Hyalgan Injections for Chondromalacia/ Bone Spur in Knee

A teammate of mine in college had a bone spur on his heel. He went through about a half-dozen injections, and ended up causing some pretty serious damage by training hard through the masked pain. My advice is to avoid the shots if you can--and if you can find a reputable surgeon, get it done.

Look into ACI or MACI.

Can't hurt to try the hyarulon injections, but, whatever you do, don't get scoped. A proceedure can accomplish absolutely nothing to restore the degenerate joint. Oorthopedic surgeons just do this because it's an easy way for them to make money.

couldn't scoping clean out the defective cartilage and get rid of the bone spur?

"Cleaning out" frayed cartilage does not really accomplish anything, that is, does not improve the condition of the joint, and is really a scientifically meritless proceedure as research has never shown it to be useful. Removing the bone spur also will not accomplish anything because A) the bone spur is not what causes the pain, and B) it would just grow back as soon as you start running agin.

Surgery for chondromalacia is usually worse than worthless, worse because it accomplishes nothing while exposing you to all the complications related to surgery. I am speaking from experience.

has anyone had success with hyalgan? Sounds kind of sketchy to me...science behind it? mostly placebo?

Hyaluronic (sp?) acid is a staple of synovial fluid, the main lubricator of joints. These injections can help lubricate your joint, and reduce pain significantly. Scoping is, or should be a last resort, but if it is used to smooth rough areas and remove bone spurs, that will also be a significant help. It will also mean not running for 4-6 weeks to allow full recovery. AND whatever biomechaincal probelm you have that caused the chondomalacia and bone spurs will have to be corrected, or you are likely to have future episodes of the same problem.

fair enough. yeah, I've been out of running for about a year (I'm the originator of the 'knee injury (this one is different)'thread) so I am reaching my wit's end on this one.

I have had these injections 3 times. Twice it helped and once it did nothing. Relative to surgery they are easy and cheap.

I have never missed a single day from the injections. I am not sure what complications can arise from them, they are pretty simple and painless(but I may just be lucky in that regard).

Just my experience. Hope it helps.

I had the same condition and could not run for a year while rehabbing it. Three different PTs. They thought I had a torn meniscus based on MRI and chronic pain that was not relieved by rehab and rest.

As a last resort, I went in to get it scoped by Dr Marder, Kings Orthopedic Surgeon, there was no tear when they went in but they found a very sharp needle like bone spur behind my knee cap that dug a trench into my articular cartilage. There was also a lot debris in my synovial fluid.

I have been running fine now and it has been 4 years since the surgery. I had a 3 week layoff post surgery and resumed rehab & running over a 3 months period.

The take home message here is that MRIs are not 100% in terms of imaging/diagnosis nor is rehab when you have a bone spur behind knee cap.

Another key point is to see a top notch orthopedic knee specialist. One with a proven track record. There a lot of horrible knee specialists!

If you rehab the knee it will help the articular cartilage heal but the bone spur will stay there and it will redamage the cartilage once you start running again!

Based on your rehab and injury history I will certainly considered getting scoped.

I had the same condition and could not run for a year while rehabbing it. Three different PTs. They thought I had a torn meniscus based on MRI and chronic pain that was not relieved by rehab and rest.

As a last resort, I went in to get it scoped by Dr Marder, Kings Orthopedic Surgeon, there was no tear when they went in but they found a very sharp needle like bone spur behind my knee cap that dug a trench into my articular cartilage. There was also a lot debris in my synovial fluid.

I have been running fine now and it has been 4 years since the surgery. I had a 3 week layoff post surgery and resumed rehab & running over a 3 months period.

The take home message here is that MRIs are not 100% in terms of imaging/diagnosis nor is rehab when you have a bone spur behind knee cap.

Another key point is to see a top notch orthopedic knee specialist. One with a proven track record. There a lot of horrible knee specialists!

If you rehab the knee it will help the articular cartilage heal but the bone spur will stay there and it will redamage the cartilage once you start running again!

Based on your rehab and injury history I will certainly considered getting scoped.

get it scoped

Does Hyalgan do anything for bone spurs? What is the process for getting a second opinion if my OS refuses surgery?

