KNEE CAP PAIN
Ross Hauser, M.D.

When there is a problem with this part of the knee it manifests as pain in the front of the knee after strong exertion (running, walking, or stair climbing.) This may be due to erosion of the cartilage on the under side of the patella, poor tracking of the patella in its groove on the front of the knee, or an inflamed tendon on the lower edge of the patella.

The patella is covered on its back side with the thickest layer of articular cartilage see also Articular Cartilage Growth (see research paper) of all the joints in the body. Erosion of this cartilage is called "chondromalacia patella." On x-ray it is seen as a decrease in the amount of cartilage underneath the kneecap. It may be caused by trauma or occur spontaneously. If the patella is fractured, pain may still persist after the fracture heals. Prolotherapy is excellent at relieving all of these pains.

Prolotherapy helps chondromalacia patellae or patellar tracking problems because the pain-producing structure is generally the patellar tendon or the musculoskeletal support around the patella. Prolotherapy for chondromalacia involves intra-articular (inside) injections as well as injections on the outside of the knee, stimulating the growth of many musculoskeletal structures around the patella. It is for this reason the knee gets stronger and the pain of chondromalacia is relieved.

Patellar Tendonitis
Another common condition is patellar tendonitis, which can occur at the sides, the top, or the bottom of the patella. It commonly occurs in athletes who do a lot of jumping, such as basketball players, volleyball players, and ballet dancers. This is why it is also known as "jumper's knee." By injecting the appropriate site with Prolotherapy, these injuries are effectively and permanently treated and the pain is relieved. This is because Prolotherapy helps strengthen the patellar tendon (though some would call this the patellar ligament since it goes between two bones, the patella and the tibia). While Prolotherapy causes a strengthening of the patellar tendon, cortisone and its related anti-inflammatories, weaken it. For this reason patients should avoid cortisone injections into the patellar tendon because of the risk of it weakening and thus leading to rupture of the tendon. This occurs because cortisone weakens the ligament/tendon-bone junction. Cortisone and the other anti-inflammatories have a lot of other bad effects.

Do Not Be Desperate for Surgery or Scopes
Patients with pain often succumb to surgical procedures, even drastic ones. A good example of drastic surgery is the recommendation to surgically remove the patella in order to remove the pain. This sometimes does relieve the pain, but at a significant cost to the body. The strength to extend the knee is reduced by about 30 percent, and the force exerted in the knee is increased. There are a host of other risks associated with surgery. The athlete must realize that with each procedure and each shaving or cutting of tissue, NSAIDS (non-steroidal anti-inflammatory drug) prescription, or cortisone shot, the odds of developing long-term arthritis are greatly increased. The key to keeping the knee strong is to stimulate the area to heal, not to cover up the pain with a cortisone shot or NSAID. Even worse is to eliminate the painful area by shaving or cutting. This just delays the pain for a few years until the remaining tissue becomes degenerated. The best approach is to stimulate the area to heal. The best way to do that is with Prolotherapy.