Chondromalacia

[citoyen]

I'm sure this has come up before but the yacf search is being unhelpful...

I've had pain in my left knee, in front and just below the kneecap, for a while. It's not there all the time but it's especially noticeable when going up stairs. I had thought it was probably just a strained ligament, but after looking into it a bit more, I wonder if it could be chondromalacia. Does that sound likely? Or even arthritis? I suppose I should probably get it checked out properly by a doctor.

As to the causes, could it be down to badly aligned cleats on my cycling shoes? I noticed while out yesterday that my left shoe when clipped in forces me to have my foot very slightly more 'heel out' than feels entirely natural. I shall adjust that before I next go out, but I'm wondering if this could have put my knee out of alignment.

[LittleWheelsandBig]

Don’t know about the medical stuff but maladjusted cleats usually leads to pain that isn’t central, typically the side or ‘top corner’ of the kneecap. If the pain is central and near the top of the kneecap, that suggests a slightly too low saddle.

[citoyen]

If the pain is central and near the top of the kneecap, that suggests a slightly too low saddle.

Thanks for the suggestion - I'll check that too. (Although the pain is more below than near the top of the kneecap.)

[DuncanM]

When you say "below", do you mean behind the kneecap in the middle of the joint, or at the bottom of the kneecap (the bit closest to your foot)?

Adjusting your cleat so the foot is in a more comfortable position sounds like a good plan, but I'd go see a doc (or a physio) just to be on the safe side. The test for anything irritating the back of your kneecap seems to be putting your leg straight, having them hold the kneecap in place, and then you tensing your quad. Don't be tempted to show how strong your quad is - it can really hurt!

A quick and easy check to compare legs - is the VMO (the small teardrop quad muscle on the inside just above the kneecap) roughly the same size on both sides? Maltracking of the kneecap is often blamed on lack of VMO strength, so if it's smaller on the side with the pain, that might point at the cause.

[giropaul]

With anything that’s new I try to work back to ask “ what was changed”? For knees I’d be especially looking at the bike ( is it the same bike as usual), the cleats ( have you changed them recently, or are they worn, or could one have slipped) , is the saddle height still what it should be ( and saddles do sag significantly over time).
If everything seems ok, I’d try using Voltorol short term, or dynamic taping ( there are some excellent guides on YouTube)
Another consideration is the conditions you have ridden in. I’m a dinosaur, but also a qualified and experienced soigneur, and I stick with the 20 degrees minimum for shorts.
A commonly forgotten aspect of cycle position is the stance. The drive through the knees should be straight, which means of some riders, maybe with wider hips, setting the pedals out a bit ( some brands offer a range, extenders and washers are also used. Cavendish, for instance, uses a wider stance set of pedals. If a rider has multiple bikes, it may vary, especially if a bike has a triple chainset for instance.
If the issue persists, a visit to a good physiotherapist who understands cycling would be my recommendation. If one says “ bring your shoes with you” it’s a good sign.

[citoyen]

When you say "below", do you mean behind the kneecap in the middle of the joint, or at the bottom of the kneecap (the bit closest to your foot)?

Bottom of kneecap - so ACL area, which is what made me initially think it was a strain.

A quick and easy check to compare legs - is the VMO (the small teardrop quad muscle on the inside just above the kneecap) roughly the same size on both sides? Maltracking of the kneecap is often blamed on lack of VMO strength, so if it's smaller on the side with the pain, that might point at the cause.

I have thought that muscle imbalance could be an underlying issue, though it's not immediately obvious to me if there's a difference in the size of VMO between each leg, so I don't think it's that. But yes, I think I need an expert opinion rather than self-diagnosis.

Another consideration is the conditions you have ridden in. I’m a dinosaur, but also a qualified and experienced soigneur, and I stick with the 20 degrees minimum for shorts.

Yes, that sounds like a good rule. I do tend to err on the conservative side with shorts-wearing - I've always felt the cold in my knees.

The more I think about it, the more I reckon saddle height could be an issue - my son was using my bike occasionally until he got his own a few months ago and he is slightly shorter than me, so....

If the issue persists, a visit to a good physiotherapist who understands cycling would be my recommendation. If one says “ bring your shoes with you” it’s a good sign.

That does sound sensible. I do know of one local specialist sports physiotherapist who is a cyclist himself - might give him a call. Maybe a session with a proper expert bike fitter would be useful too. I'm not in nearly the same physical shape as I was last time I had a bike fit, so I could probably benefit from some adjustments.