Question from Th. Rapp, Ebenweiler: I had an operation on the patellar tendon of my right knee 17 years ago, during which the outer ligament of the knee disc was cut and the inside of the patella was drilled into. I have now been diagnosed with localised osteoarthritis of the knee. My orthopaedic surgeon is of the opinion that nothing meaningful can be corrected surgically as the knee would be too unstable. He has now advised me to undergo proliferation therapy. Apart from the fact that I have to pay for this myself, I haven't been able to find out much about it so far. What are the chances of success and what side effects can I expect?
The expert advice: As far as I can see from your enquiry, you have localised weakness in the operated knee joint. After the patellar tendon was sutured at the time, it can be assumed that the localised osteoarthritis (joint wear) was caused by the scarring of the patellar tendon, which connects the kneecap on the thigh and lower leg with the muscles. The scar tissue may impair the function of the kneecap: when the knee is extended from a bent position, the two joint partners (the back of the kneecap and the end of the thigh) no longer slide smoothly past each other. This means that the joint is overloaded at certain points and wears out - resulting in localised osteoarthritis. Irritation with pain, sometimes overheating and joint effusion can be accompanying symptoms.
Proliferation therapy is usually used for instabilities, often in the spine, or for overstretched ligament structures. An injection with a sugar solution artificially triggers an inflammation that promotes scarring processes. This causes the ligamentous apparatus to shrink and thus improves stability. However, if there is no instability, I don't think it is very helpful.
In my view, the focus should be on improving joint mechanics. Cycling can play an important role in this: Pedalling with low gears with a sufficiently high saddle (up to five degrees of residual flexion in the knee joint) creates a flexing mechanism of the affected cartilage surfaces, which provides them with better care. To support this, you can use electrotherapy and acupuncture as pain therapy or "lubricate" the joint better with injections of hyaluronic acid preparations into the joint space.
