The Effectiveness of Quadriceps Strengthening in Chondromalacia Patella Rehabilitation and the Contribution to Clinical Outcomes: A Systematic Review

Chondromalacia Patella (CMP), one of the most common knee joint pathologies, is a progressive condition characterized by structural deterioration in the retropatellar cartilage and causing anterior knee pain. Although strengthening the quadriceps muscle group is considered a fundamental component of treatment, the effectiveness of different exercise protocols continues to be debated. The aim of this study is to evaluate the effectiveness of quadriceps strengthening exercises in CMP rehabilitation and to comparatively examine the clinical superiority of these methods over holistic biomechanical approaches with stabilization of adjacent joints such as the hip, in light of the literature. This study was designed as a systematic literature review. The PubMed, Web of Science, and Google Scholar databases were used to access academic publications published between January 1, 2010, and January 1, 2026; the databases were searched using the keywords "chondromalacia patella", "chondromalacia patella exercises", "chondromalacia patella rehabilitation", and "chondromalacia patella treatment". The review process was conducted according to the PRISMA guidelines, and 7 articles directly related to the topic were included in the final evaluation in line with the determined PICO criteria. The studies reviewed showed that quadriceps muscle strength loss is directly related to CMP and that both isometric and isotonic exercises provide significant improvement in pain and functional scores. However, some studies have shown that strengthening the posterolateral hip muscles provides superior and lasting results in earlier pain control compared to quadriceps exercises. In addition, holistic approaches such as spinal manipulation were found to be effective in improving knee function by correcting lumbar spinal alignment and restoring the biomechanical balance of the lower extremity kinetic chain. While exercises aimed at strengthening the quadriceps muscle are of fundamental importance in CMP rehabilitation, going beyond local approaches is necessary for the success of the treatment. In order to optimize clinical outcomes and accelerate the healing process, hip stabilization with quadriceps exercises is necessary. It is recommended that these be integrated with biomechanical approaches encompassing the entire lower extremity kinetic chain.