Outcome of combined treatment of chondromalacia of the knee using arthroscopic debridement and rehabilitation

„Outcome of combined treatment of chondromalacia of the knee using arthroscopic debridement and rehabilitation, on the basis of original material”

Wziętek B.1, Frańczuk B.2, Mańko G.3

1 Trauma and Orthopeadic Ward, County Hospital in Chrzanów
2 Clinic of Orthopeadics and Rehabilitation Collegium Medicum UJ in Kraków,
3 Rehabilitation Ward, County Hospital in Chrzanów


Chondromalacia without treatment leads to osteoarthritis. Adequate and early treatment can stop this process. The work presents the theoretical basis and outcome of the treatment of chondromalacia in the knee, using a combined method of arthroscopy and rehabilitation


The arthroscopic work on the knee involved levelling the damaged cartilage surface using manual tools, shaver and vaporizer, drilling or microfractures of the subchondral layer of the bone, shaving of hypertrophied synovium, and lateral release of the patella if needed. An authorial rehabilitation program was applied. In the beginning it consisted of: isometric exercises of quadriceps muscle, continuous passive motion, and cold compress on the knee. Later active exercises, walking without weightbearing, and autostretching in flexion contracture were applied. The ambulatory rehabilitation relied on further kinesitherapy and physiotherapy.


The outcome was evaluated average 19 months (from 4 to 30 months) after surgery using the questionnaire based on Lysholm-Gilquist Scale. The mean improvement was 34 points in Lysholm-Gilquist Scale (average from 49 before to 83,0 after). The results in different groups according to: age, grade of chondromalacia, location of chondromalacia and according to the method of treatment are given below.

The improvement in groups after lateral release of patella was lower than average 26. The group treated with microfractures (31) had better results than the group treated with drilling (22). Patients treated with shaving (32) had worse results than those treated additionally with vaporisation (38).


The combined treatment of chondromalacia of the knee using arthroscopic debridement and rehabilitation gives good results in most cases of chondromalacia up to grade III.

Tab. 1. Population by age groups

Number of the group Age range Number of patients percentage
I up to 19 years 2 4,3
II 20 do 29 5 10,9
III 30 do 39 10 21,7
IV 40 do 49 19 41,3
V 50 do 59 4 8,7
VI above 60 years 4 8,7

Tab. 2. Group of patients with chondromalacia according to degree

Grade of chondromalacia number %
I 1 2
II 17 39
III 15 34
IV 11 25

Tab. 3. Rehabilitation program used in Chrzanów County Hospital for patients following arthroscopic repair of damage to knee cartilage

Rehabilitation treatment Time from the surgery Methods Aims of rehabilitation
Continuous passive movement 2nd-5th day, later 15x ambulatory 3 x 1 hour edema-reducing, maintaining of full range of motion cartilage nutrition
Isometrical exercises of quadriceps femoris from 1st day 200 x a day in series 8 – 15 every hour maintaining stereotypes of movement and propiocepcion
Active exercises of lower limb from 2nd day 200 x a day in series 8 – 15 every hour Maintaining of muscle strength and ROM, cartilage nutrition
Walking without weightbearing from 2nd day Assistance of a physiotherapist Teaching of one leg ambulation
Full weightbearing depends on region of damage of cartilage Under guidance of a physiotherapist Cartilage nutrition Teaching of corect ambulation
Active exercises with resistance after 6 weeks Cycloergometer Increase of muscle mass
Exercises on a cycloergometer from second week Home exercises without resistance Edema-reducing, maintaining of full range of motion cartilage nutrition
Magnetronic from 3rd week 15 x 20 minute Edema-reducing cartilage regeneration
Muscle electrostimulation from 3rd week In case of muscle atrophy Muscle rebuilding
Jonoforesis (diclofenac) from 3rd week 10 x in programme Anti-inflammatory
Infrared from 6th week 10 x 15 minute before exercises Muscle tendons, and joint capsule relaxation

Tab. 4. Average results of surgical treatment and rehabilitation per group

Group n before after improvement
Localization in joint
Patello-femoral 15 56 89 33
Tibio-femoral 18 47 82 35
spread 11 46 85 39
Grade of chondromalacia
I and II 17 57 90 33
III and IV 27 44 78 34
Results after different needed procedures
Lateral release of patella 14 56 82 26
Drilling of chondral defects 6 50 72 22
Microfractures of chondral defects 4 37 68 31
Shaving 16 47 79 32
Vaporization+shaving 7 38 76 38


dr n. med. Bogdan Wziętek

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