chapter 11: Articular Cartilage Lesions in Patellofemoral Pain Patients

Budinger's (2) castigation of "internal derangement" as a diagnostic term has come to be true of "chondromalacia patellae" as well. The term has been used so widely with so little precision of meaning that much of its value has been lost. For the purposes of this book, however, the term "chondromalacia" will be defined very simply as soft cartilage, nothing more and nothing less!

The clinician sometimes finds it difficult to define accurately the origin of pain when dealing with documented anatomic and histologic lesions that do not coincide with the localization of pain on clinical examination. Such is the case with chondromalacia. On clinical examination, arthroscopy, and even at arthrotomy there may be soft cartilage on the patella of a patient with anterior knee pain. The mistake is to assume that the pain is caused by the chondromalacia. The astute clinician will recognize that chondromalacia is often a result of trauma or malalignment that causes multiple problems in the anterior knee—one of which is soft cartilage. Soft cartilage may be more clinically apparent, but in some patients the retinaculum or patellar tendon is more painful!

Nonetheless, abnormal patellofemoral function or injury can lead to progressive articular breakdown and pain from subchondral bone or secondary synovitis, in many cases.


Inside Chapter 11: