By Kathleen Gaines, MSN, RN, CBC
Medically reviewed by Stella Bard, MD
Chondromalacia surgery is usually an arthroscopic procedure performed by an orthopedic surgeon as an outpatient surgical procedure. Depending on the severity of the damage, the procedure may need to be performed as an open knee procedure and require an overnight stay in the hospital.
The goal of the surgery is to help remove or fix damaged tissue and cartilage surrounding the knee. While there are less invasive options, these rarely will fix the underlying problem and you still may need surgery.
Utilizing physical therapy and taking time to heal will allow you to regain your knee's full function and continue your daily activities. Speak to your healthcare provider to determine if surgery is the best option and what other treatment options are available.
Knowing the purpose of the surgery, surgical recovery time, risks, and contraindications can help you make an informed decision regarding chondromalacia surgery.
Morsa Images / DigitalVision / Getty Images
What Is Chondromalacia Surgery?
Skilled orthopedic surgeons perform chondromalacia surgery to remove damaged cartilage. The goal of the surgery is to help remove or fix damaged tissue and cartilage surrounding the knee.
The surgical procedure can be done via arthroscopy or open knee surgery. The decision will ultimately be up to the orthopedic surgeon based on the severity of the damage. Arthroscopy is the more typical procedure, done as day surgery with minimally-invasive techniques.
At times, osteotomy needs to be performed to correct the alignment of the knee with the thighbone and shinbone. An osteotomy refers to the cutting of the bone, either the tibia (shinbone) or femur (thighbone). The bone is reshaped to relieve pressure on damaged cartilage and reduce the risk of further complications with the knee.
If an osteotomy needs to be performed, the surgeon may be more likely to make an open knee incision; however, a high tibial arthroscopic osteotomy can be performed. An overnight hospital stay may be needed for some patients.
Contraindications
Chondromalacia surgery is essential for most patients if physical therapy isn't successful. Unfortunately, some patients cannot have this operation either because the knee is too damaged or they may need a total knee replacement. Other contraindications may include:1
Osteoarthritis
Active infection
Complex regional pain syndrome
Severe ligament instability
Chondrocalcinosis
Unrealistic patient expectations
A surgeon with a lack of experience
Obesity: Body mass index (BMI) greater than 30
While the aforementioned list is extensive, ultimately it is up to your surgeon to determine if chondromalacia surgery is a good option for you. It will be important to discuss with your healthcare provider the pros and cons of the surgery and how they are specific to your medical condition.
Potential Risks
As with any surgical procedure, there are several potential risks associated with undergoing a surgical procedure. While most are relatively minor and treatable, early complications are:2
Pain
Bleeding
Swelling
More severe and possibly life-threatening complications include pulmonary embolism and deep vein thrombosis.2
While rare, other possible complications of surgery include:2
Hemorrhage
Bone fracture
Stroke
Heart attack
Skin ulcer or blister
Wound dehiscence
Nerve palsy/injury
Tendon or ligament injury
Surgical infection
Limb ischemia
Renal failure
Pneumonia
Purpose of Chondromalacia Surgery
Chondromalacia patellae, also known as “runner’s knee,” is a condition where the cartilage on the undersurface of the patella (kneecap) deteriorates and softens. The kneecap may start to rub against the femur and cause discomfort or pain.3
Chondromalacia is seen as an overuse injury in sports. Taking time off and resting can help alleviate pain and reduce the risk of further injury. Other times, improper knee alignment is the cause and resting doesn’t provide relief.
Chondromalacia surgery is generally not a first-line procedure for this medical diagnosis. Your healthcare provider will suggest less invasive options first:
R.I.C.E (rest, ice, compress, elevate): This will be the first recommended treatment option for chondromalacia injuries. While this will not fix the underlying problem, it will help reduce discomfort, pain, and swelling. It is imperative to continue to follow your doctor's medical advice.3
Painkillers and anti-inflammatory medication: Your healthcare provider may recommend using nonsteroidal anti-inflammatory drugs (NSAIDs) and other medications to help reduce pain and inflammation.3
Physical therapy: Under the guidance of physical therapists, you will perform exercises and range of motion exercises to strengthen the surrounding muscles and joints.3
Patella taping: Taping will help lessen the pain by preventing the kneecap and sore spot from rubbing together. The tape is placed along either side of the affected knee, helping to guide and correct the patella's movement. Patella taping should be done under the guidance of your doctor and/or physical therapist.3
Before surgery, your surgeon will require several preoperative studies. These include:
X-ray: This can help rule out any underlying issues such as inflammation or arthritis
Blood tests: This will check your hemoglobin and electrolyte levels.
