Chondromalacia (Runner's Knee) | PreferredMD
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Chondromalacia (Runner's Knee)

Condition • By Biraj Patel

Chondromalacia patella, commonly known as “runner's knee,” is a condition that many active individuals have encountered at some point in their lives. But what exactly is this ailment that strikes fear into the hearts of runners and athletes alike?

What is runner's knee (chondromalacia)?

Chondromalacia is a term derived from the Greek words “chondro” (meaning cartilage) and “malacia” (meaning softening). 

In essence, it refers to the softening and deterioration of the cartilage beneath the kneecap, or patella. This condition, often dubbed “runner's knee,” is no stranger to those who love pounding the pavement or hitting the trails.

Chondromalacia causes

The most common cause of chondromalacia patella is a misalignment of the patella as it glides across the lower end of the thigh bone, the femur. This misalignment can lead to increased pressure and friction on the cartilage, eventually resulting in its softening and breakdown. 

Some factors that increase the risk of developing chondromalacia patella include:

  • Overuse in sports, such as running or skiing, which can cause repetitive stress on the joint.
  • Traumatic injury, such as patella injury, knee surgery, injury of the tendons or ligaments around the knee joint, or a bone fracture.
  • Being overweight, as people with a higher body mass index (BMI) are more likely to develop chondromalacia patella.
  • Certain activities, such as high-impact sports or manual work that involves repetitive strain on the knee joint.
  • Females are more likely to develop chondromalacia than males, possibly due to a larger Q angle, which measures the angle between the quadriceps muscles and the patella tendon.

Chondromalacia patella symptoms

Recognizing the symptoms of chondromalacia patella is essential for early diagnosis and effective treatment. Patients often complain of:

  • Aching or sharp pain around or behind the kneecap, especially during activities that involve bending the knee.
  • A creaking or grinding sensation when moving the knee.
  • The knee may become swollen and tender.
  • Some individuals experience a feeling of instability or giving way in the knee.

How to prevent runner's knee

Preventing chondromalacia patella starts with acknowledging the risk factors and making lifestyle adjustments. To prevent the onset or recurrence of runner's knee, consider the following:

  • Always warm up before exercise to prepare your muscles and joints.
  • Focus on strengthening the quadriceps, hamstrings, and calf muscles.
  • Extra weight can strain the knees, so maintaining a healthy weight is crucial.
  • Invest in appropriate footwear with adequate cushioning and support.
  • Ensure proper running or exercise techniques to minimize knee strain.

Grades of chondromalacia patella

Chondromalacia patella is characterized by varying degrees of severity and can affect individuals differently. However, it's often described in a more generalized manner.

Grade 1 chondromalacia

In this early stage, there is usually softening of the cartilage beneath the kneecap (patella). Patients may experience occasional discomfort or mild pain, particularly after physical activity.
Symptoms may be sporadic and relatively easy to manage with conservative measures like rest and physical therapy.

Grade 2 chondromalacia

At this stage, the cartilage may show signs of more significant wear and softening. Patients often experience more frequent and consistent pain, especially during activities that involve bending the knee, such as running, climbing stairs, or squatting. Physical therapy, lifestyle modifications, and medication are commonly used to manage symptoms.

Grade 3 chondromalacia

This stage is characterized by moderate to severe cartilage damage. Patients may experience intense and constant pain, even during routine activities or at rest. Non-surgical treatments like physical therapy and medication may still be attempted, but surgery may be considered in some cases.

Grade 4 chondromalacia

In the advanced stage, the cartilage may be significantly eroded or even absent in some areas beneath the patella. Patients typically suffer from severe, chronic pain and may have limited mobility. Surgical interventions, such as arthroscopy, lateral release, or microfracture, are often required to address the extensive damage and realign the patella.

Not everyone with chondromalacia will experience all these stages, and the progression can vary from person to person. Additionally, prompt diagnosis and early intervention can help prevent the condition from advancing to more severe stages. 

If you suspect you have chondromalacia patella or are experiencing knee pain, it's essential to consult an orthopedic specialist who can assess your condition and recommend appropriate treatment options based on its severity.

Chondromalacia patella treatments

When it comes to treating chondromalacia patella, the approach depends on the severity of the condition. For mild to moderate cases, non-surgical options are often recommended.

