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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="StatPearls [Internet]" /><meta name="citation_title" content="Chondromalacia Patella" /><meta name="citation_publisher" content="StatPearls Publishing" /><meta name="citation_date" content="2023/04/22" /><meta name="citation_author" content="Steven F. Habusta" /><meta name="citation_author" content="Ryan Coffey" /><meta name="citation_author" content="Subitchan Ponnarasu" /><meta name="citation_author" content="Ahmed Mabrouk" /><meta name="citation_author" content="Edward E. Griffin" /><meta name="citation_pmid" content="29083563" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK459195/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Chondromalacia Patella" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="StatPearls Publishing" /><meta name="DC.Contributor" content="Steven F. Habusta" /><meta name="DC.Contributor" content="Ryan Coffey" /><meta name="DC.Contributor" content="Subitchan Ponnarasu" /><meta name="DC.Contributor" content="Ahmed Mabrouk" /><meta name="DC.Contributor" content="Edward E. Griffin" /><meta name="DC.Date" content="2023/04/22" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK459195/" /><meta name="description" content="In 1906, for the first time, pathological changes in the patellar cartilage were reported by Budinger et al. Then, Kelly et al. described these pathological changes as chondromalacia patellar (CMP).[1] Originally, the word "chondromalacia" stemmed from Greek words. Chrondros means cartilage, and malakia means softening.[2] " /><meta name="og:title" content="Chondromalacia Patella" /><meta name="og:type" content="book" /><meta name="og:description" content="In 1906, for the first time, pathological changes in the patellar cartilage were reported by Budinger et al. Then, Kelly et al. described these pathological changes as chondromalacia patellar (CMP).[1] Originally, the word "chondromalacia" stemmed from Greek words. Chrondros means cartilage, and malakia means softening.[2] " /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK459195/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-statpearls-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/statpearls/article-19480/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK459195/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. </p></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK459195_"><span class="title" itemprop="name">Chondromalacia Patella</span></h1><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Steven F. Habusta</span><sup>1</sup>; <span itemprop="author">Ryan Coffey</span><sup>2</sup>; <span itemprop="author">Subitchan Ponnarasu</span><sup>3</sup>; <span itemprop="author">Ahmed Mabrouk</span><sup>4</sup>; <span itemprop="author">Edward E. Griffin</span><sup>5</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> LECOM</div><div class="affiliation"><sup>2</sup> Martin Army Community Hospital</div><div class="affiliation"><sup>3</sup> Ramaiah Medical College & Hospitals, Bangalore, India</div><div class="affiliation"><sup>4</sup> National Health Service (NHS), United Kingdom</div><div class="affiliation"><sup>5</sup> Lecom</div><p class="small">Last Update: <span itemprop="dateModified">April 22, 2023</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="article-19480.s1"><h2 id="_article-19480_s1_">Continuing Education Activity</h2><p>Chondromalacia is an affliction of the hyaline cartilage coating of the articular surfaces of the bone. It results in the softening and subsequent tearing, fissuring, and erosion of hyaline cartilage. Most commonly, it is recognized as involving the extensor mechanism of the knee and, accordingly, is often referred to as chondromalacia of the patella, patellofemoral syndrome, or runner's knee. The undersurface of the patella is covered with hyaline cartilage that articulates with the hyaline cartilage-covered femoral groove (trochlear groove). Post-traumatic 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 with trauma and deformities, such as the knee and patella. This activity reviews the etiology, presentation, evaluation, and management of chondromalacia patella and examines the role of the interprofessional team in evaluating, diagnosing, and managing the condition.</p><p>
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<b>Objectives:</b>
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<ul><li class="half_rhythm"><div>Review the various hypothesized etiologies for the development of chondromalacia patella.</div></li><li class="half_rhythm"><div>Describe the presentation and various testing, including any diagnostic imaging, that a provider should perform to evaluate for chondromalacia patella.</div></li><li class="half_rhythm"><div>Summarize the available treatment and management options for chondromalacia patella.</div></li><li class="half_rhythm"><div>Explain the importance of interprofessional team strategies for improving care coordination and communication to aid in the diagnosis of chondromalacia patella and improving outcomes in patients diagnosed with the condition.</div></li></ul>
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<a href="https://www.statpearls.com/account/trialuserreg/?articleid=19480&utm_source=pubmed&utm_campaign=reviews&utm_content=19480" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Access free multiple choice questions on this topic.</a>
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</p></div><div id="article-19480.s2"><h2 id="_article-19480_s2_">Introduction</h2><p>In 1906, for the first time, pathological changes in the patellar cartilage were reported by Budinger et al. Then, Kelly et al. described these pathological changes as chondromalacia patellar (CMP).<a class="bk_pop" href="#article-19480.r1">[1]</a> Originally, the word "chondromalacia" stemmed from Greek words. Chrondros means cartilage, and malakia means softening.<a class="bk_pop" href="#article-19480.r2">[2]</a> </p><p>In general, chondromalacia (sick cartilage) is an affliction of the hyaline cartilage coating of the articular surfaces of the bone. Chondromalacia patella (CMP) is when the posterior articular surface of the patella starts losing its density when in a healthy state and becomes softer with subsequent tearing, fissuring, and erosion of the hyaline cartilage. It is commonly recognized as involving the extensor mechanism of the knee and, accordingly, is often referred to as chondromalacia of the patella, patellofemoral syndrome, or runner's knee. The undersurface of the patella is covered with hyaline cartilage that articulates with the hyaline cartilage-covered femoral groove (trochlear groove). Post-traumatic injuries, microtrauma wear and tear, and iatrogenic medication injections can lead to chondromalacia development. Chondromalacia occurs in any joint and is especially common in joints with trauma and deformities.<a class="bk_pop" href="#article-19480.r3">[3]</a><a class="bk_pop" href="#article-19480.r4">[4]</a><a class="bk_pop" href="#article-19480.r5">[5]</a><a class="bk_pop" href="#article-19480.r6">[6]</a><a class="bk_pop" href="#article-19480.r7">[7]</a></p></div><div id="article-19480.s3"><h2 id="_article-19480_s3_">Etiology</h2><p>Several paths can lead to the development of chondromalacia patellae; however, the pain generator is not clearly identified and is usually multifactorial. Multiple factors have been involved, including:</p><p>