Arthroscopy: This will examine the exact condition of the knee cartilage.
Magnetic resonance imaging (MRI): This provides the most detailed view of the knee and surrounding joints. It generally is the best way to confirm chondromalacia patella.
How to Prepare
It's important to discuss with your healthcare provider the specifics of the surgery and what to expect during the postoperative phase. Ensuring you have realistic expectations for surgery is the key to success. Before surgery, have an open conversation with your surgeon.
You should contact your healthcare provider if:
You have any questions or concerns about the chondromalacia surgery
You need clarification on how to prepare for your surgery, such as which medications you should take on the morning of your surgery
You develop a fever, the flu, a cold, or COVID-19 symptoms before the procedure
Location
Chondromalacia surgery can be performed either in the hospital or an outpatient surgery center, depending on your surgeon's preference as well as your baseline health. Most patients can expect to go home after recovering in the post-anesthesia care unit. However, some will have to spend at least one night in the hospital on a medical-surgical unit.
What to Wear
The most important thing to remember for this procedure is to dress comfortably. Medical professionals recommend loose-fitting clothing to wear to and from the hospital.
Most patients wear hospital gowns after the procedure due to the medical equipment, including IVs, catheters, drains, and you may have multiple knee incisions. You can expect to wear nonskid footwear at all times when out of bed.
Food and Drink
You will be required to stop eating and drinking before surgery. This is called being NPO, which means "nothing by mouth." It is imperative to follow the NPO guidelines because if not, the surgery could be canceled.
Instructions on a specific time will vary for all patients and are determined by the surgical team. You will be given this information at a preoperative appointment, and then a follow-up reminder call is done the day before the procedure.
Take only the medications your healthcare provider tells you to take on the morning of your surgery. Take them with just enough water to swallow comfortably. Make sure to confirm the medications with your surgeon and only take them with water.
Medications
The surgeon will discuss all medications with you before the surgery. Make sure to bring a list of the medications to preoperative appointments, including the dosage, how often the medication is taken, and when it was last taken.
Also, include all vitamins and supplements in the list of medications. These are just as important as prescribed medications as they may have side effects with the anesthesia and medications used during and after the procedure.
Providers may start patients on medications before surgery to manage symptoms. These medications might include a stool softener to relieve constipation to avoid straining, which can cause additional strain on the heart. An example of this medication is Colace.4
What to Bring
You will have more considerations for what to bring if you will spend a night at the hospital than if your surgery will be day surgery. Items may include:
Comfortable, loose-fitting clothing, robe, and rubber-backed, nonskid slippers
Storage containers for glasses, contact lenses, and/or dentures if you wear them
Insurance card and personal ID card
Emergency contact information
A copy of your legal paperwork about your health (such as your health care proxy or living will)
A complete list of all the medications you currently take, including the dosages, how often you take them, and when they were last taken
Any adaptive equipment for mobility, including cane, walker, or wheelchair
If staying overnight, consider:
Personal care items such as a toothbrush and toothpaste
Earplugs and eye mask
Reading material
Cell phone charger
Pillow or blanket
You should not bring:
Valuables
Jewelry
Watches
Credit cards
Cash
Laptop
iPad
Patients' belongings will be taken to their room by hospital staff. It's important to leave all the nonessentials at home and only bring what will make you the most comfortable during the recovery.
Preop Lifestyle Changes
Lifestyle changes are essential to the success of a patient having chondromalacia surgery.
It is important to start taking the proper steps prior to the surgery to make important lifestyle changes in order to prevent postoperative complications, improve healing, decrease inflammation, and decrease possible pain. Important changes include:
Quit smoking
Stop drinking alcohol
Get plenty of rest
Increase physical activity (as tolerated)
Use an incentive spirometer
Make diet changes
What to Expect on the Day of Surgery
Before the Surgery
On the day of the procedure, you will meet with the entire healthcare team, including surgeons, cardiologist, anesthesiologist, nurses, and physical therapist. All operative consent forms will be signed at this time to ensure you are fully prepared and do not have any additional questions or concerns.
