Chondromalacia patella - any treatment that cures it?

[silver_maple]

Hi fellow knee-sufferers!

I've reviewed the board thoroughly for chondromalacia patella and could not find any posting that suggests a cure. Once afflicted, are we condemned to a softened cartilage that only gets worse over time? Yes, we could try to slow the process down, maybe halt it, but reverse and harden?

I am a 50-yo male, with chondromalacia patella in both knees, grade 1-2, right knee is worse. The right knee also has a partial meniscus tear (untreated, largely asymptomatic) and mild medial tibial chondrosis, confirmed with MRI. I was a long-distance runner for 22 years and I think that caused it. I no longer run. I am on the skinny side.

Saw a sports doc in Toronto, Canada (where I live). He said there is no patellar maltracking. Recommended strengthening the quads. Fair, not a bad thing, I am working on that. But I am sceptical stronger quads would resolve the chondromalacia given no maltracking. We also did 3 PRP injections spaced 3 weeks apart, no meaningful effect. In fact, I feel the chondromalacia has worsened over the past 6 months. Lots of crunching and cracking on knee flexion, esp. when going up stairs.

Has anyone had any success in reversing patellar chondromalacia? I am mainly interested in non-surgical means at this stage. I've read about microcurrent stimulation, ultrasound, physio, rest & ice, stem cells, PRP, Lipogems, and other means. Nothing definitive.

Pain is low level and dull but occasionally inflammation flairs up, which is joint destructive and scares me. I treat it with rest and ice but affects my sleep as well.

Thanks!

[Dave33]

Hello fellow torontonian! Yes, "chondromalacia" is sort of a catchall that all the doctors used in my intial go-around for the sports doctors around the city when it comes to patellafemoral irritation/wear.

The advice of "quadricep strengthening" is pretty much right from the hey, get this guy out of my office and see if it improves on its own before I start taking is seriously" field of medicine. Will it help? Possibly. Will it make it worse? Probably equal chance, especially with someone who has a runner's mindset on pushing the envelope. Depends on where the damage is on the kneecap.

I think (personal opinion, of course) that the absolute best course of non-surgical approach for now is rest and ice, to try to find something that doesn't hurt it, and do that for exercise. The rest is likely to help lighten your wallet as a primary effect. You may get some limited regrowth if you're really careful with it, but as we age, it's a tall order.

Good luck! Bad kneecaps are the worst.

[silver_maple]

Thanks, Dave33! Good to connect with a kindred soul in my city. I'd be interested to hear more about your story, what has worked, what hasn't. Agree with your take on things. It seems to me the whole term "regenerative medicine" (for musculoskeletal conditions) is somewhat ahead of its time in humans, although it has worked in animal studies. So there is some hope but as often, years away. "Regenerative" for the time being appears to principally lead to reduced pain and inflammation for a while, I wouldn't call that "regenerative". A few clinical studies do report tissue modification, e.g. https://pubmed.ncbi.nlm.nih.gov/31861180/. Not sure how meaningful it is.

I am thinking of doing another round of PRP, certainly not as a cure, but to tilt the knee homeostasis in the anabolic direction for a while (3-6 months). I am also considering an online consult with a top-tier U.S. hospital on "regeneration" but I very well know what's allowed in the U.S. Everyone there, from the neighborhood "stem cell clinic" to the top names are in on it without solid scientific evidence of efficacy.

I am at peace with ageing and am not particularly bothered by my receding hair line or a new wrinkle. But the prospect of reduced mobility is scary as it can lead to many other issues.

[SuspectDevice]

I've had patella chonrdo in both knees to varying degrees with varying symptoms since about age 14 (I'm now nearly 57).

Have had several MRIs and numerous doctor/orthopedic surgeon/Sports Dr/Physio consults over the decades, nothing too astounding has emerged.  I don't think it is really a tracking problem though physios will tell you different and try McConnell taping.  Mine was just a heavy knee use problem, plus plenty of frontal knee impacts when young.

One Sports Doc had the problem himself and had 'micro-fracture' done (drill small holes in back of patella in the damaged areas, they then fill in with a cartilage type material).  He reported a good result, though I don't think he pushed his knees with sport.

My OS said he was surprised I could do triathlons given the size of the defects on my R patella, but it was PFPS (chronic synovial inflam) that brought me undone, not chondro.

Re healing - mine has definitely healed to an extent (based on symptoms, not imaging) due to PFPS massively reducing the training I could do.  Now as I build that training back up, the PFPS is gone, but I can feel the chondro ebbing and flowing again.  I think all the hip/glute/core/balance work I did during my PFPS saga has helped control it.  And I regulate my training to live with the chondro.