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<b>Lower Limb Malalignment and Patellar Maltracking</b>
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</p><p>The Q angle is the measurement of the pull of the quadriceps muscle relative to the pull of the patella tendon on the patella. A normal angle is 14 degrees in men and 17 degrees in women. This variance is created because anatomically, there is normally a wider pelvis in females than in males. The Q angle is measured by drawing a line from the center of the anterior iliac spine to the center of the patella (quadriceps pull) and a second line from the mid-portion of the patella to the tibial tubercle (patella tendon pull). An abnormally high Q angle > 20 to 25 degrees, indicates lateral pull of the patella in the trochlear groove of the femur and a mechanism of articular cartilage wear and tear. The tibial tubercle trochlear groove distance (TT-TG) is a linear equivalent of the Q angle and a more accurate measure of assessing patellar maltracking.</p><p>Patellar maltracking results in narrow contact pressure areas with increased stresses and a further increase in pain. Additionally, the alignment of the patella in the vertical plane can also be abnormal. Patella Alta (high riding), and patella Baja (low riding), are both conditions that have also been implicated as a cause of chondromalacia.</p><p>Foot and ankle anatomic variances (pes planus) that cause an increased valgus orientation of the knee cause increased lateral wear of the patellofemoral joint. For example, high-heel shoes, which create increased stress on the patellofemoral joint, can also contribute to chondromalacia.</p><p>Chondromalacia patellae can be associated with miserable malalignment syndrome, a combination of specific anatomic criteria that results in increased Q angle and patellofemoral dysplasia. These criteria include femoral anteversion, genu valgum, and external tibial torsion or pronated feet.</p><p>
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<b>Muscular Weakness</b>
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</p><p>Weakness of vastus medialis obliques and general core muscles weakness.</p><p>
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<b>Patellar Lesions</b>
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</p><p>Chondromalacia is also seen as a complication of injuries direct to the patella, immobilization (casting rehabilitative periods), and surgical procedures that lead to quadriceps atrophy. The cause is the micro-trauma created by the decreased pull of the quadriceps muscle on the patella.</p><p>Most often, chondromalacia is associated with abnormal (microtrauma) wear and tear of the patellofemoral joint's hyaline cartilage. Lateral positioning of the patella in the patella-femoral joint is a frequent cause of chondromalacia. Although a tight lateral retinaculum or a lateral synovial plica may be implicated as the cause of this positioning, an abnormal Q angle is often the cause.</p><p>Contrary to congenital increased cartilage vulnerability, which is not modifiable, iatrogenic injection of chondrotoxic medication into a joint is one that patients can avoid. Intra-articular injections of bupivacaine and high doses or frequent intra-articular injections of corticosteroid lead to softening and/or articular cartilage dysfunction.</p><p>Among the causes, patella subluxation is the most common as it is more frequently missed as there is no frank dislocation.<a class="bk_pop" href="#article-19480.r8">[8]</a></p></div><div id="article-19480.s4"><h2 id="_article-19480_s4_">Epidemiology</h2><p>More women than men are affected, which is attributed to increased Q angles in women. There does not appear to be a hormonal cause of variation. Active young adults who participate in running sports or workers who increase stress in their patellofemoral joint by repeated stair climbing and/or kneeling have a higher incidence of chondromalacia.<a class="bk_pop" href="#article-19480.r9">[9]</a></p></div><div id="article-19480.s5"><h2 id="_article-19480_s5_">Pathophysiology</h2><p>Normally, patellar hyaline cartilage has a bluish-white, smooth, glistening, and resilient appearance. The pathology of chondromalacia patellae starts with softening, swelling, and edema of the articular cartilage, giving it a dull or even slightly yellowish-white appearance.<a class="bk_pop" href="#article-19480.r10">[10]</a><a class="bk_pop" href="#article-19480.r11">[11]</a> The pathology characteristically starts in the middle of the medial patellar facet, or just distal to it, and starts small, measuring about half an inch or more in diameter.<a class="bk_pop" href="#article-19480.r11">[11]</a> This will then progress to cartilage fibrillation, fissuring, and fragmentation in the more advanced stages.<a class="bk_pop" href="#article-19480.r11">[11]</a><a class="bk_pop" href="#article-19480.r1">[1]</a> Some reports suggest that CMP may be reversible or progress to advanced patellofemoral joint osteoarthritis.<a class="bk_pop" href="#article-19480.r12">[12]</a></p><p>
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<b>Pathological Process in Chondromalacia Patellae</b>
