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.
Understanding chondromalacia patella
Chondromalacia patella symptoms are usually pain around the kneecap and clicking or crunching when the joint is fully extended.
The patella, or kneecap, is covered on its back side with the thickest layer of articular cartilage of all the joints in the body. Chondromalacia (Cartilage breakdown) patella (kneecap) occurs when this cartilage deteriorates or erodes resulting in damage to the cartilage that covers the back part of the patella. This articular cartilage allows smooth movement and also provides shock absorption between the patella and the groove through which it runs that is formed by the femur and the tibia. An abnormal alignment between the patella and the femur can result, which leads to a clicking or crunching in the joint when it is fully extended.
Who gets chondromalacia patella?
We commonly see chondromalacia patella in athletes such as runners, cyclists, dancers, weight lifters, skiers, and football, basketball, baseball, soccer, and tennis players. Any sports or activities, however, that overuse the knees will put the patient at risk for developing chondromalacia patella. Running, squatting, kneeling, and climbing increase the force on the patella. These forces compress the patella against the femoral groove causing the articular surface of the patella to chip and wear away. A good way to look at it is like the tread on your tires. If the car is out of alignment, the tread will not wear evenly. If you patella is out of alignment, the articular surface will not wear evenly, causing deterioration of the cartilage.
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, cortisone injection, 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
In cases of unresponsiveness to medications or steroid injections, a surgeon may recommend an arthroscopic surgical procedure to “determine the level of damage” to the cartilage and attempt correction to the knee cap misalignment.
The knee pain patient must realize that with each procedure and each shaving or cutting of tissue, the risk of developing long-term arthritis is greatly increased. 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.
Another procedure known as a lateral release involves cutting the lateral ligaments to allow for normal position and tracking of the patella. If this does not correct the misalignment, more extensive surgical remedies may be recommended.
Chondromalacia patella and meniscus tear case history
Here is a case history. First let’s look at this very short arthroscopy report from a prominent Chicago Hospital (consistently voted among the best hospitals in the country) on our patient Barb.
Procedure done: Left knee arthroscopy and partial medial meniscectomy and debridement of chondromalacia findings, severe grade 4 chondromalacia of the medial compartment.
Mild patellofemoral changes were seen. Debridgement was carried out. Partial meniscectomy ensued. There was a root tear of the posterior horn and grooving of the medial femoral condyle which was debrided. Anterior cruciate ligament (ACL), Posterior cruciate ligament (PCL) and lateral compartment were essentially undamaged. She tolerated the procedure very well and was discharged home.
As you can see from the arthroscopy report, this patient has severe grade 4 chondromalacia and it is clear that the orthopedist removed part of her meniscus. The report does not state how much of the meniscus was removed, so please ask the surgeon how much of the meniscus was removed and exactly where it was removed. Also note this patient’s meniscal instability was improved, yet it is still present? So what do you think is going to happen to her long term?
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.