Can Stem Cell Therapy help chondromalacia patella?
- Research says stem cell therapy effective in high level athletes with Chondromalacia patella
- Research says chondromalacia patella tears or lesions may not be the cause of pain in back of knee
- Research questions use of knee braces
- Patellofemoral pain syndrome more widespread than thought
One of the most common problems we see in our new patients is the problem of Chondromalacia patella, that is the breakdown (malacia) of cartilage (chondro) behind the knee cap (patella).
In our office we have understood this to be a wide reaching problem and this has been confirmed by researchers who say patellofemoral pain is diagnosed in up to 7% of patients seeking medical care within the United States. Females experienced patellofemoral pain more often than males. The diagnosis of patellofemoral pain increased with age and the 50-59 year old age group had the most cases.1
Patellofemoral pain or Chondromalacia patella can be a tricky problem to surgically repair as noted in the literature: “Management of chondral (cartilage) defects in the athlete is complex and multifactorial. There is little high-level evidence to support one (surgical) procedure over another. 2
Cartilage and the knee cap
The patella is covered with a layer of smooth (articular) cartilage. This cartilage normally glides effortlessly across the knee during activities such as running or stair climbing, where bending the knee is involved in the activity.
After a physical examination of the patient’s knee, we find the patella has moved out of the groove in the femur where it is suppose to be during knee motion.
Many patients initially try to keep their knee cap in place with tape and braces and manage the pain and inflammation with assorted over-the-counter and sometimes prescription medications. Researchers writing in the medical journal American Family Physician say “there is little evidence to support the routine use of knee braces or non-steroidal anti-inflammatory drugs,” 3 for knee cap pain.
Chondromalacia patella is a condition that has been show to respond very favorably to our regenerative techniques, Prolotherapy 4 Platelet Rich Plasma Therapy 5 and Stem Cell Therapy 6
Researchers in the Netherlands evaluated the outcome of patients with patellar tendinopathy treated with platelet-rich plasma injections (PRP) and whether certain characteristics, such as activity level or previous treatment affected the results. What they found was: “After PRP treatment, patients with patellar tendinopathy showed a statistically significant improvement. In addition, these improvements can also be considered clinically meaningful.”7
Five years research says stem cell injections effective for chronic patellar tendon degeneration
Most impressive is new research using bone marrow stem cells.
In one recently published study that followed eight mid-20s aged athletes with chronic patellar tendon degeneration, doctors took bone marrow stem cells from the patient’s iliac bone crest (hip bone) and injected them into the knee. These patients were then followed for 5 years to measure the long-term results of the treatment. Here were the published results:
- “At 5-year followup, statistically significant improvement was seen for most clinical scores.
- Seven of eight patients said they would have the procedure again if they had the same problem in the opposite knee and were completely satisfied with the procedure.
- Seven of 8 patients thought that the results of the procedure were excellent. According to our results, (bone marrow stem cells should be) considered as a potential therapy for those patients with chronic patellar tendinopathy refractory to nonoperative treatments.” 8
1. Glaviano NR1 Kew M, Hart J, Saliba S. DEMOGRAPHIC AND EPIDEMIOLOGICAL TRENDS IN PATELLOFEMORAL PAIN. Int J Sports Phys Ther. 2015 Jun;10(3):281-90.
2.Harris JD, Brophy RH, Siston RA, Flanigan DC. Treatment of chondral defects in the athlete’s kneek. Arthroscopy. 2010 Jun;26(6):841-52.
3. Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician. 2007 Jan 15;75(2):194-202.
4. 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.
5. Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Canacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 2010; 18(4):472-479.
6. Emadedin M, Aghdami N, Taghiyar L, Fazeli R, Moghadasali R, Jahangir S, Farjad R, Baghaban Eslaminejad M. Intra-articular injection of autologous mesenchymal stem cells in six patients with knee osteoarthritis. Arch Iran Med. 2012 Jul;15(7):422-8.
7. Gosens T, Den Oudsten BL, Fievez E, van ‘t Spijker P, Fievez A. Pain and activity levels before and after platelet-rich plasma injection treatment of patellar tendinopathy: a prospective cohort study and the influence of previous treatments.Int Orthop. 2012 Apr 27. [Epub ahead of print]
8. Pascual-Garrido C,et al. Treatment of chronic patellar tendinopathy with autologous bone marrow stem cells: a 5-year-followup. Stem Cells Int. 2012;2012:953510. doi: 10.1155/2012/953510. Epub 2011 Dec 18.