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</p><p>Hyaline cartilage is composed of chondrocytes that are dispersed throughout an extracellular matrix. This matrix consists of type 2 collagen, proteoglycans, and water. The chondrocytes produce proteoglycans, which are then secreted into the extracellular matrix. Hyaline cartilage is avascular. Its nutrients diffuse into the matrix from synovial fluid. It does not repair well because of the lack of blood supply. Hyaline cartilage is also devoid of lymphatic and neural tissue.</p><p>The cartilage reacts to both the environment and physical loads. Destruction of hyaline cartilage can occur in response to chondrotoxic substances injected into a joint. It can also occur through exposure to cytokinins and proteolytic enzymes produced in response to intra-articular bacterial infections.</p><p>Hyaline cartilage degeneration also occurs in response to microtrauma wear and tear. Repeated activities that create compressive stress on the patella-femoral joint or increased loads applied to the joint can lead to chondromalacia.</p><p>Aging also affects hyaline cartilage. The number of chondrocytes in the cartilage decreases, which correlates with a reduction in the number of proteoglycans produced. This reduction leads to a decrease in the water content of the cartilage. Loss of the cartilage's elastic properties develops because of the cross-linking of collagen fibrils that also occurs with aging. The superficial zone of hyaline cartilage is the first zone to degenerate in the aging process.</p><p>The anterior fat pad and the joint capsule are most commonly involved in generating pain signals, while the subchondral bone is less likely to cause pain signals.</p><p>Pathology of chondromalacia patellae starts with softening, swelling, and edema of the articular cartilage.</p></div><div id="article-19480.s6"><h2 id="_article-19480_s6_">Histopathology</h2><p>Hyaline cartilage has four zones. The most superficial zone is a gliding surface, i.e., the articular surface of hyaline cartilage. The arrangement of its collagen fibers is parallel to the articular surface to resist shear forces. Other layers include a transitional zone that resists compressive forces and a deep zone that resists shear forces. The collagen fibers in this zone are perpendicular to the articular surface. The fourth zone is the deep calcified zone. This zone contains hydroxyapatite and calcium salts. The deep calcified zone secures the hyaline cartilage to bone.</p></div><div id="article-19480.s7"><h2 id="_article-19480_s7_">History and Physical</h2><p>Anterior knee pain is the most common chief complaint of patients with chondromalacia patellar; however, a high proportion of patients will present with insidious onset of vaguely diffuse retropatellar or prepatellar pain. This pain is usually made worse with activities that increase the stress on the patellofemoral joint, for example, stair ascending or more frequently descending, squatting, kneeling, and running, or even prolonged sitting rather, known as theatre pain. In addition to the anterior knee pain,  effusion, wasting of the quadriceps, and retropatellar crepitus have all been reported in patients with CMP despite none being specific.<a class="bk_pop" href="#article-19480.r13">[13]</a> Hence reliable diagnosis depends on the exclusion of other differential diagnoses presenting with anterior knee pain.</p><p>The varied etiological factors of chondromalacia mandate a thorough history and physical evaluation to diagnose this condition and avoid mismanagement due to misdiagnosis correctly. The history should include evaluating previous trauma, comorbid conditions, unstable joints, foot and ankle pain or dysfunction, and activity. Likewise, the physical exam should evaluate the quadriceps appearance and presence of atrophy, the orientation of the foot and ankle, as well as a specific evaluation of the patellofemoral joint.</p><p>Specific evaluation of the patellofemoral joint should include assessment of pain, effusion, quadriceps strength, patella mobility, and crepitus. Particular attention to signs of patella maltracking, which includes increased femoral anteversion, increased external tibial torsion, lateral patella subluxation, loss of medial patellar mobility, and positive patellar apprehension test.</p><p>The physical examination test, which specifically evaluates the knee for chondromalacia patellae, is Clark's test. This test evaluates patellofemoral grinding and pain by compressing the patella into the femoral trochlea and having the patient contract their quadriceps muscle-pulling the patella through the groove.</p></div><div id="article-19480.s8"><h2 id="_article-19480_s8_">Evaluation</h2><p>
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<b>Conventional radiographs:</b> Anteroposterior, lateral, and notch views. Radiographs have lower sensitivity and specificity in early grades of CMP. In advanced stages, might show chondrosis, cystic changes, advanced cartilage loss, or joint space loss. In general, radiographs can serve as guidance to the underlying etiology such as in cases of trochlear dysplasia, patella Alta, patella Baja, or lateral patellar tilt. </p><p>
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<b>CT scan:</b> gives more information with regard to patellofemoral alignment by delineating trochlear geometry. The TT-TG distance can be measured on the CT scan. In addition, torsional deformities of the lower limb can be detected and measured.</p><p>
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<b>Arthrography with plain radiographs or CT arthrography:</b>  Despite low sensitivity, may demonstrate inhibited contrast in areas of chondromalacia. Also, my sport successfully focal areas of cartilage or irregular cartilage or lost cartilage but again in advanced stages.<a class="bk_pop" href="#article-19480.r14">[14]</a></p><p>
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<b>MRI scan:</b> is the modality of choice for articular cartilage assessment with the best appearances on the T2 sequences, where abnormal cartilage shows high signal intensity. Non-invasive and more reliable and with a higher detection rate than arthroscopy.<a class="bk_pop" href="#article-19480.r15">[15]</a><a class="bk_pop" href="#article-19480.r16">[16]</a></p><p>Radiologically, patellofemoral congruency can be assessed by multiple variables: sulcus angle, trochlear depth, patellar angle, and evaluating patellar tilt by measuring lateral patellar tilt angle. In an MRI study for patients with CMP, both the lateral patellar tilt angle and trochlear depth were significantly decreased, sulcus angle was significantly higher. And there was no correlation reported between patella angle and CMP.<a class="bk_pop" href="#article-19480.r17">[17]</a> Another MRI study reported that patients with CMP  had lower lateral patellar tilt angle, lower trochlear depth, and higher sulcus angle. The ratio of the trochlear sulcus angle to trochlear depth was also suggested as a powerful predictor for early cases of CMP.<a class="bk_pop" href="#article-19480.r18">[18]</a> Additionally, tibial slope and patellar height were important factors in predicting CMP.<a class="bk_pop" href="#article-19480.r5">[5]</a></p><p>Another MRI study evaluated the correlation between obesity and CMP and reported that subcutaneous knee fat thickness was significantly higher in CMP patients in comparison with normal populations. Additionally, a significant correction was reported between subcutaneous knee fat thickness and the grade of CMP. Female patients were found to have thicker subcutaneous knee fat and more serious CMP than male patients.<a class="bk_pop" href="#article-19480.r19">[19]</a></p><p>
