PROLOTHERAPY COMBINED WITH PHYSICAL THERAPY IN A RECREATIONALLY ACTIVE MIDDLE-AGED MAN WITH CHONDROMALACIA PATELLA

Kristin Bowne,Michael Ross,Joshua Prall

doi:10.46827/ejfnsm.v2i1.99

Abstract

The purpose of this case report is to describe the use of physical therapy combined with prolotherapy in a recreationally active, middle-aged man with knee pain and chondromalacia patella. The patient was a 50 year-old male triathlete presenting with a chief complaint of persistent left knee stiffness and anterolateral knee pain. The patient’s symptoms began insidiously 9 months prior after an increase in his triathlon training activities. His knee pain progressed to the point that he could not perform any weight bearing exercise without significant discomfort. Previous treatments included management by a physical therapist, as well as corticosteroid and hyaluronic acid injections. Although these previous treatments provided minimal benefit, the patient sought further management by another physical therapist. Magnetic resonance imaging findings revealed moderate to severe chondromalacia at the lateral patellar facet. In addition to management by a physical therapist, the patient received a series of three prolotherapy injections to the knee. Physical therapy management consisted of manual therapy for the lower quarter, targeted therapeutic exercise to address strength deficits of the quadriceps and hamstring muscles, and a gradual return to weight bearing exercise and functional activity. At 4 months following the physical therapy and prolotherapy injections, the patient reported no pain during daily activities. Additionally, he had returned to swimming, cycling, unlimited walking and hiking on various surfaces, and agility drills. In patients with knee pain and chondromalacia patella, especially those who have not responded to prior interventions, physical therapy combined with prolotherapy may serve as a treatment option.  Article visualizations:<img src="/-counters-/edu_01/0887/a.php" alt="Hit counter" />

Highlights

Chondromalacia patella is defined as the softening, thinning, and degradation of articular cartilage due to repeated stress to the articular surface.[1]
In patients with advanced knee osteoarthritis, Topol et al.[6] determined that intra-articular prolotherapy injections were associated with chondrogenesis and clinical improvement compared with baseline status, as assessed through arthroscopy before and after treatment, posttreatment biopsy, and a disease-specific outcome questionnaire
Prolotherapy has been shown to be an effective treatment for patients with numerous musculoskeletal pathologies, including chondromalacia patella

Summary

Introduction

Chondromalacia patella is defined as the softening, thinning, and degradation of articular cartilage due to repeated stress to the articular surface.[1]. Recent evidence suggests that prolotherapy, which is an injection of a hypertonic irritating solution (usually dextrose) to intra- and extra-articular tissues, in the treatment of chondromalacia patella is associated with substantial gains in pain relief and functionality.[5] While the exact mechanism of prolotherapy treatment is not well understood, it is thought to induce a pro-inflammatory response that results in the release of cytokines and growth factors.[6] This results in a regenerative process within the affected joint. The purpose of this case report is to describe the use of physical therapy combined with prolotherapy in a recreationally active, middle-aged man with knee pain and chondromalacia patella. European Journal of Fitness, Nutrition and Sport Medicine Studies - Volume 2 │ Issue 1 │ 2021

Patient Case

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