Chondromalacia means 'softening of the gristle or joint cartilage' and usually refers to the kneecap (patella). The softening can be felt with a blunt probe during surgery.

Page updated October 2023 by Dr Sheila Strover (Clinical Editor)

Outerbridge Grade 0 cartilage - normal knee cartilage

Normal joint cartilage of patella (seen above the femoral groove) (Grade 0).

Outerbridge Grade I - Chondromalacia or softening of the joint cartilage

Chondromalacia - softening of the patellar joint cartilage, which can be dimpled with a rounded probe (Grade I).

 

Chondromalacia is a description, not a disorder

Chondromalacia is not a disease but simply a descriptive term. It means that the joint cartilage is becoming soft, which usually means that it is under stress, but it is up to the clinician to determine what the stressor is, and to deal with it early. The softening cannot be seen on X-ray, and cannot be determined by examination, so the descriptive term should not be applied unless that surgeon has probed the knee under arthroscopy and determined that the cartilage is indeed softenend. But then it is not right that the patient leaves the investigation under the impression that they have a disease called 'Chondromalacia'. They may have another problem, which, when managed effectively may relieve the stress on the cartilage.

Similarly, a patient should not leave the consultation believing that their diagnosis is 'Anterior Knee Pain' or 'Patellofemoral Pain Syndrome'. It may be possible to identify the reason why the front of the knee feels painful and the cartilage is soft - very often this is a mechanical problem which may be as simple as bad footwear, slight limb torsion, muscle imbalance, etcetera.

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Chondromalacia is a description, not a disorder

When a surgeon identifies softened joint cartilage during arthroscopy, he will generally use a grading system for his notes.

 

Grading cartilage damage (Outerbridge classification)

GRADE DESCRIPTION DIAGRAM
0 cartilage is normal and intact  
1 cartilage has some softening and blistering grade 1 cartilage softening
2 partial thickness (less than 50%) defect or minor tears in the surface of the cartilage grade 2 cartilage damage
3 deeper defect (more than 50%) grade 3 cartilage damage
4 full thickness cartilage loss with exposure of the subchondral bone grade 4 cartilage damage

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Will chondromalacia go away?

Early chondromalacia is a sign that the joint is under stress. If the stress is relieved before the cartilage breaks down, then all should be well after a time. But once the cartilage has started to become destroyed, then the destruction tends to be progressive.

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Forum discussions

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Peer-reviewed papers

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Synonyms: 
chondrosis
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Dr Sheila Strover (Editor)
BSc (Hons), MB BCh, MBA

See biography...

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