Chondromalacia Research Articles

Patella-patellar tendon angle and lateral patella-tilt angle decrease patients with chondromalacia patella.

The aim of the present study was to evaluate the effect of patellofemoral joint morphology and patellar alignment (lateral patellar tilt and sagittal patellar tilt) on the presence and stage of CP, and identify the differences between sexes. MRI of 243 patients [146 men (60.1%)] were evaluated retrospectively. Patients were grouped as normal group without chondromalacia, group with mild chondromalacia (grades 1-2) and group with severe chondromalacia (grades 3-4). Sagittal patellofemoral alignment was assessed by the angle between the patella and patellar tendon (P-PTA), and the angle between the quadriceps tendon and patella (Q-PA). Patellar tilt was assessed by lateral patellar tilt angle (LPTA). In addition, patellofemoral joint morphology was evaluated by measuring trochlear depth (TD), trochlear sulcus angle (TSA) and patella angle (PA). P-PTA, Q-PA, LPTA and TD values were significantly lower in patients with severe chondromalacia than in patients with both normal and mild chondromalacia (P < 0.001). TSA values were significantly higher in patients with severe chondromalacia than those with both normal and mild chondromalacia (P < 0.001). TSA was higher and TD was lower in women compared to men (P < 0.001). LPTA and P-PTA were lower in women compared to men, and the difference was significant. There was no difference in PA between the two sexes. Patellar cartilage degeneration increases with trochlear dysplasia. There is a strong correlation between patellar malalignment (lateral patellar tilt and sagittal patellar tilt) and chondromalacia patella. Women are more prone to developing CP than men.

Relation of the chondromalatia patellae to proximal tibial anatomical parameters, assessed with MRI.

BackgroundMagnetic resonance imaging (MRI) is a non-invasive highly sensitive tool for diagnosing chondromalacia patellae in the early stages. Many studies have evaluated patellar and trochlear morphology with different radiologic indices. We aimed to assess the discriminative power of tibial, patellar, and femoral indices in MRI for chondromalacia patellae.Patients and methods100 cases of chondromalacia, as well as 100 age-matched controls among the patients who underwent knee MRI between February 2017 and March 2019, were included. The standard protocol of knee MRI was applied and the diagnosis of chondromalacia was made on MRI findings. Chondromalacia subjects were also classified as grade 1 to 4 according to the Modified Outerbridge’s MRI grading system. We measured 25 MRI parameters in the knee and adjacent structures to determine the relation between chondromalacia patellae and anatomical MRI parameters.ResultsTibial slope, trochlear depth, lateral trochlear inclination, and lateral patellar tilt angle had significant correlation with chondromalacia. Any increase in lateral trochlear inclination and lateral patellar tilt angle could increase the probability of the disease (Odds ratio [OR] 1.15, 1.13; 95% CI: 1.03–1.30; 1.02–1.26, respectively), while any increase in medial tibial slope and trochlear depth could decrease the probability of chondromalacia (OR 0.85, 0.06; 95% CI: 0.73–0.98, 0.02–0.17, respectively). We also designed a model for the severity of disease by using the patellar height index (relative odds ratio: 75.9).ConclusionsThe result of this study showed the novelty role of tibial anatomy in developing chondromalacia and its mechanism. We also concluded that patellar height might be an important factor in defining disease severity.

Application of bodybuilding for correction of musculoskeletal disease in Patellofemoral Pain Syndrome - A case report

Background: Medicine and Physical Education can work together to solve many health problems. Bodybuilding is a multidisciplinary area whose goals can range from body development to the correction of postural problems and the resolution of various pathologies related to human movement. In the case in analysis, the patient presented (at rest) localized pain (twinges) in the anterior face of the left knee, with an intensity of five (0-10 scale), without phlogistic signs, which worsens when performing the squat, hindering him from leaving the bed without pain. Symptoms were exacerbated when descending stairs. Through anamnesis and directed physical examination, it were considered the possible differential diagnosis of pain in the anterior portion of the knee: Diseases in menisci, anterior and posterior cruciate ligament injuries, diseases of knee collateral ligaments, diseases of knee cartilage, diseases of patellar tendon tendinitis and patellar chondromalacia. After a correct diagnosis of patellofemoral pain syndrome, a conservative treatment was performed using bodybuilding. The results were positive after four months of treatment. From this case, it can be concluded that bodybuilding can be an alternative solution for the conservative treatment of Patellofemoral Pain Syndrome

