Chondromalacia - an explanation

M.J. is 28 years old. She is involved in a car accident. Her right knee hits a sharp object and she sustains a deep, localized injury to her articular cartilage. "You've sustained chondromalacia to your femoral condyle" says the orthopedist, "and you need surgery".

The surgery is scheduled, but the insurance company suddenly denies coverage to M.J. Why? The insurance company discovers that as a teenager another doctor had already diagnosed M.J. with chondromalacia. Thus her condition is 'pre-existing'. Ridiculous? Of course. The two doctors have used the word chondromalacia to mean two different conditions. Had both her doctors used better, more specific terms M.J. would not have to fight her insurance company.

'Chondromalacia' is at this point in time a nonsense term first coined in Germany in 1906.

Investigators in the early 20th century examined the kneecaps of cadavers and noted that the cartilage was soft. In some cases, the cartilage appeared frayed and/or ulcerated. They made the assumption that these findings in cadavers could explain knee pain in the living.

They used the term Chondromalacia, which in English translates to 'soft cartilage'.

In the 21st century there are a few problems with the use of this term -

• We now know that the articular (or joint surface) cartilage under the kneecap is the thickest and softest in the human body. Thus, chondral malacia is normal!
• There is no correlation between the presence or absence of cartilage changes under the kneecap and the existence of pain (unless there is severe wear of the cartilage). So if the doctor is using the term 'chondromalacia' to say that you have some cartilage changes under your kneecap, he or she hasn't really explained your pain.
• Some doctors use the term chondromalacia synonymously with 'pain at the front of the knee' ('anterior knee pain syndrome'), regardless of the specific cause of the pain. Same goes for 'patellofemoral syndrome'. Thus a patient with a plica, a patient with malalignment (kneecap not tracking properly), and a patient with pain referred down from the hip may all be told that they suffer from chondromalacia! It's like going to the Neurologist because you have pain at the front of your skull and being told you suffer from 'Headache Syndrome'!!!