Patellar cartilage softening

　　One possible cause of patellar softening is congenital skeletal abnormalities. Of course, in most cases, the cause of patellar softening is due to repeated flexion and extension, twisting of the knee joint, which causes continuous impact and friction between the joint surfaces over time, leading to wear and tear injuries. Some people believe it is related to endocrine factors, such as senile arteriosclerosis and insufficient local blood supply, which can also be a cause of this disease. Generally, X-rays can be used to diagnose it.
　　This disease is generally caused by repeated sprains, chronic cumulative trauma, or long-term exposure to wind, cold, and dampness. During the long-term flexion and extension activities of the knee joint, the patellofemoral joint surface is worn down and nutritionally insufficient due to repeated friction or impact, leading to degenerative changes. Fibers with localized cartilage softening origins are formed on the cartilage surface, which become dull, lose elasticity, and may even crack or become defective, thus causing the disease. At the same time, the synovial membrane and fat pad of the joint also exhibit changes such as congestion, exudation, and hypertrophy due to involvement. In addition, changes in joint position, such as incorrect force lines, high or low patella, can also cause abnormal stress on the joint cartilage, which can accelerate the process of joint cartilage degeneration and softening.
　　This disease commonly occurs in adolescents, athletes, middle-aged obese women, and the elderly with high levels of physical activity.

　　The symptoms of this disease are often not severe in the early stage, and can be relieved by rest or taking general painkillers. The lesion develops under 'hidden conditions' and continues to develop until it develops into patellofemoral arthritis. In severe cases, the range of motion of the knee joint is limited, and it is not possible to stand on one leg. In the late stage, when patellofemoral osteoarthritis has formed, there is significant damage to the cartilage and subchondral bone in the lesion area, and the cartilage has no ability to regenerate and repair. In addition, this disease is prone to complications such as meniscus injury and traumatic arthritis.

　　Patellar cartilage softening has a relatively slow onset, and the initial symptoms are usually a feeling of hidden pain or ache in the knee, which then intensifies. The symptoms are exacerbated during climbing stairs or after fatigue, and may improve or disappear after rest. The knee generally does not show obvious swelling, but there may be localized swelling if there is effusion. There may be occasional catching and popping sounds when walking.
　　There is also a situation that is more common in young athletes. Initially, there is pain below the patella, which is more obvious at the beginning of training and subsides after a little activity. Patellar cartilage softening that lasts too long during training can worsen the pain, which gradually disappears after rest. As the course of the disease extends, the pain time is more than the relief time, leading to difficulty in squatting, climbing stairs, or suddenly becoming weak and falling.
　　Of course, in most cases, there is tenderness at the edge of the patella. When the patella is pushed or pressed in the extended knee position, there may be a sense of friction and pain. In cases of simple patellar cartilage damage without joint effusion, or in the late stage of patellofemoral osteoarthritis, secondary synovitis may occur with joint effusion, and the patellar float test may be positive. In patients with a long course of disease, there may be atrophy of the quadriceps muscles.
　　The symptoms of patellar cartilage softening are mainly knee pain, which begins with pain during exertion, jumping, climbing stairs, difficulty in squatting, and feeling weak and unsteady. Joint movement may produce a sound or a sense of friction. As the condition progresses, pain while walking on flat roads, joint swelling may occur. X-rays may show no abnormalities or mild degeneration. Treatment may include topical medications, short-wave diathermy, oral drugs such as Guaifenesin and Vical, and concurrent quadriceps strength training (static squatting exercises). Generally, after treatment, the symptoms of patellar cartilage softening can disappear.

　　Prevention is more important than treatment, as the saying goes, 'Prevent problems before they happen.' Patellar cartilage softening is the same. To avoid the pain of the disease, it is necessary to do a good job of daily prevention. Many friends who suffer from patellar cartilage softening are those who do not pay attention to the protection of the knee joints in their daily lives. Therefore, developing good daily habits is very important.

　　1. Control weight:Obesity is a common cause of increased knee joint wear, as the joints of overweight individuals cannot bear the weight of the body, which accelerates the wear of soft tissues between the joints, causing the joints to degenerate prematurely and symptoms to appear.

　　2. Appropriate exercise:Perform joint unloaded exercises more often to reduce the pressure on the bones and joints, strengthen the muscles around the joints, and thereby enhance the protective function of the joints. Swimming is the best preventive measure, and cycling and walking on flat roads are also good. Avoid long-distance running, playing ball, climbing mountains, and other intense sports.

　　3. Avoid intense exercise:Avoid prolonged squatting and intense exercises such as climbing mountains and stairs, which require flexing the knees. Avoid sudden changes in the intensity of exercise; activities to enhance strength and endurance should progress gradually and increase gradually.

　　4. Pay attention to posture:Change positions frequently, avoid prolonged sitting or standing, and avoid the joints of a particular part being in a loaded state for a long time. Reduce the frequency of climbing stairs, walk less on slopes, and avoid repeated squatting.

