Management of chondromalacia patellae in elite athletes: Balancing high-performance demands with joint preservation

Background and Aims: Chondromalacia patellae presents a unique and significant challenge for elite athletes. It is not just a source of discomfort but a condition that can disrupt demanding training schedules, competitive performance, and the long-term durability of a sporting career. Materials and Methods: This narrative review synthesizes current evidence on the diagnosis and management of chondromalacia patellae in elite athletes, focusing on clinical evaluation, imaging, and treatment strategies. Results: The condition arises from a combination of anatomical, biomechanical, and training-related factors, including subtle malalignment, muscle imbalances, and the repetitive, high-load demands inherent to elite sport. Diagnosis is a careful blend of a thorough clinical assessment and advanced imaging, particularly magnetic resonance imaging, to visualize cartilage health and identify contributing structural issues. Treatment involves a multidisciplinary approach that strategically modulates biological healing capacity, biomechanical forces on the knee, and the athlete’s performance demands. A structured, phased rehabilitation program forms the cornerstone, progressing from pain control to strength restoration and ultimately to sport-specific retraining. When conservative measures are insufficient, a spectrum of advanced surgical options exists to restore cartilage or correct underlying malalignment. Conclusion: A personalized, multimodal approach is essential. While rehabilitation remains the cornerstone, biologic therapies and precision surgical interventions may aid selected patients. The primary goal is safe return to sport while preserving long-term joint health.