Is Prolotherapy effective for Chondromalacia Patella? Danielle R. Steilen, PA-C of Caring Medical discusses various treatment options.
Chondromalacia patella is a cause of patellofemoral pain syndrome or PFPS, often called Runner’s Knee. This condition often affects young, healthy individuals, and often affects athletes. The symptoms are usually pain around the kneecap and clicking or crunching when the joint is fully extended. Chondromalacia patella is thought to be caused by an irritation of the thick cartilage layer behind the kneecap as the kneecap moves up and down. The cartilage deteriorates and causes an abnormal alignment between the patella and the femur. The kneecap or patella scrapes along the leg bones.
Chrondromalacia Patella Treatments
In 2012, doctors noted that there was no consensus for treatment of Chondromalacia Patellae because many of the conservative treatments often prescribed did not provide satisfactory results. This has not changed.
Late in 2014 a study suggested that doctors try selective treatments that may or may not work with the understanding that there did not seem to be anything better. These treatments included knee taping, knee braces for older patients, physical therapy and exercise for younger patients, and even then the doctor should be realistic about how well these treatments may work.1 This is in agreement with another study that suggests that only one in three patients diagnosed with Chondromalacia Patellae were seen as “cured.” The study also showed that Chondromalacia Patellae will also cause one in four athletes to stop participating in sports because of knee pain. 2
Why did these conservative treatments not work?
Physical therapy. The treatment includes leg extensions and stretching exercises to help strengthen the thigh muscle, so the patellae or kneecap, tracks better on the femur – it doesn’t scrape the thigh bone.
As mentioned above supportive knee braces, arch supports and taping may also be recommended to improve the alignment of the kneecap. The problem with this approach is that they do not repair the deteriorated cartilage in the patellae.
Oral steroids, injectable steroids, and anti-inflammatory medications may also be prescribed. Steroids and anti-inflammatory drugs have been shown to produce short-term pain benefit, but both result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration.
Chondromalacia Patella and Surgery
If pain continues, surgery such as arthroscopy to remove pieces of cartilage may then be the next step. The knee pain patient must realize that with each procedure and each shaving or cutting of tissue, NSAID (non-steroidal anti-inflammatory drug) prescription, or cortisone injection, the risk of developing long-term arthritis is greatly increased. The key to keeping the knee strong is to stimulate the area to heal, not to cover up the pain with a cortisone injection or NSAID therapy. In drastic surgery a recommendation to surgically remove the patella in order to remove the pain my be recommended This sometimes does relieve the pain, but at a significant cost to the body. The strength to extend the knee is reduced by about 30 percent, and the force exerted in the knee is increased. There are a host of other risks associated with surgery.
As pain continues, surgery such as arthroscopy to remove pieces of cartilage may then be the next step. This sometimes does relieve the pain, but at a significant cost to the body. The strength to extend the knee is reduced by about 30 percent, and the force exerted in the knee is increased. There are a host of other risks associated with surgery.
Research on Prolotherapy for Chondromalacia Patella
In 2014, the doctors of Caring Medical published their research finding in a paper entitled: Outcomes of Prolotherapy in Chondromalacia Patella Patients: Improvements in Pain Level and Function
In this paper our team evaluated the effectiveness of Prolotherapy in resolving pain, stiffness, and crepitus, and improving physical activity in chondromalacia patients. We examined and treated Sixty-nine knees with Prolotherapy in 61 patients (33 female and 36 male) who were 18–82 years old (average, 47.2 years).
Following Prolotherapy treatments:
- Patients experienced statistically significant decreases in pain
- Stiffness and crepitus decreased after Prolotherapy,
- Range of Motion increased.
- Patients reported improved walking ability and exercise ability after prolotherapy.
- No side effects of prolotherapy were noted.
- Only 3 of 69 knees were still recommended for surgery after Prolotherapy.
- Prolotherapy decreased chondromalacia patella symptoms and improved physical ability.
- Patients experience long-term improvement without requiring pain medications.3
You can view the entire article on our Chondromalacia Patella research published in Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders.
Platelet Rich Plasma for Chrondromalacia Patella
Platelet Rich Plasma Therapy is part of our comprehensive Prolotherapy program. A treatment with Platelet Rich Plasma (PRP) consists of the injection of concentrated platelets obtained from the patient’s own blood placed at the site of the injury. This will release growth factors from the platelets which will stimulate healing and regeneration of the cartilage. The growth factors in the PRP will cause a proliferation and then the regeneration of the injured tissue. It boosts fibroblastic events involved in tissue healing causing the cartilage to heal.
1. Lack S, Barton C, Vicenzino B, Morrissey D. Outcome predictors for conservative patellofemoral pain management: a systematic review and meta-analysis. Sports Med. 2014 Dec;44(12):1703-16. doi: 10.1007/s40279-014-0231-5.
2. Rathleff MS, Rasmussen S, Olesen JL. Unsatisfactory long-term prognosis of conservative treatment of patellofemoral pain syndrome. Ugeskr Laeger. 2012 Apr 9;174(15):1008-13.
3. Hauser RA. Outcomes of Prolotherapy in Chondromalacia Patella Patients: Improvements in Pain Level and Function. Clin Med Insights Arthritis Musculoskelet Disord. 2014; 7: 13–20.