The reason a bone spur forms is because the subchondral bone (the bone tissue immediately under the joint surface) recieves is subject to an excess of force due to the loss of the hyaline cartilage which normally protects the joint. As a result of increased mechanical stress, the bone tissue hypertrophies (grows). Removing the bone spur will accomplish nothing becuase it will not restore the lost cartilage. The chondroplasty proceedure, in which the surgeon "cleans up" the defective cartialge, generally does more harm than good because A) there is no benefit to removing the frayed cartilage fibers (it does not cause the cartilage to grow back), and B) it kills some healthy cartilage tissue in the proces. The poster who said that the scope will allow the cartilage to heal is misinformed.

a strong assessment.

please tell how rehab is going to remove the bone spur?

also if the bone spur is growing from behind the knee cap and gauging the opposing articular cartilage of femoral condyle how will rehab relieve the pain and inflammation? you need to remove the bone spur so that opposing cartilage surface will not be further gauge.

i ran for 20 years before I had this problem at 36 years old. i had the surgery and i running fine now (4 years now). removing the bone spur did allow my cartilage to heal because it removed the source of the articular damage to my femoral condyle.

please tell me why didn't a decent runner who had rehab and rest for a year and saw 3 different PTs/Orthopedist could not get better? if your hypothesis was correct I should have healed in one year and return to my favorite workout of 10 x 1 mile in 4:48 to 4:52. it didn't happen after 1 year and i choose the surgery option.

3 months after surgery I was back to training at full strength (85 miles a week with two track workouts).

not all knee surgery is bad take a look at Joan Benoit (scoped and ran Oly Trials then won Oly). Her knees are still holding up. she is still running at a very high level and she just ran the last Oly Trials 24 years after her first.

are you telling she would have been better off if she skipped the 1984 trials to rehab her knee for ~ 1 year? if i followed your advice i would still be in rehab and running 12 miles a week.

please tell me orthopedia how long should a decent runner try rehab and hyalgan injections before choosing other options? 2 or 3 years?

or are you suggesting that the poster become a jogger and retire from competitive running altogether if his knee doesn't heal with rehab and hyalgan.

runfree wrote:

please tell how rehab is going to remove the bone spur?

also if the bone spur is growing from behind the knee cap and gauging the opposing articular cartilage of femoral condyle how will rehab relieve the pain and inflammation? you need to remove the bone spur so that opposing cartilage surface will not be further gauge.

i ran for 20 years before I had this problem at 36 years old. i had the surgery and i running fine now (4 years now). removing the bone spur did allow my cartilage to heal because it removed the source of the articular damage to my femoral condyle.

please tell me why didn't a decent runner who had rehab and rest for a year and saw 3 different PTs/Orthopedist could not get better? if your hypothesis was correct I should have healed in one year and return to my favorite workout of 10 x 1 mile in 4:48 to 4:52. it didn't happen after 1 year and i choose the surgery option.

3 months after surgery I was back to training at full strength (85 miles a week with two track workouts).

not all knee surgery is bad take a look at Joan Benoit (scoped and ran Oly Trials then won Oly). Her knees are still holding up. she is still running at a very high level and she just ran the last Oly Trials 24 years after her first.

are you telling she would have been better off if she skipped the 1984 trials to rehab her knee for ~ 1 year? if i followed your advice i would still be in rehab and running 12 miles a week.

please tell me orthopedia how long should a decent runner try rehab and hyalgan injections before choosing other options? 2 or 3 years?

or are you suggesting that the poster become a jogger and retire from competitive running altogether if his knee doesn't heal with rehab and hyalgan.

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Rehab will not remove the bone spur. The point that I'm trying to make, and that you continue to miss, is that removing the bone spur usually will not solve the problem.

Your surgery did not allow your cartilage to heal. I can say this with certainty simply because cartilage does not have the capacity to heal, and therefore any damage is permanent. If your cartilage is now healthy then it was never damaged in the first place.

The bone spurs associated with joint arthrosis grow around the periphery of the joint and do not come into contact with the opposing cartilage surface (unless the disease process is advanced, in which case running is already off the table). If the bone spur was really "gauging" the opposing joint surface, the joint would catch, produce gruesome bone-on-bone grinding noises, and be extremely painful to any movement. That level of damage would be irreversible and you would be talking about joint replacement, not getting scoped.

I didn't say that all knee surgery is bad. The rest of your post is just putting words in my mouth.

I didn't mean to start such arguments.

I think the answer here, fortunately or unfortunately, is for me to get the hylagan injections while at the same time mentioning the idea of Scoping my knee to the doc.

With any luck, these hylagan injections will work.

I'm only 23, so I don't want to be a gimp the rest of my life. My best years of running were supposed to be ahead of me. I hope they still are. Not only because I haven't really done anything, running wise, so far, but because I would just love to be able to run again without extreme pain in my knee.

any other takers?