CHONDROMALACIA RONALD P. GRELSAMER, MD
Knee Hip Pain
Mt SINAI HOSPITAL
5 East 98th Street
Box 1188
New York, NY 10029
Phone: 212-241 2914
Fax: 212 - 534-6202




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Chondromalacia is an outdated term. But from the 1930s until a decade ago or so the term "chondromalacia patellae" was synonymous with pain pertaining to the patella. It is a rather dated term and most orthopedists are abandoning it (or should be). Nevertheless it still deserves discussion. In the United States it is still a recognized insurance diagnosis code (717.7).

Historical Review

The concept that cartilage changes are abnormal and potentially painful is hardly new. Hunter’s admonition that ‘From Hippocrates to the present age it is universally allowed that ulcerated cartilage is a troublesome thing and that when once destroyed it is not repaired" will attest to that. Konig and Aleman were two of the first to use the term chondromalacia, though Aleman himself referred back to a 1906 text when using the term. They noted softening (malacia) of the cartilage (chondro-) in some cadavers and speculated that these could be sources of pain in the living. All of these investigators attributed the cartilage lesions to trauma. The concept that articular lesions could be secondary to malalignment is relatively recent.

  • Era 1. From roughly the mid-1920’s to the mid-1930’s chondromalacia is the term given to lesions of the patella.
  • Era 2. The term "chondromalacia patellae" (chondromalacia of the patella) becomes synonymous with patellar pain associated with cartilage lesions.
  • Era 3. Chondromalacia patellae is used to describe patellar pain with or without the presence of cartilage lesions.
  • Era 4. It becomes increasingly clear that the patella can be painful in the absence of any cartilage lesions and that cartilage lesions need not be painful. Ficat and Hungerford remind us that Büdinger’s 1908 comment "[the term] ‘Internal derangement’ will simply not disappear from the surgical literature. It is the symbol of our helplessness in regards to a diagnosis and our ignorance of the pathology" can now be just as easily applied to the term 'chondromalacia'.
  • Era 5. "Chondromalacia" falls completely out of favor to the point where its use (other than to describe a specific pathological entity) reflects unfavorably on the user.