Enhancing rehabilitation outcomes in chondromalacia Patella: The impact of combining manipulative therapy with a structured exercise program

Background Chondromalacia patella (CMP) is characterized by cartilage degeneration in the patellofemoral joint, often causing anterior knee pain and impaired knee function. Objective This study aims to evaluate the effectiveness of manipulative therapy in patients diagnosed with CMP. Methods In this prospective randomized study, 40 patients diagnosed with CMP were randomly assigned to the manipulative therapy group or the control group. Both groups underwent strengthening and stretching exercises targeting the knee and hip muscles. Additionally, the manipulative therapy group received manipulative therapy focusing on the thoracolumbar, lumbopelvic, and sacroiliac joints three times a week. Pain intensity was measured using the Visual Analog Scale (VAS), while disability was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Active knee flexion was recorded, muscle performance was evaluated using the Stair Climbing Test (SCT) and Horizontal Jump Test (HJT), and balance was assessed using the Star Excursion Balance Test (SEBT). Results Both groups showed significant improvements in VAS, active knee flexion, WOMAC scores, SCT, HJT, and SEBT outcomes. However, the manipulative therapy group demonstrated significantly greater improvements than the control group in disability (WOMAC scores, p < 0.001, d = 1.93), horizontal jump performance ( p = 0.03, d = 1.57), and balance (SEBT outcomes, p < 0.001, d = 1.60). Conclusion By integrating manipulative therapy with strengthening and stretching exercises targeting the knee and hip muscles, clinicians can offer a multifaceted intervention that addresses the biomechanical and neurophysiological aspects of the condition, enhancing the rehabilitation process and functional recovery in patients with CMP.