Question:

Hello, doctor! I hope you are well. I have two questions. I am under the care of an orthopedic surgeon for chondromalacia patellar in both of my knees. I had an MRI of one knee in July and it was clean, no torn meniscus or any tendon/ligament damage. After following a rehab exercise routine x2 months and taking Naproxen my condition has not improved, and my doctor wants to try viscosupplementation shots. He has really been promoting the new SynviscOne treatment but I have not decided yet. My first question: Is viscosupplementation normally used to treat someone with chondromalacia patellar? From what I have read online, it is used only for people with bone-on-bone arthritis. I do not want to have my knees treated with viscosupplementation shots if they will not work. My second question: How long does chondromalacia last? I have been injured since June and the only thing that brings any relief to my knees is lying on the couch with two ice bags on my knees. Naproxen helps a little, as does wearing sleeves on my knees. I want to get well and return to jogging, playing softball, and being more active around the house. Thank you very much for your help! I value your opinion and look forward to hearing from you.

Answer:

CMP or ChondraMalacia of the Patella is a very frustrating condition where the patella tends to track incorrectly resulting in pain, swelling, muscle atrophy and loss of motion.  The frustrating aspect is finding the one main cause so it can be addressed and the condition improved, this can take several months unfortunately. 

In my experience, if a torn meniscus is ruled out, we have to consider whether this CMP is caused by muscle issues (weakness, imbalance, flexibility) or bone issues (the articular cartilage – the very thin lining found under the patella – being worn down).  If you feel that the rehab was thorough and followed correctly, then you may have to consider this might be more bone/articualr cartilage.  If so, then the SynviscOne is an appropriate treatment. 

Other options to consider:  maybe another therapist who has a different rehab protocol or look at other anatomical/mechanical issues you can address such as orthotics for your shoes.  I’d also look at your mechanics in your daily living (at work, home, etc.) to see if you are doing any damage to your knees (i.e. repetitive work at desk, on your feet all day, climbing stairs often).

I hope this gives you a few things to consider as you take control of your treatment plan.  Good Luck.

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