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<b>Arthroscopy: </b>This is the most efficient modality in diagnosing chondromalacia, and determining the location and size of cartilage lesions as well as patella position. However, due to its invasiveness, non-invasive methods are essential for the diagnosis.<a class="bk_pop" href="#article-19480.r13">[13]</a><a class="bk_pop" href="#article-19480.r20">[20]</a></p></div><div id="article-19480.s9"><h2 id="_article-19480_s9_">Treatment / Management</h2><p>A trial of longstanding conservative management for at least one year should be the first line of treatment. This includes rest, activity restriction, and nonsteroidal anti-inflammatory medication, which is proven to be more effective than steroids. Rehabilitation with physiotherapy should focus on closed chain short arc quadriceps exercises and specific strengthening of vastus medialis obliqus, core muscle strengthening, and strengthening of hip external rotators. Quadriceps muscle strengthening with different exercises significantly reduces anterior knee pain in early cases of CMP.<a class="bk_pop" href="#article-19480.r21">[21]</a><a class="bk_pop" href="#article-19480.r22">[22]</a></p><p>Management of the patient with chondromalacia patellae is difficult, and there is no one specific form of treatment that is universally accepted as a standard of care. Medical management should be based on the physical exam findings. It can include patella stabilizing braces, physical therapy for quadriceps strengthening, orthotics that decrease pronation of the foot, and nonsteroidal anti-inflammatory medication. The use of platelet-rich plasma (PRP) is sometimes advocated, but it is not the standard of care. PRP has not been shown to improve patient outcomes consistently. Likewise, prolotherapy has been recommended by some authors, but it is not the standard of care and has not been shown to improve patient outcomes consistently.</p><p>
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<b>Operative Management</b>
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</p><p>Failure of conservative management will result in exploring alternative surgical options. Even though multiple effective options are available, care should be taken when recommending the best procedure, considering the patient's age and severity of CMP. Each procedure has its own merits, indications, and limitations. Available options include patellar cartilage excision, shaving, drilling, proximal soft tissue, and distal bony patellar realignment surgery. The most effective and most straightforward surgery with avoidance of quadriceps fibrosis and dysfunction is a patellar tendon medial realignment with lateral release and reefing of the medial quadriceps expansion. <a class="bk_pop" href="#article-19480.r23">[23]</a></p><p>
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<b>Arthroscopic Evaluation and Debridement:</b>
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</p><p>Indicated for diseased cartilage or chondral abrasion, fibrillation, or traumatized cartilage areas (Outerbridge grade II, III, and IV chondromalacia patellofemoral joint).<a class="bk_pop" href="#article-19480.r24">[24]</a></p><p>Debridement is either mechanical or radiofrequency.<a class="bk_pop" href="#article-19480.r25">[25]</a></p><p>
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<b>Arthroscopic or Open Lateral Retinacular Release</b>
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</p><p>Indicated for lateral patellar tilt and presence of tight lateral retinacular capsule and loose medial capsule.</p><p>
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<b>Patellar Realignment Surgery</b>
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</p><p>This is based on restoring the biomechanical force axis of the patellofemoral joint, which would improve its function; however, it would result in patellofemoral joint degeneration to a degree. <a class="bk_pop" href="#article-19480.r26">[26]</a> Indicated for severe symptoms refractory to conservative management, including physiotherapy.</p><p>Various techniques have been described in the literature covering tibial tuberosity osteotomy, tibial tuberosity anteversion, and tibial tuberosity elevation.</p><p>Maquet (anterior tubercle elevation): Not more than 1 cm is elevated to avoid the risk of skin necrosis.</p><p>Fulkerson (anterior-medialization):</p><p>This is indicated in cases of patellar instability with the presence of an increased Q angle.</p><p>Contraindicated in skeletal immaturity and in the presence of superomedial arthrosis ( It is recommended to perform an arthroscopic evaluation before surgery)</p><p>Elmslie-Trillat osteotomy</p><p>MPFL reconstruction</p><p>
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<b>Patellectomy:</b> either partial or total patellectomy. However, this procedure would be indicated only if a patient has excellent quadriceps function preoperatively and would be compliant to exercise regularly postoperatively. Total patellectomy is considered a radical procedure for managing  CMP. It is associated with greater damage to the surrounding ligaments and quadriceps femoris. Additionally, it changes the leverage effect of the extensor muscles. Several other complications have been reported in later stages after total patellectomy, such as instability of the extensor tendon and patellar tendon acute rupture. Hence partial rather than total patellectomy was usually performed in managing CMP.<a class="bk_pop" href="#article-19480.r27">[27]</a><a class="bk_pop" href="#article-19480.r28">[28]</a><a class="bk_pop" href="#article-19480.r29">[29]</a></p><p>
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<b>Salvage procedures (Historical)</b>
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</p><p>Patellar resurfacing: the McKeever prosthesis initially had a beneficial long-term effect for cases of severe CMP with advanced patellofemoral osteoarthritis; however, this procedure was abandoned due to multiple complications such as patellar tendon lesions, secondary patella fracture, avascular necrosis, patellofemoral joint instability, and prosthetic loosening.<a class="bk_pop" href="#article-19480.r30">[30]</a><a class="bk_pop" href="#article-19480.r24">[24]</a></p><p>
