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The Patella (Knee Cap)
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)
of all the joints in
the body. Erosion of this cartilage is called "chondromalacia
patellae." 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
drugs (research paper at
prolotherapy.org))
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.
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