32year old movie star flew in from L.A for evaluation of her knees. Patient states since age 18 her knees have been troubling her. The pain is mostly at the level of the knee cap. The pain is worse when she goes downstairs or works out.The knees feel weak at times.She does not recall any injuries.She has tried Physical therapy as well as chiropractice with no improvement. She is otherwise healthy does not smoke and does not drink.There is no family history of arthritis. She is too young for a total knee replacement.
Discussion: On evaluation the patella was positioned anatomically correct, Substantial crepitus on both knees, and edema mostly concentrated around Patellar femoral joint (more on the right knee). Chondromalacia patella as well as osteoarthritis are cartilage damages typically producing anterior knee pain. Another name for it is patellofemoral pain syndrome. This entity is more common in young adult females, the theory is overuse, trauma, and/or excessive stresses on the knee could be cause of it. Having Chondromalacia patella may be a risk factor for arthritis of the kneecap in older individuals. Symptoms could range from Knee tenderness especially going up and down the stairs to a grinding sensation when the knee gets extended. X-Rays are typically normal especially in early stages. Glucosamine may play a role. Avoidance of trauma or excessive stress on the knee may help.