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<b>Other Treatment Modalities</b>
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</p><p>
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<b>Cell therapy:</b>
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<a class="bk_pop" href="#article-19480.r31">[31]</a>
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<a class="bk_pop" href="#article-19480.r32">[32]</a>
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</p><p>Autologous chondrocyte implantation was first reported in 1994 for treating cartilage defects in knee osteoarthritis.<a class="bk_pop" href="#article-19480.r33">[33]</a> In the last two decades, cell therapy for osteoarthritis has emerged as a treatment. Multiple reviewers consider CMP a mesenchymal disease; therefore, cell therapy would have a positive therapeutic effect. Emerging modalities include autologous chondrocyte transplantation and injection of mesenchymal stem cells.</p><p>
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<b>Mesenchymal stem cells (MSCs):</b>
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</p><p>Intraarticular injections of MSCs from different sources were proven safe and clinically effective in treating chondromalacia patellar.</p><p>It has the advantages of being less invasive, providing symptomatic relief, and reducing inflammatory changes.</p><p>The mechanism of MSC injection is still an area of research, but it does have promising results.<a class="bk_pop" href="#article-19480.r23">[23]</a></p></div><div id="article-19480.s10"><h2 id="_article-19480_s10_">Differential Diagnosis</h2><ul><li class="half_rhythm"><div>Chondromalacia patellae/osteochondral defect</div></li><li class="half_rhythm"><div>Osteochondritis dessicans of the patellofemoral joint</div></li><li class="half_rhythm"><div>Patellofemoral osteoarthritis</div></li><li class="half_rhythm"><div>Patellofemoral pain syndrome</div></li><li class="half_rhythm"><div>Lateral patellar compression syndrome</div></li><li class="half_rhythm"><div>Plica syndrome</div></li><li class="half_rhythm"><div>Quadriceps tendonitis/tendinopathy</div></li><li class="half_rhythm"><div>Patellar tendonitis/ tendinopathy</div></li><li class="half_rhythm"><div>Saphenous neuroma</div></li><li class="half_rhythm"><div>Postoperative neuroma</div></li><li class="half_rhythm"><div>Patellar fat pad inflammation</div></li><li class="half_rhythm"><div>Hoffa disease</div></li><li class="half_rhythm"><div>Patella Alta</div></li><li class="half_rhythm"><div>Patella Baja</div></li><li class="half_rhythm"><div>Patella instability</div></li><li class="half_rhythm"><div>Bi-partite patella</div></li></ul></div><div id="article-19480.s11"><h2 id="_article-19480_s11_">Staging</h2><p>Outerbridge classification of chondromalacia patellae (5 grades from 0 to IV):<a class="bk_pop" href="#article-19480.r11">[11]</a></p><p>
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<b>Grade 0:</b> Normal cartilage</p><p>
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<b>Grade I:</b> Intact articular surface but soft, swollen, and oedematous</p><p>Some fibrillation and heterogeneity of the cartilage may be noted, which is translated on the MRI as high signal intensity</p><p>
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<b>Grade II:</b> Fissures and fragmentation of the articular surface ( an area half an inch or less in diameter)</p><p>
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<b>Grade III:</b> Focal, partial thickness cartilaginous defect. (an area more than half an inch in diameter)</p><p>
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<b>Grade IV:</b> Full thickness defect down to the subchondral bone</p><p>Commonly, these grades are assessed with an arthroscopic evaluation of the knee. MRI radiography can also classify the degree of articular cartilage wear, but it is not as accurate as the visual assessment done at arthroscopy<a class="bk_pop" href="#article-19480.r34">[34]</a><a class="bk_pop" href="#article-19480.r35">[35]</a><a class="bk_pop" href="#article-19480.r36">[36]</a><a class="bk_pop" href="#article-19480.r7">[7]</a><a class="bk_pop" href="#article-19480.r37">[37]</a></p><p>In the Asian population, Ye et al. considered further classified CMP into an early stage (grade 1–2 Outerbridge) and an advanced stage (grade 3–4), and they assumed that with the early stage, patella cartilage can self-repair in comparison to an advanced stage when it progresses to patellofemoral joint osteoarthritis<a class="bk_pop" href="#article-19480.r38">[38]</a></p></div><div id="article-19480.s12"><h2 id="_article-19480_s12_">Prognosis</h2><p>Chondromalacia patellae may be reversible, or it could progress to the development of patellofemoral osteoarthritis. Patients with knee pain resulting from chondromalacia patella often achieve full recovery. Depending on the case, recovery can occur in as little as a month or take years. Teenagers often achieve long-term recovery because their bones are still growing, and their symptoms generally ameliorate after reaching adulthood.<a class="bk_pop" href="#article-19480.r39">[39]</a></p></div><div id="article-19480.s13"><h2 id="_article-19480_s13_">Complications</h2><p>Complications in patients with chondromalacia patella may result secondary to the effects of NSAIDs (e.g., GI symptoms) use or bracing, where occasional dermatologic reactions result from the skin's reaction to the brace material. Therapeutic exercises rarely result in symptomatic aggravation. If a specific activity correlates with aggravation of symptoms, then the patient and clinician or therapist should work together to modify the activity ( r.g., alter the frequency, duration, or intensity of the activity or cease the activity temporarily if necessary.)</p></div><div id="article-19480.s14"><h2 id="_article-19480_s14_">Consultations</h2><ul><li class="half_rhythm"><div>Orthopedist</div></li><li class="half_rhythm"><div>Radiologist</div></li><li class="half_rhythm"><div>Rheumatologist</div></li><li class="half_rhythm"><div>Physical therapist</div></li></ul></div><div id="article-19480.s15"><h2 id="_article-19480_s15_">Deterrence and Patient Education</h2><p>Patient education revolves around compliance with medication, therapeutic exercises, post-surgical rehabilitation, and elimination of any aggravating movements or activities when possible.</p></div><div id="article-19480.s16"><h2 id="_article-19480_s16_">Enhancing Healthcare Team Outcomes </h2><p>The diagnosis and management of chondromalacia patella are complex and best done with an interprofessional team that includes an orthopedic surgeon, emergency department physician, sports physician, physical therapist, nurse practitioners/PAs, rheumatologist, and nursing staff. Once diagnosed, management is difficult because no single treatment works consistently in all patients. Nonsurgical therapy is usually the first step. If that fails, PRP and prolotherapy may be other options. Surgery is undertaken when conservative measures fail. However, the surgery does not always result in positive outcomes, and a significant number of patients continue to complain of pain.<a class="bk_pop" href="#article-19480.r22">[22]</a><a class="bk_pop" href="#article-19480.r40">[40]</a> This is why interprofessional communication, record-keeping, and activity coordination are necessary to achieve optimal outcomes. [Level 5]</p></div><div id="article-19480.s17"><h2 id="_article-19480_s17_">Review Questions</h2><ul><li class="half_rhythm"><div>
