CHONDROMALACIA PATELLAE: ETIOLOGY, DIAGNOSIS, AND TREATMENT – A NARRATIVE REVIEW

Jan Romaniuk; Michał Romaniuk; Julia Groszewska; Daria Julia Woszczyk; Agata Rapior; Kinga Lubomska; Patrycja Jagura; Agata Mytych; Marta Dziedziak; Łukasz Nosek

doi:10.31435/ijitss.1(49).2026.4670

Authors

Jan Romaniuk Medical University of Lublin, Poland https://orcid.org/0009-0000-3017-3330
Michał Romaniuk Medical University of Lodz, Poland https://orcid.org/0009-0008-6002-000X
Julia Groszewska Medical University of Lodz, Poland https://orcid.org/0009-0002-4637-1264
Daria Julia Woszczyk Medical University of Lodz, Poland https://orcid.org/0009-0004-9897-0618
Agata Rapior Medical University of Lodz, Poland https://orcid.org/0009-0002-0300-2303
Kinga Lubomska Medical University of Lodz, Poland https://orcid.org/0009-0002-8777-5273
Patrycja Jagura Medical University of Lodz, Poland https://orcid.org/0009-0008-2394-3673
Agata Mytych Wroclaw Medical University, Poland https://orcid.org/0009-0004-4575-6327
Marta Dziedziak Wroclaw Medical University, Poland https://orcid.org/0009-0004-3463-2804
Łukasz Nosek Wroclaw Medical University, Poland https://orcid.org/0009-0006-8294-5842

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.4670

Keywords:

Chondromalacia Patellae, Patellofemoral Joint, Anterior Knee Pain, Magnetic Resonance Imaging, Conservative Treatment, Surgical Treatment

Abstract

Chondromalacia patellae (CMP) is a degenerative disorder of the hyaline cartilage of the patella, forming part of the patellofemoral joint. Due to its key role in joint biomechanics, CMP commonly manifests as anterior knee pain and functional limitation, which can significantly impair patients’ quality of life. Early and accurate diagnosis, along with appropriate treatment, is crucial due to the very limited regenerative capacity of articular cartilage. This narrative review analyses current evidence regarding the etiology, diagnostic approaches, and treatment options for CMP, including conservative management, regenerative therapies (autologous chondrocyte implantation and mesenchymal stem cell therapy), and surgical interventions. A comprehensive literature search of the PubMed database (2010–2025) was performed, prioritising meta-analyses, systematic reviews, and randomised controlled trials relevant to the topic. CMP represents a complex degenerative condition requiring an integrated clinical and imaging-based approach. Magnetic resonance imaging is highlighted as the primary non-invasive diagnostic modality, while evidence supporting regenerative therapies remains promising but limited. Early recognition and tailored management strategies are essential to prevent disease progression and improve long-term functional outcomes.

References

Fox, A. J., Bedi, A., & Rodeo, S. A. (2009). The basic science of articular cartilage: Structure, composition, and function. Sports Health, 1(6), 461–468.

Outerbridge, R. E., & Dunlop, J. A. (1975). The problem of chondromalacia patellae: A long-term follow-up study. Clinical Orthopaedics and Related Research, (110), 177–196. https://doi.org/10.1097/00003086-197507000-00024

Fulkerson, J. P. (2002). Diagnosis and treatment of patients with patellofemoral pain: Clinical and biomechanical considerations. The American Journal of Sports Medicine, 30(3), 447–456.

Rombaut, L., Malfait, F., Cools, A., De Paepe, A., & Calders, P. (2010). Musculoskeletal complaints, physical activity, and health-related quality of life among patients with the Ehlers–Danlos syndrome hypermobility type. Disability and Rehabilitation, 32(16), 1339–1345.

Davis, I. S., & Powers, C. M. (2015). Patellofemoral pain syndrome: Proximal, distal, and local factors—An international retreat summary. Journal of Orthopaedic & Sports Physical Therapy, 45(9), A1–A16. https://doi.org/10.2519/jospt.2015.0306

Zheng, X., Zhao, F., Zhang, Y., et al. (2021). Mesenchymal stem cells in the treatment of cartilage regeneration: Advances, mechanisms, and future perspectives. Stem Cell Research & Therapy, 12, 412.

Habusta, S. F., Coffey, R., Ponnarasu, S., Mabrouk, A., & Griffin, E. E. (2023). Chondromalacia patella. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459195/

Chamorro-Moriana, G., Espuny-Ruiz, F., Ridao-Fernández, C., & Magni, E. (2024). Clinical value of questionnaires and physical tests for patellofemoral pain: Validity, reliability, and predictive capacity. PLoS ONE, 19(4), e0302215. https://doi.org/10.1371/journal.pone.0302215

Szkudlarek, M., & Court-Payen, M. (2023). The ultrasound assessment of osteoarthritis: Current status and future perspectives. Journal of Ultrasonography, 23(95), e179–e189.

Zhang, H., Ning, Z., Lu, Z., Zhou, S., Shao, Y., Yang, P., & Hao, L. (2024). Research progress of ultrasound in accurate evaluation of cartilage injury in osteoarthritis. Frontiers in Endocrinology, 15, 1420049.

Xará-Leite, D., Andrade, R., Hinckel, B. B., Leite, A., & Espregueira-Mendes, J. (2023). Magnetic resonance imaging for patellofemoral cartilage injuries: A systematic review of current evidence. Knee Surgery, Sports Traumatology, Arthroscopy, 31(1), 30–47.

Outerbridge, R. E. (1961). The etiology of chondromalacia patellae. The Journal of Bone and Joint Surgery. British Volume, 43-B(4), 752–757.

Kornaat, P. R., Ceulemans, R. Y., Kroon, H. M., et al. (2017). MRI assessment of patellofemoral cartilage damage: Current concepts and clinical relevance. European Radiology, 27(9), 3849–3862. https://doi.org/10.1007/s00330-017-4764-9

Barton, C. J., Lack, S., Hemmings, S., Tufail, S., & Morrissey, D. (2022). The best practice guide to conservative management of patellofemoral pain: Incorporating level 1 evidence with expert clinical reasoning. British Journal of Sports Medicine, 56(4), 203–210.

van der Heijden, R. A., Lankhorst, N. E., van Linschoten, R., Bierma-Zeinstra, S. M. A., & van Middelkoop, M. (2015). Exercise therapy for patellofemoral pain: A systematic review and meta-analysis. British Journal of Sports Medicine, 49(14), 921–929. https://doi.org/10.1136/bjsports-2014-093637

Filardo, G., Perdisa, F., Roffi, A., et al. (2016). Stem cells in articular cartilage regeneration: Current status and future perspectives. International Orthopaedics, 40(5), 1011–1022. https://doi.org/10.1007/s00264-015-3046-5

Welch, T., Mandelbaum, B., & Tom, M. (2016). Autologous chondrocyte implantation: Past developments, current techniques, and future directions. Sports Medicine and Arthroscopy Review, 24(2), 85–91. https://doi.org/10.1097/JSA.0000000000000115

The Ohio State University Wexner Medical Center. (2023). Autologous chondrocyte implantation (ACI) rehabilitation protocol. https://medicine.osu.edu/-/media/files/medicine/departments/sports-medicine/medical-professionals/knee-ankle-and-foot/autologous-chondrocyte-implantation_2023.pdf

Barry, F., & Murphy, M. (2013). Mesenchymal stem cells in joint disease and repair. Nature Reviews Rheumatology, 9(10), 584–594.

Fulkerson, J. P. (2004). Disorders of the patellofemoral joint (4th ed.). Lippincott Williams & Wilkins.