Patient: I’m an athlete and have chondromalacia patella in both my knees, and need to get some advice on treatments. I rested the knee completely from all exercises for about 5 months once, but after I started doing exercises the pain came back again. I need to get advice.
Symptoms: Knee pain in both knees, tendinitis in both quadricep tendons
Doctor: Hello,Thank you for your medical query at AskTheDoctor.comI understand your concern.Chondromalacia of the patell a occurs due to excessive use of the knee joint putting strain on the patella.Though the primary reason is not known, some people have a slight misalignment of the patella and they are more prone to this condition.The first recommended step is to avoid overuse, and also lose weight.The treatment of this problem is usually non-operative and includes; weight loss, medications involving painkillers, activity modifications, softer soled shoes, physical therapy and occasionally injections. If these modalities are unsuccessful then surgery is an option. The goal of treatment if to improve pain and improve the function. None of these options will change the underlying wear and there is nothing at this point that will re-grow cartilage. The patella helps to improve the biomechanics of the quad muscle.You already stopped all exercises for 5 months, but the pain is still back. Now, you need to go for regular physiotherapy and learn a few quadriceps strengthening exercises. You also need to maintain your BMI within 18-22, as in patients with Chondromalacia, 1 pound gained is equivalent to 4 pounds of pressure put on the patella. There are specific grading based exercises which your physical therapist can guide you with.If none of these measures help, surgery is the only option.Hope this was helpful,Feel free to discuss further,Regards.
Comments / Follow Ups
Thanks for the reply. Let me clear up a few things about me first :
I’m 5’10, 172 lbs, about 15-16% body fat. Athletic…So weight isn’t the issue.
I also have tendinitis 2nd to 3rd degree in both quadricep tendons, that (to me) is primarly where I’ve always felt the pain when squatting, or doing lunges, etc. Though the past few months I have felt a small “clicking” in my right knee sometimes.
When I started crossfit recently, it would just hurt to do any type of squat, even with light weight (80 lbs). For comparison, I used to do reps of 240 lbs with no problem. So I feel the pain primarly in my quads.
I have read that people say they feel pain when sitting with this condition. I have never felt any pain when sitting down.
I’ve been to a sports medicine and traumatology expert, and he recommended first physical therapy, that includes electromagnetic therapy, inferential current therapy, and ultrasound therapy for 10 sessions. Then he said once I get back to the states (I’m in mexico now), to get the following :
platalet rich plasma therapy
Sodium hyaluronate for my knees
and Ozone O3 therapy
So my questions are, do you know anything about the above therapies and what do you think and also, how much have you seen traditional physical therapy workouts and exercises to help with this condition?
My goal isn’t to just be able to walk and sit pain free (I already can and have been able to do that). My goal is to be able to squat pain free and to ideally be able to get back to athletics, etc.
That’s the best way to explain it, looking forward to your reply.
Thank you for your additional information.
It does clear a lot of things.
I appreciate your will to still remain athletic fighting through all the pain. Most of the patients stop working out and stop putting any further additional pressure on the knees once diagnosed with Chondromalacia.
You’re not overweight and that definitely helps. Try to maintain your weight in the same range.
The sports medicine expert has advised electromagnetic therapy, inferential current therapy, and ultrasound therapy, and this is the recommended treatment of your condition. The tendinitis does complicate the issue, and as of now, the pain could be more due to the tendinitis and less due to Chondromalacia. Physical therapy does help, but the patients still complain of on and off pain, when overexerted. Since you want to lift weights and do squats even with physical therapy, you may experience some discomfort in the future.
Out of the 3 you mentioned, Sodium Hyaluronate is the most tried method, and it is mostly given to patients with OA and severe pain. These people do complain of pain-free period following the injection, as it basically works like a shock absorber. So, it depends on how you feel after the injections- if you’re able to squat without any pain.
As of now, you’re on the right track. But it can’t be predicted whether the pain will completely go away following this treatment.
Hope this was helpful,
All The Best!!
Patient: Hey Doc,
Last question – do you happen to know or have any idea of the cost range for the sodium injection? Ball park figure? I can’t seem to find any info on it online, or where I can even get one.
Unfortunately, I won’t be able to give you the exact information. But roughly it costs around 60-70 $ per injection, and it needs to be taken either once every 2 weeks or once every month for 3 months, depending on the condition of the joint.