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Intra-articular Injections for Knee Chondromalacia: A Systematic Review of Randomized Controlled Trials
Roger De la Cerna-Luna1, Miguel Cabanillas-Lazo2, Paula Arnillas Brigneti1
1Physical Medicine and Rehabilitation Department, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru.
American Journal of Physical Medicine & Rehabilitation
|June 15, 2026
Summary
Intra-articular hyaluronic acid (HA) injections likely offer minimal benefit for chondromalacia pain and symptoms. Evidence for platelet-rich plasma (PRP) and prolotherapy effectiveness in knee chondromalacia remains inconclusive due to limited comparative studies.
Area of Science:
- Orthopedics
- Regenerative Medicine
- Evidence-Based Medicine
Background:
- Chondromalacia is a condition characterized by damage to the cartilage on the underside of the kneecap.
- Intra-articular injections are a common treatment modality explored for managing chondromalacia symptoms.
Purpose of the Study:
- To systematically review randomized controlled trials (RCTs) assessing the efficacy of intra-articular injections for knee chondromalacia.
- To evaluate the impact of treatments like hyaluronic acid (HA), platelet-rich plasma (PRP), and prolotherapy on pain, function, and structural outcomes.
Main Methods:
- Systematic review of literature from MEDLINE/PubMed, Embase, and Cochrane Library.
- Inclusion of six RCTs with a total of 393 participants.
- Meta-analyses and GRADE approach for certainty of evidence assessment.
Main Results:
- Hyaluronic acid (HA) injections showed probable minimal effect on pain and symptom severity at six months.
- Impact of HA on knee extensor strength and structural outcomes remains uncertain.
- Limited evidence exists for platelet-rich plasma (PRP) and prolotherapy due to lack of comparison with placebo or no-treatment controls.
Conclusions:
- Intra-articular HA injections likely provide little to no significant benefit for pain or symptom severity in chondromalacia.
- The effectiveness of PRP and prolotherapy for chondromalacia cannot be firmly concluded.
- The overall certainty of evidence for intra-articular injections in chondromalacia is limited.