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</div></li></ul></div><div id="article-19480.s18"><h2 id="_article-19480_s18_">References</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="article-19480.r1">Kelly MA, Insall JN. Historical perspectives of chondromalacia patellae. <span><span class="ref-journal">Orthop Clin North Am. </span>1992 Oct;<span class="ref-vol">23</span>(4):517-21.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/1408036" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1408036</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="article-19480.r2">Gordon HM. Chondromalacia patellae. <span><span class="ref-journal">Aust J Physiother. </span>1977 Sep;<span class="ref-vol">23</span>(3):103-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25026604" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25026604</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="article-19480.r3">Bączkowicz D, Kręcisz K, Borysiuk Z. Analysis of patellofemoral arthrokinematic motion quality in open and closed kinetic chains using vibroarthrography. <span><span class="ref-journal">BMC Musculoskelet Disord. </span>2019 Jan 31;<span class="ref-vol">20</span>(1):48.</span> [<a href="/pmc/articles/PMC6357468/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6357468</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30704430" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30704430</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="article-19480.r4">Franco BAFM, Sadigursky D, Daltro GC. Patellar position in patients with patellofemoral syndrome as characterized by anatomo-radiographic study. <span><span class="ref-journal">Rev Bras Ortop. </span>2018 Jul-Aug;<span class="ref-vol">53</span>(4):410-414.</span> [<a href="/pmc/articles/PMC6052178/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6052178</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30027071" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30027071</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="article-19480.r5">Aysin IK, Askin A, Mete BD, Guvendi E, Aysin M, Kocyigit H. Investigation of the Relationship between Anterior Knee Pain and Chondromalacia Patellae and Patellofemoral Malalignment. <span><span class="ref-journal">Eurasian J Med. </span>2018 Feb;<span class="ref-vol">50</span>(1):28-33.</span> [<a href="/pmc/articles/PMC5843449/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5843449</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29531488" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29531488</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="article-19480.r6">Resorlu M, Doner D, Karatag O, Toprak CA. The Relationship between Chondromalacia Patella, Medial Meniscal Tear and Medial Periarticular Bursitis in Patients with Osteoarthritis. <span><span class="ref-journal">Radiol Oncol. </span>2017 Dec;<span class="ref-vol">51</span>(4):401-406.</span> [<a href="/pmc/articles/PMC5765316/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5765316</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29333118" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29333118</span></a>]</div></dd><dt>7.</dt><dd><div class="bk_ref" id="article-19480.r7">Eckenrode BJ, Kietrys DM, Parrott JS. Effectiveness of Manual Therapy for Pain and Self-reported Function in Individuals With Patellofemoral Pain: Systematic Review and Meta-analysis. <span><span class="ref-journal">J Orthop Sports Phys Ther. </span>2018 May;<span class="ref-vol">48</span>(5):358-371.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29308698" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29308698</span></a>]</div></dd><dt>8.</dt><dd><div class="bk_ref" id="article-19480.r8">Outerbridge RE, Dunlop JA. The problem of chondromalacia patellae. <span><span class="ref-journal">Clin Orthop Relat Res. </span>1975 Jul-Aug;(110):177-96.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/1098819" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1098819</span></a>]</div></dd><dt>9.</dt><dd><div class="bk_ref" id="article-19480.r9">Zhang H, Kong XQ, Cheng C, Liang MH. A correlative study between prevalence of chondromalacia patellae and sports injury in 4068 students. <span><span class="ref-journal">Chin J Traumatol. </span>2003 Dec;<span class="ref-vol">6</span>(6):370-4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/14642059" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14642059</span></a>]</div></dd><dt>10.</dt><dd><div class="bk_ref" id="article-19480.r10">Marega T. [Post-traumatic chondromalacia of the knee-cap]. <span><span class="ref-journal">Fracastoro. </span>1968 Jan-Feb;<span class="ref-vol">61</span>(1):83-9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/5739234" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 5739234</span></a>]</div></dd><dt>11.</dt><dd><div class="bk_ref" id="article-19480.r11">OUTERBRIDGE RE. The etiology of chondromalacia patellae. <span><span class="ref-journal">J Bone Joint Surg Br. </span>1961 Nov;<span class="ref-vol">43-B</span>:752-7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/14038135" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14038135</span></a>]</div></dd><dt>12.</dt><dd><div class="bk_ref" id="article-19480.r12">Bentley G, Dowd G. Current concepts of etiology and treatment of chondromalacia patellae. <span><span class="ref-journal">Clin Orthop Relat Res. </span>1984 Oct;(189):209-28.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/6383677" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6383677</span></a>]</div></dd><dt>13.</dt><dd><div class="bk_ref" id="article-19480.r13">Leslie IJ, Bentley G. Arthroscopy in the diagnosis of chondromalacia patellae. <span><span class="ref-journal">Ann Rheum Dis. </span>1978 Dec;<span class="ref-vol">37</span>(6):540-7.