individual specializes in the knee area:
Tomasz Szymański – material development
Michał Drwięga
Konrad Słynarski
Agnieszka Wintrowicz
Karol Kosterna
Marcin Gruba
Bartosz Dominik
Patryk Ulicki
Dariusz Grzelecki
Michał Bartoszewicz
Anna Krześniak

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