　　5. Pay attention to keeping warm:Do not let the joint come into contact with cold wind. With the weather getting colder and colder, it is even more important to pay attention to the protection of the knee joint. It is advisable to wear knee pads in cold weather.

　　Patellar cartilage softening can cause great harm to us, such as knee pain, limited mobility, and even muscle atrophy, affecting our ability to move. Therefore, everyone should pay attention to protecting the knee joint in daily life to prevent the harm of patellar cartilage softening to our health.

　　Patellar cartilage softening is a condition where the patellar cartilage surface, after chronic injury, swells, cracks, breaks, erodes, and eventually detaches, leading to similar pathological changes in the corresponding femoral condyle cartilage, forming osteoarthritis of the patellofemoral joint. The diagnosis of this disease requires the combination of the following examinations to be clear.

　　1. X-ray film

　　Early scans show no abnormalities, while late scans may show semi-circular osteophytes of the patella affecting the patellofemoral joint surface, causing it to be uneven or the space to be narrow. X-ray films can also reveal some causes, such as small patella, high patella, or low lateral condyle of the femur, etc.

　　2. Radionuclide bone scanning

　　During radionuclide bone scanning, lateral view shows localized radioactive concentration of the patella, which has diagnostic significance in the early stage.

　　3. Arthroscopy

　　Arthroscopy is the most valuable method for diagnosing patellar cartilage softening. It can clearly determine whether there are lesions in the joint cartilage and the extent of involvement, as well as the degree of patellar softening. It can also better differentiate from diseases characterized by anterior knee pain, especially in difficult-to-diagnose patients.

　　The nutrition of patellar cartilage mainly comes from synovial fluid. Abnormalities in synovial fluid composition due to various causes can lead to malnutrition of patellar cartilage, making it prone to degenerative changes with minor injuries. The treatment of this disease mainly focuses on non-surgical methods.

　　In terms of diet, patients with patellar cartilage softening should try to maintain a light and easy-to-digest diet. It is best to avoid spicy,刺激性, greasy, smoked, and fried foods. This helps keep the intestines smooth, which is beneficial for body regulation, but it is also important to ensure a balanced intake of nutrition.

　　1. Use more fruit juices, fresh fruits, and jam, etc., as these foods contain sugar and organic acids, which are helpful for intestinal peristalsis. In addition, honey, raw cucumber, kohlrabi, dried radish, sweet potatoes, and other foods can produce gas and stimulate intestinal peristalsis.

　　2. Pay attention to dietary fiber, increase gastrointestinal motility, and avoid overly refined foods to prevent constipation.

　　3. When eating, arrange for the patient to maintain a comfortable sitting position and avoid various adverse stimuli.

　　4. Consume foods rich in vitamin B1, such as coarse grains, bran, beans, lean meat, animal internal organs, fresh vegetables, etc.

　　5. Increase water intake and often eat semi-liquid foods. Patients often have the psychological tendency to drink less water due to fear of frequent urination, which is not beneficial to the patient. Paralyzed patients should have adequate water supply.

　　The nutrition of patellar cartilage mainly comes from synovial fluid. Abnormalities in synovial fluid composition due to various causes can lead to malnutrition of patellar cartilage, making it prone to degenerative changes with minor injuries. The treatment of this disease mainly focuses on non-surgical methods.

　　1. After the onset of symptoms, the knee joint should be braced for 1-2 weeks, while simultaneously performing quadriceps resistance exercises to enhance knee stability.

　　2、肿胀、疼痛突然加剧时，应行冷敷，48小时后改用湿热敷和理疗。

　　2. When swelling and pain suddenly worsen, cold compress should be applied, and then hot compress and physical therapy should be used after 48 hours.

　　3. The anti-inflammatory drug 'glucosamine and meclofenamate' contains glucosamine, which helps in the synthesis of proteoglycans in cartilage, can be taken orally at a dose of 0.2-0.4g twice a day, which can relieve pain and is conducive to cartilage repair.

　　4. Intra-articular injection of sodium hyaluronate (sodium hyaluronate) can improve the viscosity and lubricating function of synovial fluid, protect the joint cartilage, promote the healing and regeneration of joint cartilage, alleviate pain, and increase joint mobility. Usually, 2ml is injected each time, once a week, and 4-5 times as a course.

　　6. Intra-articular injection of triamcinolone acetonide can alleviate symptoms, but since it inhibits the synthesis of glycoprotein and collagen, it is not conducive to cartilage repair and should be used with caution.

　　7. Surgery can be considered for those who have strict non-surgical treatment failure or congenital malformations.

　　Surgical Purpose:

　　(1) Increase the stability during the activity of the patellar joint, such as the release of the lateral joint capsule, the elevation of the femoral condyle, etc.

　　(2) Scrape off the smaller erosive lesions on the patellar joint cartilage to promote repair.

　　(3) For those with complete destruction of the patellar joint cartilage, the excision of the patella can be used to alleviate the progression of patellofemoral osteoarthritis, but the knee joint becomes significantly weak after surgery, making it difficult to continue their sports career.