Percepções dos profissionais de educação física das academias de Montes Claros-MG acerca da conduta na pós-reabilitação da lesão Condromalácia Patelar

Objetivo: Analisar a percepções dos profissionais de educação física sobre a lesão Condromalácia Patelar, bem como a conduta clínica para o tratamento desta patologia. Métodos: A pesquisa foi descritiva e de corte transversal, desenvolvida por abordagem qualitativa. Foram entrevistados 12 profissionais formados no curso de educação física – Bacharelado, atuantes como instrutor/personal na cidade Montes Claros-MG. A coleta de dados foi realizada entre os meses de agosto e setembro de 2019. Teve como instrumento a entrevista individual com roteiro semiestruturado, onde foi transcrita na íntegra e, após transcrição e leitura dos relatos, utilizando o método da categorização como coleta dos dados. Resultados: As ideias consideradas mais relevantes da entrevista foram selecionadas e agrupadas em quatro categorias. Foi possível evidenciar que os profissionais, parecem não apresentar um conhecimento satisfatório da Condromalácia Patelar, visto que, apresentaram respostas superficiais ou que não condiz com a literatura presente. Conclusão: Conclui-se que apesar da pós-reabilitação ser uma área de importante atuação para o campo da educação física, ainda falta o conhecimento necessário para atuação dos mesmos, podendo agravar, ou não, o quadro patológico do cliente. Nessa perspectiva, futuros estudos devem ser realizados para investigação da Condromalácia Patelar e outras lesões relacionadas a saúde/reabilitação.

Effect of Extracorporeal Shock Wave combined with Rehabilitation Training on Patients with Chondromalacia Patellae

Effect of Extracorporeal Shock Wave combined with Rehabilitation Training on Patients with Chondromalacia Patellae

The patellofemoral joint – often forgotten, ­erroneously unconsidered or simply misunderstood?

Up to 40% of all athletes suffer from patellofemoral disorders every season, with a high prevalence of 15-25% especially in pivoting sports [1]. It has a high risk of recurrence, might persist for a prolonged time and therefore considerably influence the athlete’s trainability and performance over his career. Exercise-related, peripatellar pain is the most frequent observed condition and usually described as anterior knee pain (AKP), or synonymously called patellofemoral pain syndrome (PFPS). The formerly used term “chondromalacia patellae” has been shown to be misleading, and is no longer used in literature...

Evaluation of correlation between clinical and magnetic resonance imaging findings of patellar chondromalacia

Evaluation of correlation between clinical and magnetic resonance imaging findings of patellar chondromalacia

Chondromalacia Patella among Military Recruits with Anterior Knee Pain: Prevalence and Association with Patellofemoral Malalignment.

Background:The aim of this study was to investigate the frequency of chondromalacia patella (CMP) and to evaluate its relation with trochlear morphometric and patellofemoral alignment measurements as well as with edema in superolateral region of Hoffa's fat pad (SHFP) in military recruits with anterior knee pain (AKP).Materials and Methods:Knee magnetic resonance imaging examinations of 288 military recruits with AKP were retrospectively evaluated. Patellar cartilage lesions were graded using modified Noyes system. Quantitative measurements of trochlear morphology (sulcus angle, trochlear sulcus depth, and lateral trochlear inclination [LTI]) and patellofemoral alignment (patellar translation [PT], lateral patellofemoral angle (LPA), Insall-Salvati index, and tibial tuberosity-trochlear groove distance) were made. The SHFP region was assessed for the presence of edema. Mean values of measurements in knees with and without CMP and in knees with early and advanced stage CMP were compared.Results:We found CMP in 169 (58.7%) patients. Patients with CMP demonstrated a significantly greater sulcus angle (P = 0.012), smaller LTI (P = 0.004), greater PT (P = 0.01), smaller LPA (P = 0.036), greater Insall-Salvati ratio (P = 0.034), and higher incidence of SHFP edema (P = 0.001) compared to those without CMP. While none of the measurements were associated with the severity of cartilage damage, the incidence of SHFP edema was significantly correlated with the severity of CMP (P = 0.001).Conclusion:CMP is a common disorder among military recruits with AKP. Patellofemoral malalignment is an important contributory factor in the development of CMP, and the presence of edema in SHFP may be a strong indicator of underlying severe CMP in this population.