[silver_maple]

Thanks for sharing your story, SuspectDevice. Our chondro etiologies are similar - no maltracking, simply excessive use. I stopped running 11 years ago but kept hiking and long city walks for years after. Now I have to scale these back, too. I've heard chondro could reverse itself if one is young (< 25 yrs) and refrains from pushing the joint for a few months. Over 50, not so much.

I am doing some isometric exercises for the quads and more rest but it appears I'll have to live with this. And as the years pile on probably other not so good things will happen, like it or not. If I elect to try something "regenerative", I can report. I am not keen on micro-fracture - generally results in inferior fibrocartilage.

Partly as an aside, joint distraction has been repeatedly shown to result in articular cartilage regeneration, e.g. https://pubmed.ncbi.nlm.nih.gov/28618871/. The received wisdom is that avascular, aneural hyaline cartilage has little, if any, regenerative capacity. I've read the synovium contains some stem cells that migrate over to cartilage defects if the joint is left in peace.

Dave33, I went through your posts. You've been through a lot, man! It's inspirational that you are still actively engaged in traditional Canadian pursuits like hockey.

[SuspectDevice]

I'm not sure if I get some healing of my chondro, or just a settling of inflammation around the damaged areas.  I do recall a previous MRI showing deep fissures in my patella cartilage.

These days I can cycle very hard for an hour or so without flaring any pain up for more than a day or so.  Sometimes (y'day), I get no flare at all.

I've also learned to tell the difference between chondro pain (more of a sharp catching) and PFPS = synovial inflam (a more constant burning/ache).  Chondro pain is much much easier to live with.

Yes, I also have other fun age issues going on - enlarged prostate (currently controlled by meds), high blood pressure (controlled with meds) and arthritic symptoms in thumbs, big toes, wrists, lower back.  But I keep on doing whatever training I can as the exercise endorphins help accept these aging problems.

When the stars align and injuries allow (all running related), I can do the odd sprint triathlon though I'm about 17% slower than I was 10 years ago....but still get a buzz when I beat a 20-something year old    Mostly though I just cycle/swim/gym 6-7 days/week for between 30-90mins.  I think doing what you can is important to maintain some strength & fitness as you get older.

[Dave33]

Dave33, I went through your posts. You've been through a lot, man! It's inspirational that you are still actively engaged in traditional Canadian pursuits like hockey.

Hehe, I'd say that 90% of the negative experience was self inflicted; regardless, I count myself lucky compared to what I read a number of posters going through. I was pleased to finally find a solution, in no small part due to this website, but the half-measures were definitely worse than doing nothing at all.

Keep us updated as to what and how you're doing.

[RGB]

Sorry guys - I'm unable to restrain myself from adding my uncalled for opinion which is similar to Dave33's.

My original problems were a meniscus tear and focal lesion in the trochlea groove, diagnosed in my late 40s. All non-surgical interventions were ineffective, all surgical interventions made things worse, until the final one which was a PFJR. It's fantastic now (at 58) in comparison to before the PJFR but I'm unable to say whether or not it's better than if I had done nothing when it was first diagnosed. I can say that the 10 years or so of trying various treatments/surgeries was a waste of time, effort and emotional energy. So if I had a patellofemoral problem now I'd be looking for a material improvement in technology before starting down the same pathway I took 10 years ago and I'm not aware of one.

Sorry to be so negative - I don't feel that way about my own knee now because it's actually pretty good and I'm now able to carry out the activities which are important to my physical and mental wellbeing. But the journey to here was not a great one. Good luck and regards to all.

[Mikewithers86]

RGB I think you are spot on. I am optimistic that Jointstem or tissuegene-c will be approved within a matter of a few years but I genuinely think that PFJR is the way to go if those fail to amount to anything. This notion that people with chondro should simply live with it isn’t flying with me. We deserve the exact same treatment options made available to those who have OA.

[silver_maple]

Jointstem appears to have passed Phase 2b/3a FDA approvals but I am not sure how close it is to final approval consideration. This Phase 3 study by the drug's main sponsor (see link) started last year and is scheduled to stretch to 2027. Results analysis, and if positive, FDA review afterwards - we may be looking at 2030. If all goes well.

https://clinicaltrials.gov/ct2/show/NCT04427930

I am less sanguine on the allogenic Invossa/tissuegene.

[Leeds, UK]

Hi,
I have chondromalacia of L Knee (right knee was Grade 4 and required surgery. See my post about that if you like). I have found the approach of Doug Kelsey to be very helpful - using exercises that load the knee, within it's envelope of function. I used a Total Trainer and did lot of squats with low % of body weight and gradually built it up as cartilage got nourished and reconditioned.
https://www.dougkelsey.com/knee-cartilage/
Two books - one on Runner Knee and one on arthritis  - I found his framework and approach very helpful. Long, slow approach to nudge cartilage back to health.
Left knee now way better. Still a little crepitus but a lot less and knee more resilient