Outcomes of Prolotherapy in Chondromalacia Patella Patients: Improvements in Pain Level and Function
Chondromalacia patella (CMP), also more commonly referred to as patellofemoral pain syndrome, has classically been identified as one of the resultant factors towards osteoarthritis (OA). CMP is a product of inflammation and progressive degradation and thinning of cartilage underneath the patella which results in mild to severe chronic pain around the knee cap, stiffness and crepitation, along with exacerbation of pain upon physical activities such as climbing stairs, running and squatting. The cause of CMP range from various age groups of 18 to 82 years old and the etiology can range from age-related to trauma such as: overuse, ligament injury, excess laxity to joint hyper mobility. In addition, anatomical variants such as congenital flat feet or the patella not fitting properly into the femoral groove upon movement can result in CMP.
Current treatments for CMP only helps in minor symptoms of pain which includes rest and vitamin D; nonsteroidal anti-inflammatory drugs (NSAIDs); muscle strengthening exercises, corticosteroids; and as a last resort, knee replacement. A recent study on the effectiveness of prolotherapy in CMP patients was conducted by Dr. Ross Hauser. This was a retrospective study which enrolled 61 patients and 69 knees with clinical findings of CMP (8 patients with bilateral CMP) from February 2008 to September 2009. From the selected patients, each knee received prolotherapy injections (15% dextrose, 0.1% procaine, and 10% sarapin) in a series of 24-40 injections with intervals of 4-6 weeks to allow sufficient time for fibrous collagen production.
Prolotherapy had a notable effect for improved pain levels and related symptoms of chondromalacia patella in greater than 92% of patients. Improvements also included range of motion, stiffness, crepitus and an overall reduction in pain symptoms during exercise. These results were obtained through follow-ups by phone call and office visits in sequence of post-injection day one, 1 month and 3 months. During follow-ups, patients filled out a self-assessment on pain levels that addressed a pain scale from 0-10 (0 being no pain and 10 being severe, debilitating pain) during rest, activities of daily living, exercise, and levels of stiffness and crepitation. However, a control group and radiographic studies were not conducted and warrants further observation if there is any cartilage regeneration through imaging studies. Overall, this significant reduction in pain symptoms and improvements in physical activity for patients with CMP, along with reduction of pain medications, indicates prolotherapy as a possible first line conservative treatment in CMP patients and deviate away from OA progression.
For the latest research and leading-edge therapies treating osteoarthritis, attend the upcoming PRP & Regenerative Medicine Symposium with Cadaver Lab, June 6-7, 2014 in Las Vegas – also streamed online, www.prpseminar.com.