Patellar and Quadriceps Tendon Diseases, Enthesopathy

The patella (knee cap) is surrounded by the tendons of the quadriceps muscle, with the muscle initially attaching to the patella and then continuing around it, also attaching to the tibia (shin bone) with the patellar tendon. These attachment points can weaken, leading to chronic inflammation. This can result in swollen and painful knees, exacerbated by activities such as squatting, jumping, and dynamic movements, while rest tends to improve symptoms. Treatment typically involves rest, pain relievers, and physical therapy, with most cases showing symptom improvement within a few months. In cases of persistent symptoms, PRP (Platelet-Rich Plasma) therapy is often a successful treatment option.

Osgood-Schlatter Disease

Osgood-Schlatter disease affects young athletes, characterized by irritation of the tendon beneath the patella, specifically where there is a growth zone. Symptoms include pain and swelling below the knee, occurring during rapid growth and intense physical activity. Treatment usually involves rest, pain relievers, and physical therapy, with symptoms often improving within a few months. If symptoms persist, Platelet-Rich Plasma (PRP) treatment may help, although there is limited research supporting its beneficial effects..

Knee Cartilage (Meniscus) Injury

Injuries to the inner knee cartilage (meniscus) are quite common. In a typical case, the meniscus initially starts to protrude, which is easily detectable through ultrasound. Over time, the protruding meniscus degenerates, tears, and wears down due to its improper position during knee flexion. Injuries often occur at the rear horn of the meniscus, but patients typically perceive it as general or internal knee pain. This condition is common in middle-aged individuals and occasionally in the young. Usually, the cartilage surfaces appear intact or minimally worn. Initially, pain tends to spontaneously decrease, but degeneration continues. Treatment is challenging, and arthroscopy may be an orthopedic surgical solution. Regenerative approaches can be attempted, often requiring multiple sessions, as meniscus injuries are slow to heal. In such cases, the treating physician may administer a specialized PRP formulation directly into the meniscus tear.

Knee Degeneration, Arthritis

The most common condition affecting many individuals aged 45-50+  is knee osteoarthritis. In this condition, the cartilage covering the knee wears down, and the meniscus degenerates and protrudes. In approximately 90% of patients, the inner side of the knee is primarily affected, making it sensitive – including the inner side of the thigh bone and shin bone, the entire meniscus, and often the posterior surface of the patella. Eventually, the entire knee may become symptomatic. Trauma, accidents, congenital, or acquired deformities can also lead to complaints originating from the outer side of the knee.

Physical therapy is the first choice, as always with chronic pain conditions.

However, when physical therapy proves unsuccessful or limited in it’s efficacy, various other treatment options are available. These include hyaluronic acid injections, PRP therapy, and in selected cases, stem cell treatment. A further option is radiofrequency denervation of the knee, where tiny sensory nerves around the knee are deactivated. Often, a combination of these approaches is applied, achieving rapid and long-lasting pain reduction.

Hyaluronic acid treatment is quick and straightforward, with research confirming excellent results lasting up to 3-6 months. Unfortunately, it does not slow the progression of knee degeneration.

PRP reatment effectiveness has been analyzed through 86 randomized controlled trials to date, involving the examination of thousands of patients. It has been demonstrated that the appropriate quantity and quality of PRP improve the knee’s condition in the long term. Numerous studies have followed patients for years, confirming pain reduction and improved functionality. Your treating physician can determine the most effective therapy using a specific PRP device and preparation methods.

In severe cases, knee replacement surgery  may be a solution.