Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN
We are going to look at the problem of Patellofemoral Pain Syndrome as a problem of knee instability. A problem that can be treated with regenerative medicine injections such as prolotherapy.
In our three decades of treating and researching problems of the knee. we found prolotherapy (dextrose injections), can be effective for many patients with Patellofemoral Pain Syndrome because it targets and treats knee instability. It does so by strengthening lax ligaments and tendons supporting the patella. This concept of treating the unstable knee targets whole knee treatments because, as we have found, problems of the patella do not typically happen in isolation.
You must treat the whole knee to fix the problem of patella pain
A study in the journal Radiology and Oncology (1) discussed what radiological findings revealed in 100 patients with patella problems.
- Mild osteoarthritis (grade I and II) was determined in 55 patients
- Severe osteoarthritis (grade III and IV) in 45 cases.
- The cartilage behind the knee cap at the retropatellar joint:
- 25 patients were assessed as normal cartilage,
- 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and
- 46 with severe chondromalacia patella (grade III and IV).
- Medial meniscus tear was determined in 51 patients.
- Severe osteoarthritis and chondromalacia patella were positively correlated with a meniscal tear. (If you have chondromalacia patella you likely have a meniscus tear).
- The researchers observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear.
Comprehensive Prolotherapy for Patellofemoral Pain Syndrome – treating the whole knee
In 2014, our team published research in the journal Clinical medicine insights. Arthritis and musculoskeletal disorders. (2) We conducted a retrospective evaluation of the efficacy of prolotherapy in alleviating pain, stiffness, and crepitus, as well as enhancing physical activity among consecutive patients with chondromalacia.
In this study, a total of sixty-nine knees from 61 patients (33 females and 36 males) aged between 18 and 82 years (mean age, 47.2 years) were included in the study. Each patient received 24 prolotherapy injections to the anterior knee. At least six weeks following their final prolotherapy session, patients were asked to self-assess their knee pain at rest, during activities of daily living and exercise, as well as their range of motion (ROM), stiffness, and crepitus. We documented the severity of symptoms, the persistence of symptom improvement, the quantity of pain medication utilized, and patient satisfaction levels before and after treatment. Post-prolotherapy, patients exhibited statistically significant reductions in pain at rest, during activities of daily living, and while exercising. Additionally, stiffness and crepitus diminished, and ROM improved. Patients reported enhanced walking and exercise capabilities following prolotherapy. For daily pain levels, ROM, daily stiffness, crepitus, and walking and exercise abilities, 85% of patients reported sustained improvements exceeding 75%.
Summary 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.
When we examine a patient with patellofemoral pain syndrome, we can see that the patella is usually “tracking laterally.” This means that the knee cap is slightly out of the central groove it normally sits in and has moved to one side. This is reflected on x-ray such as the one below.
We explain to the patient that our goal of treatment is to get the kneecap back into its groove with simple dextrose injections targeting the muscle attachments that connect the muscle to the knee cap (the quadriceps tendon at the patella tendon). We also explain that we want to target the various ligaments in the knee, to strengthen them, and help pull the knee back into correct anatomical alignment.
Read our published research
Evidence-Based Use of Dextrose Prolotherapy for Musculoskeletal Pain: A Scientific Literature Review: This paper has been cited by 45 research studies as we were able to demonstrate level 1 and 2 evidence to support the use of dextrose Prolotherapy for osteoarthritic pain and function, tendinopathies, myofascial pain syndrome, sacroiliac pain, and myofascial pain syndrome. There is level 3 evidence in support of the use of dextrose Prolotherapy for diffuse muscusloskeletal pain involving the spine, pelvis and peripheral joints. Dextrose Prolotherapy should be recommended for such musculoskeletal conditions as tendinopathy, ligament sprains, Osgood-Schlatter disease and degenerative joint disease, including osteoarthritis.
More reading
Prolotherapy for knee instability in Patellofemoral Pain Syndrome
References
1 Resorlu M, Doner D, Karatag O, Toprak CA. The relationship between chondromalacia patella, medial meniscal tear and medial periarticular bursitis in patients with osteoarthritis. Radiology and oncology. 2017 Nov 29;51(4):401-6. [Google Scholar]
2 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. [Google Scholar]