31 Jul Runner’s Knee

There are several conditions that are commonly called “runner’s knee,” which is quickly assumed to be an overuse injury suffered by marathon runners or other track and field athletes. However, there are several conditions that cause knee pain and not all of them are triggered by overuse. Some are the result of having flat feet, arthritis or simply going through a growth spurt. Especially prone to runner’s knee are athletic teenagers, who overuse their knees while going through a growth spurt.

One of the conditions called runner’s knee is chondromalacia patellae, which is a deterioration of the cartilage that resides on the underside of the patella, commonly called the kneecap. Not only are runners prone to this condition, but skiers, soccer players, and other athletes are also afflicted.

Overuse is certainly a contributing factor. However, arthritis can also cause chondromalacia patellae. It can also be caused by congenital defects that create a misalignment of the kneecap. A traumatic, one-time injury resulting in a dislocation or partial dislocation can cause a misalignment, which then causes the cartilage to wear down. Other contributing factors are:

• Weak hamstrings and quadriceps (muscles of the thigh)
• Imbalance of adductor and abductor muscles which force the kneecap to one side when flexing (these muscles run on the inside and outside of the thighs)
• Lack of stretching prior to exercise
• Gender and age. Women are more prone to this condition than men due to smaller muscles. Rapidly growing teenagers and older persons are also susceptible
• Flat feet

Symptoms and Diagnosing

In ideal conditions, the backside of the patella slides over the cartilage of the femur (the thigh bone). This is held together by a series of bands that hold muscles to bone (tendons) or hold bones to other bones (ligaments). When the tendons or ligaments are not working properly, the patella and femur can rub together, wearing down the cartilage and eventually wearing down the bones, as well.

The primary symptom is a pain in the knee that is caused by movement. Diagnosis is done through a physical examination, often followed by either X-ray, T-scan or MRI imaging to confirm the diagnosis.

A diagnosis of chondromalacia patellae is done with a grading system that tells you how advanced the condition might be. The condition has four grades with Grade 1 indicating the condition has begun with Grade 4 defining a condition that is most severe. Grade 4 is characterized by significant cartilage deterioration and bone-to-bone rubbing.

Treatment

There are several possible responses to runner’s knee that begin with rest, icing the area and mild pain relief medication, including nonsteroidal anti-inflammatory drugs, such as ibuprofen and other over the counter medications. In addition, physical therapy may be used to teach proper stretching and to strengthen muscles that pull the patella back to the proper position.

If the primary treatment options don’t work, it is possible that arthroscopic surgery could be the best option. The first task of this surgery is to examine the kneecap closely, which can often be done with a camera inserted into the joint through a small incision. Depending on what is discovered during the exploratory phase, doctors could recommend a lateral release, which involves cutting ligaments that allow the patella to come back into alignment or simply allows the patella to move more freely. Other surgical interventions your doctor might recommend are a cartilage graft or physically smoothing the back of the kneecap to allow for smoother movement.