</span> [<a href="/pmc/articles/PMC1000292/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1000292</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/749700" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 749700</span></a>]</div></dd><dt>14.</dt><dd><div class="bk_ref" id="article-19480.r14">Elias DA, White LM. Imaging of patellofemoral disorders. <span><span class="ref-journal">Clin Radiol. </span>2004 Jul;<span class="ref-vol">59</span>(7):543-57.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15208060" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15208060</span></a>]</div></dd><dt>15.</dt><dd><div class="bk_ref" id="article-19480.r15">Pihlajamäki HK, Kuikka PI, Leppänen VV, Kiuru MJ, Mattila VM. Reliability of clinical findings and magnetic resonance imaging for the diagnosis of chondromalacia patellae. <span><span class="ref-journal">J Bone Joint Surg Am. </span>2010 Apr;<span class="ref-vol">92</span>(4):927-34.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/20360517" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20360517</span></a>]</div></dd><dt>16.</dt><dd><div class="bk_ref" id="article-19480.r16">Özgen A, Taşdelen N, Fırat Z. A new MRI grading system for chondromalacia patellae. <span><span class="ref-journal">Acta Radiol. </span>2017 Apr;<span class="ref-vol">58</span>(4):456-463.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27329395" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27329395</span></a>]</div></dd><dt>17.</dt><dd><div class="bk_ref" id="article-19480.r17">Tuna BK, Semiz-Oysu A, Pekar B, Bukte Y, Hayirlioglu A. The association of patellofemoral joint morphology with chondromalacia patella: a quantitative MRI analysis. <span><span class="ref-journal">Clin Imaging. </span>2014 Jul-Aug;<span class="ref-vol">38</span>(4):495-498.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24651059" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24651059</span></a>]</div></dd><dt>18.</dt><dd><div class="bk_ref" id="article-19480.r18">Resorlu H, Zateri C, Nusran G, Goksel F, Aylanc N. The relation between chondromalacia patella and meniscal tear and the sulcus angle/ trochlear depth ratio as a powerful predictor. <span><span class="ref-journal">J Back Musculoskelet Rehabil. </span>2017;<span class="ref-vol">30</span>(3):603-608.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27911285" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27911285</span></a>]</div></dd><dt>19.</dt><dd><div class="bk_ref" id="article-19480.r19">Kok HK, Donnellan J, Ryan D, Torreggiani WC. Correlation between subcutaneous knee fat thickness and chondromalacia patellae on magnetic resonance imaging of the knee. <span><span class="ref-journal">Can Assoc Radiol J. </span>2013 Aug;<span class="ref-vol">64</span>(3):182-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22884229" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22884229</span></a>]</div></dd><dt>20.</dt><dd><div class="bk_ref" id="article-19480.r20">Baysal O, Baysal T, Alkan A, Altay Z, Yologlu S. Comparison of MRI graded cartilage and MRI based volume measurement in knee osteoarthritis. <span><span class="ref-journal">Swiss Med Wkly. </span>2004 May 15;<span class="ref-vol">134</span>(19-20):283-8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15243849" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15243849</span></a>]</div></dd><dt>21.</dt><dd><div class="bk_ref" id="article-19480.r21">Bakhtiary AH, Fatemi E. Open versus closed kinetic chain exercises for patellar chondromalacia. <span><span class="ref-journal">Br J Sports Med. </span>2008 Feb;<span class="ref-vol">42</span>(2):99-102; discussion 102.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17615174" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17615174</span></a>]</div></dd><dt>22.</dt><dd><div class="bk_ref" id="article-19480.r22">Petersen W, Ellermann A, Rembitzki IV, Scheffler S, Herbort M, Brüggemann GP, Best R, Zantop T, Liebau C. Evaluating the potential synergistic benefit of a realignment brace on patients receiving exercise therapy for patellofemoral pain syndrome: a randomized clinical trial. <span><span class="ref-journal">Arch Orthop Trauma Surg. </span>2016 Jul;<span class="ref-vol">136</span>(7):975-82.</span> [<a href="/pmc/articles/PMC4908172/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4908172</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27146819" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27146819</span></a>]</div></dd><dt>23.</dt><dd><div class="bk_ref" id="article-19480.r23">Zheng W, Li H, Hu K, Li L, Bei M. Chondromalacia patellae: current options and emerging cell therapies. <span><span class="ref-journal">Stem Cell Res Ther. </span>2021 Jul 18;<span class="ref-vol">12</span>(1):412.</span> [<a href="/pmc/articles/PMC8287755/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8287755</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34275494" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34275494</span></a>]</div></dd><dt>24.</dt><dd><div class="bk_ref" id="article-19480.r24">Zha GC, Feng S, Chen XY, Guo KJ. Does the grading of chondromalacia patellae influence anterior knee pain following total knee arthroplasty without patellar resurfacing? <span><span class="ref-journal">Int Orthop. </span>2018 Mar;<span class="ref-vol">42</span>(3):513-518.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28986675" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28986675</span></a>]</div></dd><dt>25.</dt><dd><div class="bk_ref" id="article-19480.r25">Dehaven KE, Dolan WA, Mayer PJ. Chondromalacia patellae in athletes. Clinical presentation and conservative management. <span><span class="ref-journal">Am J Sports Med. </span>1979 Jan-Feb;<span class="ref-vol">7</span>(1):5-11.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/420389" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 420389</span></a>]</div></dd><dt>26.</dt><dd><div class="bk_ref" id="article-19480.r26">Tseng TH, Tsai YC, Lin KY, Kuo YK, Wang JH. The correlation of sagittal osteotomy inclination and the anteroposterior translation in medial open-wedge high tibial osteotomy-one of the causes affecting the patellofemoral joint? <span><span class="ref-journal">Int Orthop. </span>2019 Mar;<span class="ref-vol">43</span>(3):605-610.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29700583" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29700583</span></a>]</div></dd><dt>27.