Q: I am 31 years old woman having pain in the right knee mostly while bending or sitting cross-legged or in a squatting position. I get a creaking sound while walking. My height is 5.1 feet and weight is 67 kg (increased due to pregnancy) and I was doing rigorous exercise like jogging for 30 minutes, cycling for 15 minutes, etc. for the last 5 months. I consulted an orthopaedician and he diagnosed it as chondromalacia patellae and suggested resting for 2 months. I want to know does this mean complete bed rest (which will increase my weight) or can I do regular walking or jogging? Will this affect the knee problem more? What is chondromalacia patella? How will this be cured?

A:Chondromalacia Patellae is a condition in which there is degeneration of the cartilage lining the under surface of the patella. This is a common condition though the name seems fancy. Unlike the age related changes that happen in the cartilage of knee joint Chondromalacia Patellae occurs in the younger patients and the cartilage damage some how seems to surface from the deeper layers of the cartilage (unlike degeneration of old age which moves from the surface layer to the deeper layer). The patient may have associated underlying conditions that contribute to early degeneration like; knock knees or some mal-alignment of the muscle that moves the patella (quadriceps). There are several factors other than these that have been attributed to the onset of chondromalacia but it is not yet clear what is the exact cause. The severity of chondromalacia patellae may vary from the mildest when the cartilage looks normal to the severe case where the cartilage appear flaked exposing the underlying bone. Treatment of the condition depends on any underlying condition that is contributing to it and symptomatic relief measures like; medicines for pain, exercises to build up the quadriceps and modifications in lifestyle to avoid squatting and sitting cross legged. If there is a specific underlying problem like mal-alignment of bones or muscle function then surgery may be indicated for that. Surgery is indicated for the damage cartilage if all other measures have failed. And this includes examining the cartilage through an arthroscope (an instrument to look in to the knee joint) and then mechanically shaving the damaged cartilage or drilling to facilitate healing. Rarely, there is a surgery that is done to reduce the pressure on the knee cap. Having described all this, most people only need simple exercises and pain killers. If you take a survey of procedures done, at best a diagnostic arthroscopy or shaving may have been done by an occasional orthopaedic surgeon. So, my recommendation is do the static quadriceps taught to you by the orthopaedic surgeon or therapists, avoid squatting or sitting cross legged, avoid jogging? It is better to walk than to jog and double check with your surgeon that there is no mal-alignment problem in the knee.