What is the cause of knee cap pain and how is the treatment?
There are many causes of knee joint pain. Meniscus tear, ligament injuries and cartilage problems are among them. "Chondromalacia patella" is the most common cause of pain around the knee joint.
The knee has 2 joints. One is the main weight bearing tibia-femoral joint, the other is the patello-femoral joint which doesn't carry weight during standing but works as a pulley while knee bending or climbing stairs. The load on the patello-femoral joint reaches to 3-4 times of the body weight with knee bending. Depending on the amount of load and repetition of the activity, cartilage of patella may soften and progressively degenerate. This condition is named as "chondromalacia patella". Chondro means cartilage in Latin and malacia means softening.
Chondromalacia patella may be seen in every age but it is most common in age 30-50 where the daily activity is higher. In some cases there may be some predisposing structural and angular malformations. Those abnormalities causes increased rubbing of the patella thus resulting in early patellar cartilage softening and erosion. The daily activities that cause high amount of knee flexion, like sitting in a narrow place for long time, over usage of the stairs or sport activities like squatting are the predisposing factors for patella cartilage degeneration.
In patellar cartilage degeneration the pain is not local and usually radiates to all the knee joint and even to the anterior calf region. It is a dull, regional pain and the patient usually has difficulty in defining the complaint. The pain increases with knee bending activities whereas there is no serious complaint during straight walking. The intensity of the pain typically increases in cold weather.
The first line treatment mainly depends on limitation of the pain aggrevating motions, mainly knee bending. Strengthening of the muscles around the knee joint is important since they are the main dynamic force that pulls the patella and decrease the contact surface. Intra-articular hyaluronic injection, PRP and stem cell treatments may be beneficial. In resistant cases, if an anatomical pathology is defined, surgical reconstruction operations solve the problem permanently.