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The treatment of chondromalacia remains controversial, but most individuals can undergo effective treatment by resting the knee and adhering to a proper physical therapy program. Allowing the inflammation of chondromalacia to settle is the first step of treatment. Avoiding painful activities that irritate the knee for several weeks, followed by a gradual return to activity is important. In this time, cross-training activities, such as swimming, can allow an athlete to maintain their fitness while resting the knee. The next step in treatment is a physical therapy program that should emphasize strengthening and flexibility of the quadriceps and hamstring muscle groups. Use of nonsteroidal anti-inflammatory medication is also helpful to minimize the pain associated with chondromalacia. Treatment with surgery is declining in popularity for two reasons: good outcomes without surgery, and the small number of patients who actually benefit from surgical treatment.

Since chondromalacia patellae causes the kneecap to scrape the leg bones when the knee is moved, traditional treatment usually involves leg extensions and stretching exercises to help strengthen the thigh muscle so the patellae, or kneecap, tracks better on the femur. The problem with this approach is that it does not do anything to repair the deteriorated cartilage in the patellae and, thus, does not alleviate the chronic pain that people with this condition experience.

Another standard practice of traditional medicine is to inject steroids into the knee, or to prescribe anti-inflammatory medications. However, in the long run, these treatments do more damage than good. Cortisone shots and anti-inflammatory drugs have been shown to produce short-term pain benefit, but both result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration. Plus, long-term use of these drugs can lead to other sources of chronic pain, allergies and leaky gut syndrome.

When all else fails, patients who experience chronic joint pain are usually referred to a surgeon. Unfortunately, surgery often makes the problem worse. Surgeons will use x-ray technology as a diagnostic tool, which does not always properly diagnose the pain source. Decisions to remove cartilage tissue will most commonly result in arthritis.

Temporarily resting the knee and taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin may help relieve pain. Physical therapy, especially quadriceps strengthening and hamstring stretching, may be helpful.

Limit participation in sports or strenuous activity until the pain has gone away. Avoid activities that increase the knee pain, such as deep knee bends, until the pain improves.

If the alignment of the patella cannot be corrected with therapy, surgery may be an option. Depending on the type of misalignment, the surgery may be arthroscopic (using a camera, which allows a smaller incision) or open.

Three hundred and nineteen patients who had chondromalacia patellae and persistent patellofemoral pain after six months of conservative management underwent arthroscopy and arthroscopic surgery. The results in four aetiological groups were reviewed at one year and five years after operation. Morbidity was minimal. Lavage produced early remission in all groups. Shaving offered a particular advantage in the post-traumatic group. Lateral release plus shaving and lavage was beneficial in the group with maltracking patellae and in half of the idiopathic group. In the group with unstable patellae, lateral release produced good results in only one in four patients. In conclusion, we consider that arthroscopic surgery has a useful role to play in the management of chondromalacia patellae.

The primary goal for treatment and rehabilitation of chondromalacia patella is to create a straighter pathway for the patella to follow during quadriceps contraction. Selective strengthening of the inner portion of the quadriceps muscle will help normalize the tracking of the patella. Cardiovascular conditioning can be maintained by stationary bicycling (low resistance but high rpms), pool running, or swimming (flutter kick). Reviewing any changes in training prior to developing chondromalacia patella pain, as well as examining running shoes for proper biomechanical fit, are critical to avoid repeating the painful cycle. Generally, full-squat exercises with weights are avoided. Occasionally, bracing with patellar centering devices is required. Physical therapy can be helpful to begin the strengthening program and to organize optimal exercise routines.