Comparison of 2D Fat Suppressed Proton Density (FS-PD) and 3D (WATS-c) MRI pulse sequences in evaluation of chondromalacia patellae

BackgroundComparing the diagnostic performance of widely used 2D FSE technique (fat-suppressed proton density; FS-PD) and the 3D technique (water-selective cartilage scan; WATS-c) in evaluation of the chondromalacia patella by using arthroscopy as reference standardResultsSeventy-five adult patients were enrolled in this study. They underwent MRI examinations then arthroscopy done in 2–4 days after it. MRI was done using 2D (FS-PD) and 3D (WATS-c) sequences and MR images were compared by two radiologists separately, then grading of the cartilage lesions was performed according to modified Noyes grading system and comparison between grade 0–1, 2, and 3 lesions was done using arthroscopic findings as a reference. A false-negative result is considered if there was undergrading of chondromalacia and false-positive result if chondromalacia was overgraded. Each sequence sensitivity, specificity, and accuracy was calculated by both readers.For reader 1, the sensitivity is 69% for WATS-c and 80% for FS-PD and the accuracy is 90% for WATS-c and 92% for FS-PD and for reader 2, the sensitivity is 56% for WATS-c and 84% for FS-PD and the accuracy is 88% for WATS-c and 94% for FS-PD.Conclusion2D FS-PD images showed better diagnostic performance than 3D WATS-c images for evaluating chondromalacia patella.

Role of magnetic resonance imaging in the evaluation of the anterior knee pain

BackgroundTo review the most common causes of Anterior knee pain (AKP), with an emphasis on their MRI findings; 70 patients were included (24 males and 46 females). Their age range is 10–53 years with a mean ± SD of 28.8 ± 9.06 years. All patients performed MRI of the affected knee.ResultsEleven disease entities were encompassed in this study; the patellar causes were dominating, where the chondromalacia patella being found in 43% of cases (n = 30), patellar instability was found in 19% (n = 13), transient patellar dislocation was found in 7% (n = 5), patellar tendinopathy was found in 4% (n = 3), and bipartite patella was found in 1% (n = 1). Hoffa’s disease was found in 14% (n = 10); the anterior meniscal tear was found in 13% (n = 9). Quadriceps tendinopathy was found in 3% (n = 2), and quadriceps tear was found in 4% (n = 3). Cartilage disease was found in 6% (n = 4); Osgood–Schlatter disease was found in 4% (n = 3); the coexistence of more than an entity was found in 13 cases (18.5%).ConclusionsMRI provided a safe and accurate modality in the diagnosis of different causes of AKP with a high specification in detecting the grades and the types of some diseases.

Patellar calcar: morphometric analysis by knee magnetic resonance imaging and three-dimensional reconstruction software-assisted.

Patellar calcar corresponds to a greater trabecular bone density area in the patella lateral facet, whose morphometry is uncertain. This study aimed to describe patellar calcar morphometry by knee MRI and develop a 3D reconstruction software-assisted. Consecutive adult patients, submitted to knee MRI, between 2014 and 2017, were entered in IMPAX software. Exclusion criteria are history of patellar surgical intervention, trauma, chondromalacia, bone edema or bipartite patella. All MRI images were retrospectively reviewed by three readers. MRI patellar calcar measurements are height, width, thickness and posterior distance. 3D model protocol reconstruction: 3D Slicer software was used to design a preliminary model for each patient, and then all were automatically merged into one, which was finalized using the software segmentation tools. For 3D patellar calcar location, the transpolar axis was designed. 250 MRI were analyzed, patellar calcar was present in 208 (83.2%); 101 men and 107 women. Mean age was 44.3 ± 15.6years. height 13.84 ± 2.42mm (male: 14.50 ± 2.42; female: 13.21 ± 2.26) (p < 0.0001), width 12.21 ± 2.26mm (male 13.14 ± 2.22; female 11.33 ± 1.93) (p < 0.0001). No statistically significant difference of thickness 0.56 ± 0.22mm (male: 0.56 ± 0.25; female: 0.56 ± 0.20) and posterior distance 2.37 ± 0.80mm (male: 2.46 ± 0.89; female: 2.29 ± 0.69) between genders was found. 3D model results: transpolar axis went through the patellar calcar in all the cases. This study shows in a 3D model reconstruction, what was previously described in the literature, determining for the first time the patellar calcar morphometry in the knee MRI and identifying it as a regular finding in this imaging test.

