Grade 3 Chondromalacia: Patella, Knee, Medial Femoral Condyle, Hip, Shoulder, Treatment

Grade 3 Chondromalacia:

• What is Grade 3 Chondromalacia?
• Patella
• Knee
• Medial Femoral Condyle
• Hip
• Shoulder
• Treatment

What is Grade 3 Chondromalacia?

Grade 3 chondromalacia refers to a moderate-to-severe stage of cartilage damage in which the articular cartilage shows deep fissuring, cracking, or fragmentation that extends down to more than 50% of the cartilage thickness. Unlike early-stage chondromalacia, where cartilage softening is mild, grade 3 indicates significant structural damage that can interfere with smooth joint movement. This condition commonly affects weight-bearing or high-motion joints such as the knee, patella, hip, and shoulder.

Clinically, grade 3 chondromalacia is often associated with persistent pain, swelling, stiffness, and mechanical symptoms such as grinding or catching. It is frequently detected through MRI or arthroscopy. While the cartilage is not completely worn down to bone (which would be grade 4), the damage is advanced enough to significantly impact function and quality of life. Early recognition and appropriate management are essential to slow progression and prevent full-thickness cartilage loss.

Patella

When grade 3 chondromalacia affects the patella, it is commonly referred to as chondromalacia patellae. This condition involves deep cartilage fissures on the undersurface of the kneecap, leading to anterior knee pain. Patients often report pain while climbing stairs, squatting, running, or sitting for prolonged periods with bent knees, a phenomenon known as the “theater sign.”

Patellar grade 3 chondromalacia is often related to maltracking of the patella, muscle imbalances, or overuse injuries. Weak quadriceps, tight hamstrings, or abnormal alignment of the knee joint can worsen cartilage damage. Management focuses on reducing stress on the patellofemoral joint through strengthening, activity modification, and sometimes bracing or taping.

Knee

In the knee, grade 3 chondromalacia commonly affects the articular cartilage of the femur, tibia, or patella. The damaged cartilage causes increased friction during joint movement, leading to pain, swelling, and stiffness. Patients may experience difficulty with weight-bearing activities such as walking long distances, climbing stairs, or standing for extended periods.

Knee chondromalacia at this stage is often seen in athletes, individuals with prior knee injuries, or those with early degenerative joint disease. MRI findings typically show deep cartilage fissures without complete bone exposure. Early intervention is important to prevent progression to osteoarthritis, which can significantly limit mobility.

Medial Femoral Condyle

The medial femoral condyle is a frequent site of grade 3 chondromalacia, especially in patients with varus knee alignment or increased load on the inner knee compartment. Damage in this area can cause localized medial knee pain, swelling, and a feeling of instability during movement.

Cartilage lesions on the medial femoral condyle are clinically significant because this region bears a large portion of body weight. Without appropriate management, the damaged cartilage may deteriorate further, increasing the risk of full-thickness cartilage loss. Treatment often includes unloading strategies, physical therapy, and in some cases, surgical cartilage repair techniques.

Hip

Although less common than knee involvement, grade 3 chondromalacia in the hip affects the articular cartilage of the femoral head or acetabulum. Patients typically present with groin pain, stiffness, and reduced range of motion. Symptoms may worsen with prolonged standing, walking, or pivoting movements.

Hip chondromalacia is often associated with femoroacetabular impingement (FAI), trauma, or early osteoarthritis. MRI arthrography is particularly useful in identifying cartilage damage in the hip. Early diagnosis allows for joint-preserving strategies aimed at reducing mechanical stress and preserving cartilage health.

Shoulder

In the shoulder, grade 3 chondromalacia typically involves the glenoid or humeral head cartilage. Patients may experience deep shoulder pain, crepitus, and reduced range of motion, especially during overhead activities. This condition is often seen in individuals with prior shoulder instability, repetitive overhead use, or degenerative changes.

Shoulder chondromalacia at this stage can interfere with daily activities and sports performance. Imaging studies such as MRI help assess the extent of cartilage damage. Conservative treatment is usually the first approach, focusing on pain control and restoring shoulder mechanics.

Treatment

Treatment of grade 3 chondromalacia is typically individualized and depends on the affected joint, symptom severity, and patient activity level. Conservative management includes physical therapy to strengthen supporting muscles, reduce joint stress, and improve biomechanics. Pain control may involve NSAIDs, activity modification, weight management, and joint-supporting braces.

If conservative measures fail, interventional options such as corticosteroid injections, viscosupplementation, or platelet-rich plasma (PRP) therapy may be considered. In selected cases, surgical options like arthroscopic debridement, microfracture, or cartilage restoration procedures may be recommended. Early and appropriate treatment can help slow disease progression and improve long-term joint function.