The registered nurse will take vital signs, including:
Heart rate
Blood pressure
Temperature
Pulse oximetry
Respirations
Pain level
Blood sugar
Before going into the operating room for the procedure, patients will have preoperative tests done if needed. You will also be given a surgical soap that must be used on the surgical sites to properly cleanse the area and prevent infection.
After cleaning, you will be given a hospital gown, and the nurse will shave the surgical area if needed. The surgeon will mark the surgical site after you are fully prepped.
The nurse and surgical team will review your medications. Be prepared to discuss all of your medications, vitamins, and supplements at this time, including the dosages, the last time they were taken, and how often they are taken. Bringing a list of the information is helpful so nothing is missed.
Patients are instructed to empty their bladder before going into the operating room, remove all jewelry, glasses, contact lenses, and dentures, if applicable. Finally, the nurse will insert an intravenous catheter (IV) that will be used to provide hydration, medications, and anesthetics during the procedure.
During the Surgery
When it’s time for the surgery, you will be taken into the operating room on a stretcher and then placed onto the operating room table. You will then be prepared for general anesthesia, which will last for the duration of the surgery. Before the operation begins, the following will take place:
You will be given a small dose of medication to help you relax while the surgical team is preparing.
Vital sign monitors are placed.
Your skin will be cleaned again with a surgical cleaner and draped in sterile drapes, exposing only the surgical area.
An endotracheal tube will be placed by the anesthesiologist to help you breathe during the procedure. Anesthesia medications can make it difficult to breath, and this will allow the team to help control your breathing while on the ventilator.
After you are put to sleep, the surgeons will insert a small camera, called an arthroscope, into your knee joint. The camera displays pictures on a video monitor.
The surgeon uses these images to guide surgical instruments to remove the damaged chondromalacia. Several additional small incisions will be made in the surrounding area to insert the other needed surgical instruments.5
Most surgeons prefer to perform this procedure via arthroscopy; however, it can be done via an open mid-knee incision.
If the procedure is done via an open mid-knee incision, a flap is created, and spacers are used to pull back the skin, tissue, and muscle. This will expose the ligaments and bone structures.
An open incision may be indicated based on the severity of damage to the knee; however, some surgeons prefer this surgical method, as they suggest this provides a clearer view of the entire surgical field.
After the surgeon has located the area of the knee, it will be cut, shaved, or fixed depending on the severity of the damage. Once the knee is repaired, the surgeon will remove the instruments and close the incisions with sutures, derma bond (surgical glue), and Steri-Strips.5
After the Surgery
Following the procedure, you will be taken to the PACU to recover. If there are complications, you may need to be transported to the intensive care unit; however, this is unlikely. While in the PACU, the nursing staff will monitor your vital signs, hydration, and pain.
All appropriate interventions will be given, and discharge instructions will be given. This will include postoperative pain medications and antibiotics, limitations, and future surgical appointments.
Some patients will have to spend the night in the hospital; therefore, the patient will be transported to a medical-surgical room for the night. Patients may see a physical therapist while in the hospital to cover exercises, braces, and crutch training. If patients are not spending the night, this will be taught preoperatively.
Recovery
The recovery process will vary depending on the individual and the severity of the injury. Recovery after open-knee surgery is longer, and physical therapy is more intense than for those who have an arthroscopy procedure.
You will be followed closely by the surgeon during the initial six weeks. Post-operative appointments can be expected on days 7, 10, and 14. By day 14, your surgeon will remove any sutures or staples used to close the incision.
You will have a knee immobilizer or brace for two to four weeks after surgery, meaning that crutches or a wheelchair will be needed. Physical therapy will be started immediately following the procedure to work on range of motion exercises that will decrease swelling and reduce pain.6
Most surgeons recommend no weight bearing for two weeks. You can do toe touching with crutches at two to six weeks while you can bear about 25% to 50% of your weight. Exercises with the physical therapist will help with weight-bearing exercises.
After about four to six weeks, you should be able to walk without crutches, but still while wearing a brace. By 12 weeks, you can be walking without a brace. Full recovery can take six to 12 months.6
Your physical therapy regimen will be determined by your medical team and should be followed precisely as not to do damage.
Healing
It is important to inspect your surgical incision and/or dressing several times a day during the healing process. You want to monitor for signs and symptoms of surgical site infection. If you cannot see the incisions yourself, you will need someone to assist you or have a visiting home care nurse come to perform incision checks.
