[Chondropathia patellae].

Abstract

Chondropathia patellae on a constitutional basis, in the narrow sense of the term, is predominantly responsible for producing the painful or irritated knee in juveniles and adolescents, with an incidence peak around the 20th year of life. The traumatic form associated with signs will often produce the same disorders of the patellar gliding path and of the gliding areas, such as the hyperpression and lateralisation syndrome, as well as habitual luxation. Clinically, degenerative articular damage may temporarily exacerbate into a kind of synovitis "chondsrodetritica", especially on overstraining and after microtraumas. On reviewing the case history, the retropatellar pain after prolonged seating and on walking downhill, is particularly characteristic; this pain can also radiate in medial direction. It is also often reported that the knee tends to "give way" suddenly, and to "interlock" or "become entangled". The leading clinical symptom is, besides a feeling of roughness, the "characteristic" pain caused by the gliding pressure of the patella. Conservative treatment, consisting of physiotherapy, isometric exercises of the quadriceps femoris muscle preceded or if permissible followed by heat and massage treatment, and therapy directed at protecting the cartilage - while avoiding cortisone preparations - should be discontinued if the success of treatment does not last significantly longer than the application. Satisfactory results can be obtained with the three basic operations such as proximolateral relief operation (longitudinal splitting of the retinacula), distal relief surgery (lifting of the tuberositas) and smoothening or more vertical excision of the focus of cartilaginification, in conjunction with further surgical interventions.