Clinical manifestations of chondromalacia patella in 260 Iranian patients

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AbstractBackground and aim: Chondromalacia patella, which is characterized by softening of the patellar cartilage, is the most common cause of anterior knee pain in young women. The aim of this study was to identify the clinical features of patients with chondromalacia patella in Iran.Methods: All patients under 40 years, complaining of mechanical knee pain who were referred to Amir A’lam Rheumatology Unit, with positive shrug sign and normal knee X‐rays during the period September 2000 to September 2002, were included in this study. After physical examination and knee radiography, patients with knee arthritis, knee osteoarthritis and knee periarthritis were excluded. Patients with the clinical diagnosis of chondromalacia patella were studied. The demographic data, clinical disease characteristics and disease course were recorded.Results: There were 260 patients. They were predominantly female (F : M, 2.6 : 1), in the third decade of life and a mean age of 22.8 years at the onset of disease. Bilateral involvement was found in 92% of patients. The first manifestation was knee pain. The history of trauma or swelling of the knee occurred in about 20% of cases. The history of dislocation was 3%. Sitting with flexed knees, stairs, and the use of Turkish WCs aggravated the knee pain. About one‐third had knee malalignment, mostly mild genu varus. Patella alta was seen in 1.6%. Q‐angle more than 15° was seen in 90.8%. Mean Q‐angle was 21.9°, mean patellar angle was 122.6°, and mean intercondylar angle was 141.5°. All patients had the shrug sign. About 90% had Rabot test and crepitation, 3.5% had knee effusion, and 1% had knee laxity. Lower limb discrepancy was seen in 6.2% and spinal deformity in 10%. Ninety‐three percent of the patients were treated by conservative (medical) therapy.Conclusion: So the classic case of chondromalacia patella is a woman in her third decade of life with mechanical knee pain and positive shrug test.