Chondromalacia Patella is a fancy medical name for the degenerative breakdown of cartilage on the backside of the knee cap.  Cartilage is a rubbery and durable protective lining at the ends of bones in joints that allows fluid movement of the joint without friction or grinding of bones.  Basically through repetitive wear and tear the cartilage on the back of the knee cap slowly thins downs and over time this eventually can lead to knee pain and even instability. (1)

Who gets Chondromalacia Patella?

• Runners
• Young Athletes
• Females (more so than males)

Signs and Symptoms

• Dull and Achy Knee Pain behind the knee cap (patella) 
• Pain going up and down stairs
• Pain while running
• Inflammation and Swelling of the front of the knee
• Trouble bending the knee

Diagnosis of Chondromalacia Patella

Chondromalacia Patella is typically diagnosed through primary care physicians or Orthopedic doctors.  The diagnosis can be made through a detailed case history along with specific knee tests performed by the doctor to elicit the symptoms the patient is experiencing.  Additionally, imaging is typically completed as well for the final diagnosis.  The two most common imaging studies utilized are x-rays and MRI’s for chondromalacia patella, with MRI being the gold standard.  Some insurance companies may require an x-ray to be completed prior to authorizing the MRI. (2)   

Conventional Treatments

Typical first line treatments for chondromalacia patella are rest, ice and over the counter non-steroidal anti-inflammatories (NSAIDs) such as Ibuprofen, Naproxen, Aspirin etc.  If the pain persists, physical therapy would be indicated.  The last option of treatment is surgical intervention that can include releasing the ligaments around the patella for more fluid movement or shaving down the arthritis on the back of the knee cap for less pain and grinding.  Both surgical options will not restore the tissue back to normal health but can relieve pain. (3)

PRP for Chondromalacia Patella

Platelet rich plasma is a new therapy for chondromalacia patella and thus research is only in the beginning stages.  That being said, there are some promising studies showing great benefits.  Let’s dive into what we know so far.

The first study is a case report paper on a 48 year old woman who had knee pain for 3 years in both her knees.  She had tried over the counters, muscle relaxers and physical therapy with no benefits.  She was evaluated and diagnosed with stage 2 chondromalacia patella bilaterally.  The doctor then completed a series of 3 PRP treatments on the patient spaced 1 month apart for each.  One month after the 3rd treatment the patient was re-evaluated using the WOMAC questionnaire.  The patient’s knee pain had significantly decreased and her functionality had increased.  The authors concluded that this was an effective low risk option for people with chondromalacia patella. (4)  

The second study was larger and involved 24 patients with chondromalacia patella with at least grade II severity or higher.  This study took place at a hospital in Spain and the doctors also gave the patients 3 PRP treatments but they were spaced 1 week apart in this time.  The researchers completed a follow-up evaluation 6 months after the last treatment and measured the outcomes on the WOMAC scale as well as visual analog scale.  They found that PRP significantly reduced pain on both scales and improved function and decreased stiffness on the WOMAC measurements.  The doctors concluded that there was a good level of evidence to use PRP as a conservative treatment in chondromalacia patella patients. (5)

The third study was larger and involved 69 total patients with chondromalacia patella between grade II-IV.  The patients were divided up into 2 groups, with one group receiving PRP treatment and the other group prolotherapy treatment.  Each group received a total of 3 treatments that were each spaced 3 weeks apart from each other.  All patients were re-evaluated at the 12 month mark following the treatments.  The results showed patients experienced decreased pain overall, increased range of motion of their knee, increased exercise ability, decreased crepitus (cracking/grinding sound of bones), and decreased amount of medication the patients needed to take.  The researchers concluded that PRP relieves symptoms of chondromalacia patella and improves physical ability. (6)    

Benefits of PRP for Chondromalacia Patella

• Reduces Pain in the Knee
• Improves Function
• Reduces Stiffness
• Increased range of motion
• More effective than conservative treatments

Our Clinics Approach to Chondromalacia Patella

At Atlas Health Medical Group, Dr. Krueger deploys a comprehensive approach to treating chondromalacia patella that involves 3 main strategies.

1. Comprehensive Platelet Rich Plasma (PRP) injections:  One aspect that makes our results consistently good compared to other regenerative medicine clinics is our thorough approach to treatment.  For example, most orthopedic clinics will do just 1 injection as their treatment for chondromalacia patella.  This may provide some benefit, typically short term, but fails to address all the underlying causes of the condition.  Our treatments typically involve many injections throughout the knee joint in order to stabilize and strengthen all the structures involved in the condition as well as the structures being used to compensate for the damaged area.  All treatment sites are numbed with local anesthesia and even though there are a lot of injections, it’s very tolerable.   
2. Optimizing Nutrition:  A patient’s diet plays a massive role not only in their pain progression but also their ability to heal and recover from treatment.  A body that is chronically inflamed will have higher pain and heal slower.  To maximize the results of the PRP injections, we strongly advise patients to switch to an anti-inflammatory diet.  This is essentially a no sugar, no processed food diet with lots of healthy proteins and fatty acids.  The first step we advise patients to take is to eliminate sugar out of the diet.  This step alone is a game changer and often just doing this will lower pain down by 1-2 levels.  Practical examples of this would be giving up soda pop for water, or giving up ice cream and dessert for a cup of berries.  
3. Personalized Supplements: The final piece of the puzzle is tailoring a customized supplement plan to optimize recovery and minimize inflammation.  There are a few key supplements that fit this description that we frequently use but for all patients a basic starting block approach would include a bioavailable multivitamin and a high quality fish oil in therapeutic doses.  In some cases, we can switch a patient off of NSAIDs such as Ibuprofen to healthier alternatives that are just as effective clinically.  

Summary

Platelet Rich Plasma or PRP is a new treatment for chondromalacia patella with very promising results both clinically and in limited research to date.  This condition is commonly seen in young active adults especially young female athletes and can be treated successfully without surgical intervention.  The earlier the diagnosis and treatment, the better the long term results.  Fortunately, modern regenerative medicine can reduce knee pain associated with chondromalacia patella and improve function and stability.   

Additional Resources

Facebook Knee Pain Support Group

Author:

Dylan Krueger, NMD

Atlas Health Medical Group