Injury Risk Associated With Sports Specialization and Activity Volume in Youth.

Background:Sports specialization has become increasingly common among youth.Purpose/Hypothesis:To investigate the relative importance of specialization vs volume of activity in increasing risk of injury. Hypotheses were that specialization increases the risk of injury and that risk varies by sport.Study Design:Cohort study; Level of evidence, 2.Methods:A prospective analysis was conducted with data collected from 10,138 youth in the Growing Up Today Study—a prospective cohort study of youth throughout the United States—and their mothers. Activity was assessed via questionnaires in 1997, 1998, 1999, and 2001. Sports specialization was defined as engaging in a single sport in the fall, winter, and spring. Injury history was provided by participants’ mothers via questionnaire in 2004. The outcome was incident stress fracture, tendinitis, chondromalacia patella, anterior cruciate ligament tear, or osteochondritis dissecans or osteochondral defect.Results:Females who engaged in sports specialization were at increased risk of injury (hazard ratio [HR], 1.31; 95% CI, 1.07-1.61), but risk varied by sport. Sports specialization was associated with greater volume of physical activity in both sexes (P < .0001). Total hours per week of vigorous activity was predictive of developing injury, regardless of what other variables were included in the statistical model (males: HR, 1.04; 95% CI, 1.02-1.06; females: HR, 1.06; 95% CI, 1.05-1.08). Among females, even those engaging in 3 to 3.9 hours per week less than their age were at a significantly increased risk of injury (HR, 1.93; 95% CI, 1.34-2.77). In males, there was no clear pattern of risk.Conclusion:Sports specialization is associated with a greater volume of vigorous sports activity and increased risk of injury. Parents, coaches, and medical providers need to be made aware of the volume threshold above which physical activity is excessive.

Hyaluronate acid for treatment of chondromalacia patellae: a 52-week follow-up study

To assess the therapeutic effect of hyaluronate acid (HA) injection through the subpatellar route for treatment of chondromalacia patellae (CP). Eighty-eight patients with the diagnosis of CP were enrolled in this prospective study, including 38 with early CP (CP group) and 50 with advanced CP (patellofemoral arthritis group) diagnosed based on image presentations. All the patients received intra-articular HA injections through a subpatellar route once a week for 5 consecutive weeks. The primary outcome measures included WOMAC index scores and Lequesne scores before and at 4, 12, 26 and 52 weeks after the injections. The secondary outcome measures included the 30-m walking time and stair ascending and descending time (one floor) before and at 1, 2, 3, and 4 weeks after the injections. In both groups the patients showed significantly decreased WOMAC scores and Lequesne scores at 4, 12, 26 and 52 weeks after HA injections as compared with the baseline scores (all P &lt; 0.01). No significant difference was found between the two groups in WOMAC scores and Lequesne scores at 4 or 12 weeks after the injections (both P&gt;0.05). The WOMAC scores and Lequesne scores at 26 and 52 weeks after the injections were significantly higher in patellofemoral arthritis group than in CP group (both P &lt; 0.05). In both groups, the 30-m walking time and the stair ascending and descending time decreased significantly at 1, 2, 3, and 4 weeks after HA injections (all P &lt; 0.05) without significant differences between the two groups (all P&gt;0.05). HA injection through the subpatellar route is effective for treatment of CP. HA injection produces better long-term efficacy for treatment of early CP than for advanced CP where patellofemoral arthritis occurs.

Injury Risk Associated with Sports Specialization in Youth

Objectives: Sports specialization has become increasingly common among youth. Our goal was to examine the independent prospective associations of sports specialization and volume of activity with injury risk in youth. Methods: A prospective analysis in 2018 using data collected from 10,138 youth in the Growing Up Today Study, a prospective cohort study of youth throughout the United States, and their mothers. Activity was assessed via questionnaires in 1997, 1998, 1999 and 2001. Sports specialization was defined as engaging in one sport in the fall, winter, and spring. Injury history was provided by participants’ mothers via questionnaire in 2004. The outcome was incident stress fracture, tendinitis, chondromalacia patella or anterior cruciate ligament tear. Results: Females who engaged in sports specialization were at increased risk of injury (females: hazard ratio (HR)=1.31, 95% confidence interval (CI) 1.07 -1.61), but risk varied by sport. In both genders sports specialization was associated with greater volume of physical activity (p&lt;0.0001). Total hours/week of vigorous activity was predictive of developing injury (males: HR=1.04, 95% CI 1.02 -1.06; females: HR=1.06, 95% CI 1.05 -1.08). Among the females even those engaging in 3-3.9 hours per week less than their age were at a significantly increased risk of injury (HR=1.93, 95% CI 1.34-2.77). In males there was not a clear pattern of risk. Conclusion: Sports specialization is associated with higher volume of vigorous sports activity and increased risk of injury. Parents, coaches, and medical providers need to be made aware of the volume threshold above which physical activity is excessive.