Runner's knee exercises

Exercises and stretches can help strengthen the surrounding muscles and improve patellar alignment. Here are some effective exercises for runner's knee.

Quad sets

  • Sit on the floor with your legs extended.
  • Tighten the muscles on the top of your thigh (quadriceps) by pushing the back of your knee into the floor.
  • Hold for a few seconds and then relax.
  • Perform 2–3 sets of 10–15 repetitions for each leg.

Straight leg raises

  • Lie on your back with one leg extended and the other bent at a 90-degree angle.
  • Lift the extended leg to the level of your bent knee and hold for a few seconds.
  • Slowly lower your leg back down.
  • Perform 2–3 sets of 10–15 repetitions for each leg.

Hamstring curls

  • Use an exercise band or a cable machine.
  • Attach the band or cable to your ankle and lie on your stomach.
  • Bend your knee and bring your heel toward your buttocks.
  • Slowly return to the starting position.
  • Perform 2–3 sets of 10–15 repetitions for each leg.


  • Lie on your side with your legs bent at a 90-degree angle.
  • Keep your feet together and lift the top knee as high as you can without moving your pelvis.
  • Lower your knee back down.
  • Perform 2–3 sets of 10–15 repetitions for each leg.

Mini squats

  • Stand with your feet hip-width apart.
  • Slowly bend your knees, as if you're about to sit in a chair, while keeping your weight on your heels.
  • Make sure your knees do not go past your toes.
  • Return to the starting position.
  • Perform 2–3 sets of 10–15 repetitions.


  • Use a step or a sturdy platform.
  • Step up with one foot, then bring the other foot up.
  • Step back down in reverse order.
  • Perform 2–3 sets of 10–15 repetitions for each leg.

Wall sits

  • Stand with your back against a wall and your feet about hip-width apart.
  • Slide down the wall, so your knees are bent at a 90-degree angle.
  • Hold this position for as long as you can, gradually increasing the duration.

Leg press

  • Use a leg press machine at the gym or a resistance band.
  • Push your legs against the resistance, extending your knees.
  • Slowly return to the starting position.
  • Perform 2–3 sets of 10–15 repetitions.

Remember to start with exercises that are appropriate for your fitness level and gradually increase the intensity and repetitions as your strength improves. If you experience pain or discomfort while doing these exercises, stop immediately and consult with an orthopedic specialist. They can provide personalized guidance and adapt the exercises to your specific needs.

Chondromalacia patella medication

NSAIDs like ibuprofen (Advil, Motrin) or naproxen (Aleve) can help reduce pain and inflammation associated with chondromalacia patella. These are available over the counter or as prescription-strength medications.

Acetaminophen (Tylenol) is another over-the-counter pain reliever that can be used for mild to moderate pain. Unlike NSAIDs, acetaminophen doesn't have anti-inflammatory properties.

In cases of severe pain and inflammation, a healthcare provider may prescribe stronger medications, including prescription-strength NSAIDs or other pain management drugs.

Topical creams or gels containing analgesic agents can be applied directly to the affected area for localized pain relief. These may contain ingredients like lidocaine or diclofenac.

Runner's knee brace

A runner's knee brace, also known as a patellar brace or knee strap, is a supportive device designed to help alleviate pain and provide stability for individuals experiencing chondromalacia patella. These braces are often used as part of a comprehensive treatment plan to manage the condition. 

RICE protocol

Rest, ice, compression, and elevation can help manage acute symptoms.

Chondromalacia patella surgery

In severe cases or when conservative treatments fail, surgery may be necessary. Surgical options include:

  • Arthroscopy: A minimally invasive procedure to remove damaged cartilage and realign the patella.
  • Lateral release: A surgical procedure that helps correct patellar alignment.
  • Microfracture: Stimulates the growth of new cartilage.

Discuss chondromalacia patella treatments with the best orthopedic surgeons on PreferredMD

Сhondromalacia patella can be a daunting condition. Recognizing the causes, symptoms, risk factors, and prevention techniques is crucial for those who love to stay active. Remember, early intervention and consultation with an orthopedic expert can pave the way to a healthier, pain-free future. Don't let chondromalacia keep you from the activities you love; take the first step towards recovery today.

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