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Caring Medical &
Rehabilitation Services


Chicagoland office
715 Lake Street, Suite 600
Oak Park, IL 60301

Southwest Florida office
9738 Commerce
Center Court
Fort Myers, FL 33908

708.393.8266 Phone
855.779.1950 Fax

Treatment of Chondromalacia Patella

Nathan was on a long bike ride training for an upcoming Ironman Triathlon. Towards the end of the ride, he noticed Knee Pain in his left knee. He also felt some knots in his quadriceps. He continued his Ironman training, including riding his bike for 60-70 miles, even though he was experiencing discomfort. By November, the pain in his knee was too much to handle, and Nathan decided to see a doctor.  An MRI revealed Nathan had Chondromalacia Patella of the knee.

What Is Chrondromalacia Patella?

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.

Nathan’s particular symptoms were pain at the kneecap, numbness going from his quadriceps to his calf, and cracking of the kneecap with movement. He tried physical therapy in December and January. He also took some time off from training. Physical therapy and rest are frequently the initial treatments recommended for chondromalacia patella in conventional medicine.  This often provides relief in the beginning, but the relief does not last.  This was the case for Nathan.  There was no lasting relief, because the underlying cause was not addressed.  The cartilage was still damaged.

Some other conventional treatments that are recommended include shaving or cutting of tissue, NSAID (non-steroidal anti-inflammatory drug) prescription, and/or cortisone injection. These treatments increase the risk of developing long-term arthritis.  NSAID therapy and cortisone injections only cover up the pain. We also would not recommend trying to eliminate the pain by shaving, cutting, or removing tissue.  A better approach would be to keep the knee strong by stimulating the knee to heal.

What are the symptoms of Chondromalacia Patella?

Symptoms of chondromalacia patellae are straight forward – knee tenderness and pain, felt most intensely when squatting, kneeling, going up or down stairs and sitting with the knee bent for extended periods of time.  A grinding feeling may be noted when the knee is extended.

How Do You Heal Chondromalacia Patella of the Knee?

Nathan came to Caring Medical seeking Prolotherapy treatments. Upon examination, moderate tenderness was noted around the kneecap. Severe crepitus or crunching was also noted with movement of the kneecap. Clarke’s Sign was positive, which is an indicator of PFPS or chondromalacia patella. Danielle explained to Nathan that he was a good candidate for Prolotherapy, and recommended treating him every 4-6 weeks estimating 3-6 treatments to achieve full healing. Nathan agreed, and was treated with Prolotherapy the same day. Comprehensive Prolotherapy, meaning using a strong enough solution providing many injections to the entire area, will stimulate healing of the patient with chondromalacia patellae in the knee.
Prolotherapy injections treat chondromalacia patella by stimulating the repair of the damaged cartilage in the knee.  Prolotherapy will boost healing in the knee and cause regeneration and repair of the cartilage. Prolotherapy also helps the patellar tracking by strengthening the patellar tendon or the musculoskeletal support around the knee.

Can You Exercise After Receiving Prolotherapy for Chondromalacia Patella?

Nathan was given strict exercise guidelines after his initial treatment:

  1. He was to take it easy for 4 days after the treatment to allow for the swelling and inflammation toreduce, which is a normal process after Prolotherapy injections.
  2.  He was to avoid anti-inflammatories, and apply heat instead of ice.
  3. He could bike and swim, but if he noticed any swelling, he would need to scale it back for a few days, as  swelling is a sign that he overdid the exercise. He was also instructed to feel the knee for any warmth, which would be another sign of him overdoing exercise.
  4. He was to begin with 30 minutes of cycling. He needed motion in the knee, but not excessive amounts. He could run intervals, beginning by walking for a minute, then running for a minute. He could increase running gradually, not to exceed 4 minutes. This would be reassessed at the next visit.
  5. If his baseline pain was a 2 out of 10, it was okay for the pain to increase to a 4 out of 10, as long as the pain level went back down to baseline two hours after stopping the exercise.
  6. He was to do nothing that caused sharp pain.

By the fourth visit, Nathan felt 60% improved. He still experienced some pain with numbness at the kneecap after exercising. On examination, crunching of the kneecap was noted, but there was no pain with full range of motion.  Danielle recommended  Platelet Rich Plasma Therapy at this visit, and Nathan agreed.

Again, Nathan was to take it easy with no exercise for 4 days. He could now increase his exercise regime beginning with swimming, then alternating with cycling, jogging, and running. He needed to continue to be aware of any warmth or swelling as described previously.

A Brief Explanation of Platelet Rich Plasma

PRP Prolotherapy injections for accelerated healing.

PRP Prolotherapy injections for accelerated healing.

A treatment with Platelet Rich Plasma (PRP) consists of the injectionof 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.

After this PRP treatment, we didn’t see Nathan for six months.  When he returned to the office for another treatment, he said he was now able to run without pain, was able to cycle without pain, and was able to weight train with no pain. His goal was to continue training pain-free.  The PRP from this last visit continued regenerating the cartilage in Nathan’s knee, and allowed him to get to the place of running the longer distances he desires.

 

Chondromalacia Patella and Physical Therapy

Since chondromalacia patella causes the kneecap to scrape the leg bones when the knee is moved, traditional treatment usually involves 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. 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 it does not do anything to repair the deteriorated cartilage in the patellae and, thus, does not alleviate the chronic pain that people with this condition experience.

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.

As 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. Trying to eliminate the painful area by shaving, cutting, or removing tissue only delays the pain for a few years until the remaining tissue becomes degenerated. Patients and athletes with chondromalacia patellae often succumb to surgical procedures, even drastic ones. A good example of drastic surgery is the recommendation to surgically remove the patella in order to remove the pain. 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. 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. Trying to eliminate the painful area by shaving, cutting, or removing tissue only delays the pain for a few years until the remaining tissue becomes degenerated. Patients and athletes with chondromalacia patellae often succumb to surgical procedures, even drastic ones. A good example of drastic surgery is the recommendation to surgically remove the patella in order to remove the pain. 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.

See our Chondromalacia Patella research published in Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders.

Think Prolotherapy may be for you? Call us!

Schedule a consultation via email or call us at 708-393-8266, and tell us more about your case to determine if you are a good candidate for Comprehensive Prolotherapy. Caring Medical is a leader in Prolotherapy, Stem Cell therapy, and Platelet Rich Plasma, with offices in Chicago land and Southwest Florida, servicing patients from around the globe. Our Prolotherapy practitioners, Dr. Ross Hauser, PA Danielle Steilen, or Dr. Timothy Speciale, would be happy to help you achieve the pain-free life you desire. The difference is in the care, technique, and experience you get with the team at Caring Medical.

The Prolotherapy treatment regimens suggested here are based on the experience of Caring Medical, and are provided for informational purposes only. They do not apply to every case or condition. A person using these recommendations without the aid of a personal physician does so at their own risk. It is essential to have your condition evaluated by your own healthcare provider. For a consultation with one of our specialists, please make an appointment.

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