The relationship between patellofemoral arthritis and fat tissue volume, body mass index and popliteal artery intima-media thickness through 3T knee MRI

Background/aimEvaluating the relationship of patellar chondromalacia with obesity, infrapatellar fat pad (IFP) volume and popliteal artery intima-media thickness (IMT).Materials and methodsA total of 203 patients with different degree of patellar chondromalacia (103 male, 100 female) and 52 control subjects (19 male, 33 female) were included and grouped according to sex, age, body surface area (BSA), body mass index (BMI) and patellar chondromalacia classification. All measurements were completed with 3T magnetic resonance imaging (MRI). Articular cartilage and IFP volume were measured in saggital plane using double echo steady state (DESS) and DIXON sequences, respectively. Patellar cartilage damage was graded using modified outerbridge classification, and the relations among cartilage volume and BMI, BSA, IFP, IMT were statistically assessed.ResultsPopliteal artery IMT showed an independent association with the prevalence of cartilage defects and IFP volumes (P ˂ 0.001). There was an association between BMI and IFP volumes (P ˂ 0.001). However, no differences were observed between IFP volume and different chondromalacia groups. When IFP measurements were corrected using individual BMI and BSA values, a positive correlation was found between control and advanced chondromalacia groups (P ˂ 0.001).ConclusionThis study demonstrates the relationship among obesity, IMT and chondromalacia and highlights this potential circle to develop effective treatments and inhibit the progression of chondromalacia.

A New Approach to Treatment of Patellar Chondromalacia; Intra-Articular Injection of Hyaluronic Acid

A New Approach to Treatment of Patellar Chondromalacia; Intra-Articular Injection of Hyaluronic Acid

Analysis of patellofemoral arthrokinematic motion quality in open and closed kinetic chains using vibroarthrography

BackgroundKnee movements performed in open (OKC) and closed (CKC) kinetic chains generate various patterns of muscle activities and especially distinct contact stresses in the patellofemoral joint (PFJ). In contrast to these features, the arthrokinematic motion quality (AMQ) of the PFJ has not been compared between mentioned conditions. In this study we performed vibroarthrographic analysis of AMQ in movements performed in OKC and CKC, in healthy subjects and individuals with chondromalacia patellae, to assess which of the test conditions is more efficient in differentiation between healthy and deteriorated joints. Moreover, our analysis will broaden the knowledge related to behavior of normal and pathological synovial joints during motion with and without weight bearing. It is an essential issue, due to the recently observed significant interest in comparing potential benefits and limitations of CKC and OKC exercises as they relate to lower extremity rehabilitation.Methods100 subjects (62 healthy controls and 38 subjects with PFJ chondromalacia) were enrolled. During repeated knee flexion/extension motions performed in OKC (in a sitting position) and CKC (sit-to-stand movements), the vibroarthrographic signals were collected using an accelerometer and described by variability (VMS), amplitude (R4), and spectral power in 50–250 Hz (P1) and 250–450 Hz (P2) bands.ResultsSignificant differences in VMS [V], R4 [V], P1 [V2/Hz] and P2 [V2/Hz] between OKC and CKC were found (0.0001, 0.969. 0.800 0.041 vs 0.013, 3.973, 6.790, 0.768, respectively, P < 0.001). Moreover, in both analyzed load-related conditions the subjects with chondromalacia were characterized by significantly higher values of all parameters, when compared to controls (P < 0.001), with effect size values over 0.6.ConclusionsWe showed that motion of the physiological, unloaded PFJ articular surfaces in OKC is nearly vibrationless, which corresponds with optimal AMQ of PFJ, while loaded movements in CKC are characterized by a higher vibroacoustic emission level. Moreover, chondral lesions should be considered as an increased friction-related, aggravating factor of AMQ, which is critical in CKC movements under load. Nonetheless, OKC and CKC conditions are characterized by large effect sizes, and provide an efficient test frame for differentiating physiological knees and joints with chondral lesions.

