Why does patellar cartilage suffer?
The kneecap acts as a pulley to increase the strength of the quadriceps muscle. When bent, it should slide smoothly along the groove of the femur. If the outer part of the quadriceps muscle is stronger than the inner one, if the gluteal muscles are weak and the thigh falls inward when loaded, if the foot is flattened, the patella moves outward and is pressed against one edge of the groove. The pressure in this area increases many times, the cartilage loses its smoothness, softens, and cracks. The load when going down stairs and squats is especially high, hence the typical complaints.
- Violation of the patella sliding trajectory
- Thigh muscle imbalance
- Weakness of the gluteal muscles
- Flat feet and knee valgus
- Features of the shape of the groove of the femur
- Consequences of injury and dislocation of the patella
Causes and risk factors
Most often, the problem occurs when the load increases sharply: a person starts running, adds squats, switches to training on stairs, or changes the surface. In adolescents, during a period of rapid growth, the muscles cannot keep up with the bones, and the patella loses stability. Weakness and shortening of the thigh muscles, uncomfortable or worn-out shoes, running on an inclined surface, and squatting play a role. Less commonly, the cause is a previous dislocation of the patella, the anatomical features of the knee structure and the consequences of cartilage injury.
- Dramatic increase in training volume
- Weakness of the quadriceps and gluteal muscles
- Shortening of the posterior thigh muscles
- Adolescence is a period of rapid growth
- Flat feet, worn shoes
- Squatting and kneeling work
- Suffered dislocation of the patella
- Overweight
Symptoms
The pain is dull, aching, felt around the kneecap or under it, and it is difficult for a person to show one point - he covers the knee with his palm. It typically gets worse when going down stairs, squats, running downhill, and also after sitting for a long time in a movie theater or car, when you want to straighten your leg. There is often a crunching, clicking and friction sensation when bending. There is usually little or no swelling. As a rule, there is no blocking of the joint and a feeling of instability - their presence indicates another problem.
- Pain around and under the kneecap
- Strengthening when going down stairs and squats
- Pain after sitting for a long time with a bent knee
- Crunching and clicking noises when moving
- Slight swelling
- Weakness and rapid fatigue of the hip
Diagnostics
The diagnosis is mainly clinical. The doctor evaluates the gait, the axis of the legs, the condition of the feet, the strength and flexibility of the muscles, checks the mobility of the patella and the soreness of its edges, and observes the performance of a squat on one leg. An X-ray of the knee, including a special projection for the patella, helps to exclude arthrosis and assess the position of the cup. An ultrasound shows the condition of the tendons and the presence of fluid. MRI is indicated for persistent pain, suspected cartilage or meniscus damage, and before the decision to proceed with surgery.
- Examination, assessment of gait and leg axis
- Functional tests and single leg squat
- X-ray of the knee, including projection of the patella
- Ultrasound of the knee joint
- MRI for persistent pain
- Foot assessment and shoe selection
Treatment
The main method is an exercise program that strengthens the quadriceps muscle, especially its inner part, and the gluteal muscles, which are responsible for the correct position of the hip. Additionally, the back of the thigh and lower leg are stretched. The load is not removed completely, but replaced with a painless one: a bicycle with a high saddle, swimming, walking on a flat surface. Taping, orthopedic insoles for flat feet, and proper shoes help. Painkillers are used briefly. Surgery is rarely required for severe cartilage damage or patellar instability.
- Exercises for the quadriceps and gluteal muscles
- Hamstring and calf stretch
- Temporarily replacing running with cycling and swimming
- Patella taping
- Orthopedic insoles for flat feet
- Selection of shoes and correction of running technique
- Short courses of painkillers
- Surgical treatment in rare cases