Check your incision for any of the following:7
Redness
Swelling
Warm or hot to touch
Tenderness
Pain
Drainage at the incision site (blood and/or pus)
Fever
If you experience any of the aforementioned symptoms or signs, it is imperative to call your surgeon immediately. Surgical site infections are serious but can be treated with antibiotics if identified early.
Coping With Recovery
One of the biggest challenges during postoperative time is pain management. You will be sent home with a prescription of narcotic pain medicine. Your surgeon will manage your pain management regimen. It is important to follow all recommendations precisely as given.
During the first week, you can expect to use narcotic pain killers to help manage your postoperative pain, as well as over-the-counter (OTC) pain medications such as Tylenol and Advil.
Over-the-Counter Pain Medications
OTC pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), including Advil (ibuprofen), can be used in combination with other pain relievers. Tylenol (acetaminophen) is also commonly prescribed after surgery.
It's important to remember proper dosages and timing of OTC medications as accidental overdose is possible. Make sure to let the medical team know if you have a history of kidney, liver, or heart problems, as these can be affected by these drugs.
Prescription Pain Medications
For more intense pain and during the first few days after surgery, you will be prescribed an opioid drug such as Percocet, Vicodin, or Oxycontin to ease your pain. It’s important to note that these are highly addictive and should be taken only as directed.
You may experience the following side effects while taking prescription pain medication:
Fatigue
Hypotension
Bradycardia (slow heartbeat)
Nausea
Constipation
Skin rash
Bradypnea (slow breathing)
It is recommended that all unused prescription pain medication be disposed of properly or returned to the pharmacy.
Nonmedical Approaches
Complementary therapies such as aromatherapy, meditation, and/or guided imagery can be helpful during the recovery process. It's important to remember that these alternative approaches should not replace needed pain medication but rather should act in conjunction with your doctor's pain management regimen.
While you may want to attempt recovery with little to no medication, it is also important to remember to listen to your body. Untreated pain can cause numerous physical complications and should not be ignored.
Doctors recommend trying distraction—listening to your favorite music, playing board games, or card games. This may ease anxiety or stress as a means to get your mind off the pain.8
Another approach is the use of guided imagery. This involves closing your eyes, breathing very deeply, and picturing yourself in an ideal location or a “happy place.” Over time, you should be able to feel positive emotions from where you are, leaving you calmer and more in control.
Long Term Care
Surgery can be physically, mentally, and emotionally exhausting. However, it is essential to follow all of your surgeon's recommendations to prevent further damage and complications to the surgical area.
Maintaining the physical therapy regimen as well as healthy lifestyle will help with wound healing, range of motion, and pain management.
Possible Future Surgeries
Because this surgery is more common in younger people, it is possible that you may need to have additional surgeries. Furthermore, this surgery does not prevent you from injuring the same knee or needing the same surgery again.
The goal of the surgery and therapies after are to strengthen the knee, surrounding muscle, and ligaments to prevent the injury from reoccurring. Unfortunately, some people are injured again.
Lifestyle Adjustments
Some individuals will be advised to make significant lifestyle changes to minimize the risk of additional knee problems and future surgeries. For example, it might be recommended to switch to lower-impact sports to decrease the amount of pressure placed on the knees, surrounding cartilage, and tissue.
Sources
Lifebridge Health. Patellofemoral surgery and replacement.
Salzler MJ, Lin A, Miller CD, Herold S, Irrgang JJ, Harner CD. Complications after arthroscopic knee surgery. The American Journal of Sports Medicine. 2014;42(2), 292-296. doi:10.1177/0363546513510677
Nevada Orthopedic & Spine Center. Chondromalacia patella.
MedlinePlus. Stool softeners.
American Academy of Orthopaedic Surgeons. Knee arthroscopy.
Orthopedic Specialists of North Country. Recovery from arthroscopic knee repair surgery.
Johns Hopkins Medicine. Surgical site infections.
Aghbolagh MG, Bahrami T, Rejeh N, Heravi-Karimooi M, Tadrisi SD, Vaismoradi M. Comparison of the effects of visual and auditory distractions on fistula cannulation pain among older patients undergoing hemodialysis: A randomized controlled clinical trial. Geriatrics (Basel). 2020 Sep 16;5(3):53. doi:10.3390/geriatrics5030053
By Kathleen Gaines, MSN, RN, CBC
Kathleen Gaines, MSN, RN, CBC, is a nurse and health journalist, as well as an adjunct clinical faculty member at hospitals in the Philadelphia area.
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