</dt><dd><div class="bk_ref" id="article-19480.r27">Cavaignac E, Pailhé R, Reina N, Wargny M, Bellemans J, Chiron P. Total patellectomy in knees without prior arthroplasty: a systematic review. <span><span class="ref-journal">Knee Surg Sports Traumatol Arthrosc. </span>2014 Dec;<span class="ref-vol">22</span>(12):3083-92.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24760164" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24760164</span></a>]</div></dd><dt>28.</dt><dd><div class="bk_ref" id="article-19480.r28">Fujimura K, Sakuraba K, Kamura S, Miyazaki K, Kobara N, Terada K, Miyahara H. Reconstruction of Acute Patellar Tendon Rupture after Patellectomy. <span><span class="ref-journal">Case Rep Orthop. </span>2018;<span class="ref-vol">2018</span>:7549476.</span> [<a href="/pmc/articles/PMC5902117/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5902117</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29808145" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29808145</span></a>]</div></dd><dt>29.</dt><dd><div class="bk_ref" id="article-19480.r29">Hiemstra LA, Frizzell B, Kerslake S. Medial Quadriceps Tendon Femoral Ligament Reconstruction After Patellectomy: A Treatment for a Dislocating Quadriceps Tendon. <span><span class="ref-journal">J Am Acad Orthop Surg Glob Res Rev. </span>2017 Mar;<span class="ref-vol">1</span>(1):e001.</span> [<a href="/pmc/articles/PMC6132308/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6132308</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30211345" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30211345</span></a>]</div></dd><dt>30.</dt><dd><div class="bk_ref" id="article-19480.r30">Harrington KD. Long-term results for the McKeever patellar resurfacing prosthesis used as a salvage procedure for severe chondromalacia patellae. <span><span class="ref-journal">Clin Orthop Relat Res. </span>1992 Jun;(279):201-13.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/1600657" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1600657</span></a>]</div></dd><dt>31.</dt><dd><div class="bk_ref" id="article-19480.r31">Steinert AF, Ghivizzani SC, Rethwilm A, Tuan RS, Evans CH, Nöth U. Major biological obstacles for persistent cell-based regeneration of articular cartilage. <span><span class="ref-journal">Arthritis Res Ther. </span>2007;<span class="ref-vol">9</span>(3):213.</span> [<a href="/pmc/articles/PMC2206353/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2206353</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/17561986" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17561986</span></a>]</div></dd><dt>32.</dt><dd><div class="bk_ref" id="article-19480.r32">Freitag J, Bates D, Boyd R, Shah K, Barnard A, Huguenin L, Tenen A. Mesenchymal stem cell therapy in the treatment of osteoarthritis: reparative pathways, safety and efficacy - a review. <span><span class="ref-journal">BMC Musculoskelet Disord. </span>2016 May 26;<span class="ref-vol">17</span>:230.</span> [<a href="/pmc/articles/PMC4880954/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4880954</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27229856" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27229856</span></a>]</div></dd><dt>33.</dt><dd><div class="bk_ref" id="article-19480.r33">Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. <span><span class="ref-journal">N Engl J Med. </span>1994 Oct 06;<span class="ref-vol">331</span>(14):889-95.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8078550" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8078550</span></a>]</div></dd><dt>34.</dt><dd><div class="bk_ref" id="article-19480.r34">Antholz CR, Cherian JJ, Elmallah RK, Jauregui JJ, Pierce TP, Mont MA. Selective Patellar Resurfacing: A Literature Review. <span><span class="ref-journal">Surg Technol Int. </span>2015 May;<span class="ref-vol">26</span>:355-60.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26055032" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26055032</span></a>]</div></dd><dt>35.</dt><dd><div class="bk_ref" id="article-19480.r35">Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. <span><span class="ref-journal">Clin Orthop Relat Res. </span>2005 Jul;(436):100-10.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15995427" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15995427</span></a>]</div></dd><dt>36.</dt><dd><div class="bk_ref" id="article-19480.r36">Bernstein J, Cain EL, Kneeland JB, Dalinka MK. The incidence of pathology detected by magnetic resonance imaging of the knee: differences based on the specialty of the requesting physician. <span><span class="ref-journal">Orthopedics. </span>2003 May;<span class="ref-vol">26</span>(5):483-5.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12755211" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12755211</span></a>]</div></dd><dt>37.</dt><dd><div class="bk_ref" id="article-19480.r37">Adams AJ, Kazarian GS, Lonner JH. Preoperative Patellofemoral Chondromalacia is Not a Contraindication for Fixed-Bearing Medial Unicompartmental Knee Arthroplasty. <span><span class="ref-journal">J Arthroplasty. </span>2017 Jun;<span class="ref-vol">32</span>(6):1786-1791.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28254376" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28254376</span></a>]</div></dd><dt>38.</dt><dd><div class="bk_ref" id="article-19480.r38">Ye QB, Wu ZH, Wang YP, Lin J, Qiu GX. [Preliminary investigation on the pathogeny, diagnosis and treatment of chondromalacia patella]. <span><span class="ref-journal">Zhongguo Yi Xue Ke Xue Yuan Xue Bao. </span>2001 Apr;<span class="ref-vol">23</span>(2):181-3.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12905899" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12905899</span></a>]</div></dd><dt>39.</dt><dd><div class="bk_ref" id="article-19480.r39">Mouzopoulos G, Borbon C, Siebold R. Patellar chondral defects: a review of a challenging entity. <span><span class="ref-journal">Knee Surg Sports Traumatol Arthrosc. </span>2011 Dec;<span class="ref-vol">19</span>(12):1990-2001.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/21607740" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21607740</span></a>]</div></dd><dt>40.</dt><dd><div class="bk_ref" id="article-19480.r40">Lack S, Barton C, Vicenzino B, Morrissey D. Outcome predictors for conservative patellofemoral pain management: a systematic review and meta-analysis. <span><span class="ref-journal">Sports Med. </span>2014 Dec;<span class="ref-vol">44</span>(12):1703-16.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25100644" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25100644</span></a>]</div></dd></dl></div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_top_margin">
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