Chondromalacia Patellae — When the Front of the Knee Hurts
Table of Contents
What is chondromalacia
Chondromalacia patellae is a condition in which the joint cartilage on the back of the patella becomes soft (softened) and roughened, causing pain at the patellofemoral joint. It is common in women in their 20s to 40s and is felt as a dull ache at the front of the knee. When going down stairs or walking down a slope, the patellofemoral pressure rises to as much as 3.5 times body weight, making the pain particularly severe.
Theater sign
After sitting with the knee bent for a long time and then standing up, pain at the back of the patella is greatest. This is called the theater sign, characterized by a stiff, painful knee when leaving a movie theater. The pain occurs because in the flexed position the patella is pressed firmly against the trochlear groove of the femur, concentrating force on the damaged cartilage surface.
Causes — patellar alignment and muscle imbalance
When the patella moves while drifting laterally (lateral tracking), friction concentrates on a specific part of the cartilage. Underlying factors include weakness of the vastus medialis oblique (VMO), tightness of the lateral retinaculum, and an increased Q-angle (wide pelvis, knock knees). In Korean medicine, this is interpreted as qi-and-blood stagnation and reduced cartilage nutrition due to kidney deficiency.
Korean medicine treatment
- Acupuncture: Needling Hakjeong (Heding), Xiyan, and Xuehai improves blood flow around the patella and reduces pain.
- Pharmacopuncture: Placenta pharmacopuncture is injected into the patellar tendon insertion and the medial joint surface to promote nutrient supply to the cartilage.
- Chuna manipulation: Patella mobilization corrects lateral drift and induces normal patellar tracking.
- Herbal medicine: A modified Dokhwalgisaeng-tang strengthens the muscles and ligaments around the joint and slows cartilage degeneration.
VMO strengthening exercises
The vastus medialis is most active in the final 30 degrees of knee extension. Doing mini squats (within 30 degrees of flexion) against a wall, or performing straight leg raises with the toes slightly externally rotated and the leg extended, selectively strengthens the VMO. Squatting and deep squats raise patellofemoral pressure and must always be avoided.