Initial Treatment for Chondromalacia Patellae

Understanding Chondromalacia Patellae

Activity-related anterior knee pain that worsens with stairs and prolonged sitting is a characteristic of chondromalacia patellae, according to the American Academy of Family Physicians 2
Pain is often exacerbated by activities that increase patellofemoral joint loading, as reported by the British Journal of Sports Medicine 1

The British Journal of Sports Medicine recommends knee-targeted exercise therapy, which has demonstrated high certainty evidence for short-term pain reduction (SMD 1.16, 95% CI 0.66, 1.66) and moderate certainty evidence for short-term function improvement (SMD 1.19, 95% CI 0.51, 1.88) 1
Progressive quadriceps strengthening in both open and closed chain exercises is recommended by the British Journal of Sports Medicine 1
Hip-and-knee-targeted exercise therapy may be considered, with modification of task/load/intensity/frequency based on pain response, as suggested by the British Journal of Sports Medicine 3

Patellar taping is recommended for short-term relief of pain and improved function (Grade B recommendation) by the American Academy of Orthopaedic Surgeons 4
Prefabricated foot orthoses may be considered for patients who respond favorably to treatment direction tests, according to the British Journal of Sports Medicine 3
Patellofemoral braces may help resist lateral displacement of the patella and provide subjective improvements in pain and disability, as reported by the American Academy of Family Physicians 6

Education should include explanation of the diagnosis and expected recovery timeline, guidance on managing activity and load modification, reassurance that pain does not necessarily correlate with damage, and building confidence and reducing fear of movement, as recommended by the British Journal of Sports Medicine 3

Avoid lateral heel wedges as they have limited evidence for effectiveness and may worsen symptoms, according to the American Academy of Orthopaedic Surgeons 4
Range-of-motion and flexibility exercises are an option to address impairments (Level V evidence, Grade C recommendation) by the American Academy of Orthopaedic Surgeons 4

Patients should be informed that recovery may take several months, as reported by the Diabetes/Metabolism Research and Reviews 8