Effects on patellar chondromalacia of the size of the infrapatellar fat pad

Infrapatellar fat tissue (IPFP), which is placed in the anterior compartment, has a vital role in the biomechanics of knee. It is thought that infrapatellar fat pad, which also functions as a storage for repair cells after injury, has a protective effect in mechanical and inflammatory knee pain. In this study, the relationship between patellar chondromalacia, which is among significant causes of anterior knee pain, and the sizes of IPFP was investigated. MRI images of patients over 18 years of age, who underwent MRI examination in June 2017 - December 2017, were examined retrospectively by recovering from the electronic patient registration system in the hospital. Eighty-three cases had patellar chondromalacia with normal-healthy IPFP tissue in the examination of knee MRI, and 53 cases without chondromalacia were included in the study. The average age of all evaluated 134 patients was 37.8 (22-68) years. The degree of chondromalacia patella was made according to Outerbridge classification. The height and depths of IPFP in all cases were measured from the widest site on the T1-weighted MRI images in the sagittal plane. The relationship among age, gender, the degree of patellar chondromalacia and IPFP sizes were evaluated. While the average of 51 patients without patellar chondromalacia was 29.04 (22-51) years, the average of 83 patients with chondromalacia was 43.20 (27-68) years. According to Outerbridge classification, patellar chondromalacia grade 3 in 14 patients, grade 2 in 41 patients, grade 1 in 26 patients and grade 4 in 2 patients were observed. It was not seen a significant difference between the groups in terms of gender (p = 0.78). It was seen a significant increase in between patellar chondromalacia and increasing age (p

Assessment of the relationship between patellar volume and chondromalacia patellae using knee magnetic resonance imaging.

OBJECTIVE:In this study, we evaluated the relationship between patellar volume and chondromalacia patellae.METHODS:A total of 162 patients who underwent knee magnetic resonance imaging (MR) due to knee pain at our department between January 2017 and May 2017 were included in this study. Of the cases, 111 were chondromalacia patellae, and 51 were healthy individuals. The patella volumes of all cases were analyzed using semi-automated software. Staging in cases with chondromalacia was graded according to the Outerbridge classification (stages 1–4). The relationship between patellar volume, presence of chondromalacia, cartilage thickness, age, and sex was analyzed statistically.RESULTS:Of the 162 cases, 67 (41.4%) were male, and 95 (58.6%) were female. The median age of the cases was 44. Patellar volume was a minimum of 12.24, a maximum of 39.44, and a median 21.4 cm3, and it was higher in cases with chondromalacia (p=0.026). In patients with chondromalacia patellae, the thickness of cartilage in the medial facet was lower. There was a statistically significant weak positive correlation between chondromalacia grade and patellar volume (p=0.031, r=0.204).CONCLUSION:This study showed that chondromalacia patellae, one of the important causes of chronic frontal knee pain, has a statistically significant relationship with patellar volume. The medial facial cartilage of the patella was thinner than in cases with chondromalacia patellae. Although the mean age of the cases with chondromalacia was higher than the cases without chondromalacia, there was no significant difference between male and female individuals.

Chondromalacia Patellae: A Review

Chondromalacia patella (knee pain) is the softening and breakdown of the tissue (cartilage) on the underside of the kneecap (patella) and is often referred to as chondromalacia of the patella, patellofemoral syndrome, or runner's knee. Pain Results when the knee and the thigh bone (femur) rub together. Abnormal knee cap positioning, tightness or weakness of the muscles associated with the knee, too much activity involving the knee, and flat feet may increase the likelihood of chondromalacia patella. The undersurface of the patella is covered with hyaline cartilage that articulates with the hyaline cartilage covered femoral groove (trochlear groove). Posttraumatic injuries, microtrauma wear and tear, and iatrogenic injections of medication can lead to the development of chondromalacia. Chondromalacia occurs in any joint and is especially common in joints that have had trauma and deformities. Cartilage is the soft tissue padding which is present between all joint and bones and acts like a shock absorber. The cartilage experiences a lot of wear, tear and damage over time. The cartilage is essentially avascular (has no blood or nerve supply) and is therefore quite a difficult area to heal. Long term therapy is essential in ensuring healthy repair so that further complications are not experienced in the future.