Front Knee Pain - Chondromalacia Patella

Front knee pain is a very common problem faces by many people. The front knee pain usually causes by the tissue around the kneecap including the tendons, bones and cartilage surfaces. These tissues are undertaken high forces during daily activities and sports. Sports activities like running, hiking, jumping, and squatting can impose up to 6 times of body weight to these tissues. Repetitive high usage of these issues will gradually leads to tissue breakdown and subsequently feels the front knee pain. 

PATHOLOGY

Medical survey show that almost everybody encounter cartilage damage on knee cartilage when they perform arthroscopic surgery. At the age of 15 and above, the cartilage surfaces behind the kneecap are usually begin to tear out. The front knee pain from chondromalacia mostly happen with the age of 15 to 60 years old. In addition to it, most of the people diagnose with chondromalacia do not have symptoms.

All the tissues around the kneecap cartilage area are surrounding by nerve except cartilage surfaces. From there the nerve produce pain feeling to us. The most common situation is the tenderness when we touch the kneecap. It can be swelling. Grinding sound can be heard from front kneecap when we perform squatting and bending.

The medical finding for the front knee pain is the damage of the cartilage behind the kneecap or patella. The cartilage that covers the kneecap bone is the thickest cartilage in human body system. It is so thick so that it can support our body weight and pressures from heavy activities while maintain the joint in between connected firmly. 

TREATMENT

The first choice treatment of front knee pain or chondromalacia of the patella is strengthening program of the quadriceps muscle. Strengthening of the quadriceps muscle if done in correct manner can provides approximately 90% recovery rate for the pain of front knee condition chondromalacia. The reason that strengthening of the quadriceps muscle so effective is that it removes the pressure away from the kneecap cartilage and puts it into the muscular tissue. With this strengthening program it let the pressure distribute evenly in the knee cap and thigh bone joint.

EXERCISES




Front knee pain exercises involves strengthening-stretching of the quadriceps muscle. All strengthening of the quadriceps muscle should be done within the range that keeps pressure on the kneecap low. This range is between full extensions where the knee is straight to approximately 45 degrees of bending of the knee. The exercises should be done with high repetition in 3 sets of 20 or 30 which are appropriate. There should be no pain during the exercises. Ice should be applied to the front part of the knee for approximately 10-20 minutes after the exercise program.

Anti-inflammatory medicines are very useful and can be taken on a daily basis. Exercises can be performed on a daily basis, but should be performed at least three times a week. Daily activities that can result to the front knee pain should be avoided or reduce to minimal. If the recommended exercise program done persistently and properly, most people able to recover.

VISCO SUPPLEMENTATION

Lubrication or visco supplementation injection may be required if exercise and strengthening of the quadriceps muscle are not resolve the front knee pain.

Synovial fluid within the knee joint is highly viscous which provides a friction-free environment. Hyaluronic acid (HA) which is present in synovial fluid is also found in most body tissues. In a healthy body system in adult, synovial fluid HA has a molecular weight of 4-5 million. HA also binds to proteoglycans to stabilize the structure of the articulate cartilage.

Lubrication or Hylagan injections provide the joint lubrication and shock absorption, as well as decrease friction or rubbing within the knee joint which may slow the progression of osteoarthritis. However, not all the patients who receive Hylagan injections relief from the front knee pain, only about 50% have symptomatic relief. One injection is given into the knee joint each week for three weeks and may be repeated as soon as 6 months. Studies also show that Hylagan injections might be useful for the first time, but if the front knee pain happen again, the injection of Hylagan will no more effective and useful.

SURGICAL TREATMENT

When exercises fail to improve the front knee pain, surgery may be the last resort and the only solution if the symptoms are significant enough to severely affected our daily activities and mobility.

Osteoarthritis

Osteoarthritis is one types of arthritis commonly heard amongst aged population, especially female over age of 55 years old. Osteoarthritis is abbreviated as OA or referred to as degenerative arthritis or degenerative joint disease (DJD). Among the over 100 different types of arthritis conditions, osteoarthritis is the most common happen condition.

Cartilage is a connector between the bones and the joints that serves as a "cushion". Arthritis always caused by tear down and eventual loss of the cartilage of joints. Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees.

Primary osteoarthritis is mostly a result of natural aging of the joint. When we are getting older, the fluid compound of the cartilage will increases, and the protein substance makeup of cartilage will degenerates. Gradually, cartilage begins to degenerate by flaking. In advanced osteoarthritis, cartilage cushion between the bones and the joints will totally loss. Joint pain will gradually appear and become obvious over repetitive use of the worn joints for our daily activities.



Signs and symptoms of osteoarthritis vary from patient to patient. Osteoarthritis of the knees always linked to obesity or excess upper body weight, or has history of injury or joint surgery. Bowlegged is a osteoarthritis condition cause by progressive cartilage degeneration of the knee joints that lead to deformity and outward curvature of the knees.

People with osteoarthritis of the weight-bearing joints such as the knees can develop a limp. The limping condition can go worsen over the time as more cartilage degenerates. Medicine and some common treatments may not curable for some patients regarding to the joint pain and limping. Severe osteoarthritis of the knees is one of the most common reasons for knee replacement surgical.

There is no way to use blood test for the diagnosis of osteoarthritis. However blood test can be performed to exclude diseases that can cause secondary osteoarthritis, as well as to exclude other arthritis conditions that look similar to osteoarthritis.

X-rays of the affected joints can be used to diagnose osteoarthritis. The common X-ray findings of osteoarthritis include loss of joint cartilage, narrowing of the joint space between adjacent bones, and bone spur formation.

Weight reduction cause by obesity that put on excessive weight on joint is important for the treatment. Intense activities that put excessive stress on the joint cartilage should avoid. There are no specific treatments to halt cartilage degeneration or to repair damaged cartilage in osteoarthritis. The goal of treatment in osteoarthritis is to reduce joint pain and inflammation while improving and maintaining joint function. Physical therapy and mechanical support devices such as knee braces can relief the condition.