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The impact affects the cartilage. The more wear-and-tear on the cartilage around the kneecap, the less it will be able to absorb shock of impact.
Usually, runners will develop "runner's knee", which has to do with your quad muscles. Only one side of the quads will get stronger, causing the other side to be weaker. Because of this proportionate distribution of strength, the knee cap is pulled toward the stronger side. This makes the knee cap to not fit in place of the socket, and rub against 1 side of the bone. The impact creates pain and swelling of the area. Physical therapy of the quad muscles (upper leg exercises) to strengthen the right muscles can fix this problem.
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