How to manage chondrosis in the left lateral knee?

Management of Chondrosis in the Left Lateral Knee

The optimal management of lateral knee chondrosis requires a comprehensive approach combining non-pharmacological and pharmacological interventions tailored to reduce pain, improve function, and maintain quality of life. 1

Non-Pharmacological Interventions

Exercise Therapy (First-Line Treatment)

• Strengthening exercises focusing on quadriceps muscles should be implemented as the cornerstone of treatment 1
• Closed kinetic chain exercises (semi-squats) are more effective than open kinetic chain exercises (straight leg raises) for chondral lesions 2
• Low-impact aerobic exercises help maintain joint mobility while minimizing cartilage stress 1
• Exercise programs should be regular and ongoing, ideally supervised initially to ensure proper technique 1

Weight Management

• Weight reduction is strongly recommended for patients with BMI ≥25 kg/m² to reduce mechanical stress on the knee joint 1
• Even modest weight loss can significantly improve symptoms and slow disease progression 1

Physical Support and Bracing

• Lateral tibiofemoral bracing can help redistribute load away from the affected lateral compartment 1
• Use of a cane (held in the hand opposite to the affected knee) can reduce joint loading during ambulation 1
• Appropriate footwear and lateral wedge insoles may help redistribute forces away from the lateral compartment 1

Self-Management and Education

• Self-efficacy and self-management programs significantly improve outcomes and should be incorporated into treatment plans 1
• Patient education about activity modification and joint protection techniques is essential 1

Pharmacological Management

Topical Treatments

• Topical NSAIDs should be used as first-line pharmacological therapy for localized lateral knee pain 1
• Topical capsaicin can be considered as an alternative or adjunct therapy for pain relief 1

Oral Medications

• Oral NSAIDs should be used when topical treatments provide insufficient relief, with appropriate gastrointestinal protection if needed 1
• Acetaminophen may be tried but has limited efficacy compared to NSAIDs 1
• Duloxetine can be considered for patients with inadequate response to NSAIDs 1
• Tramadol may be used for short-term management of severe pain, but with caution due to risk of dependence 1

Intra-articular Therapies

• Intra-articular corticosteroid injections provide short-term pain relief and can be used for acute flares 1
• Hyaluronic acid injections are not recommended by current AAOS guidelines 1

Surgical Considerations

When to Consider Surgical Intervention

• Surgical options should be considered when conservative measures fail to provide adequate symptom relief 1
• For small chondral lesions (<2 cm²), chondroplasty or microfracture may be appropriate 3, 4
• For larger lesions (≥2 cm²), osteochondral allograft transplantation or matrix-associated chondrocyte implantation may be considered 3
• The decision for surgery should be based on lesion size, location, patient age, activity level, and overall knee alignment 4

Rehabilitation After Surgical Intervention

• Early rehabilitation (0-6 weeks) should focus on passive, active-assisted, and non-weight bearing range of motion exercises 5
• Weight-bearing restrictions depend on the size, location, and surgical procedure performed 5
• Progressive strengthening should be implemented as healing progresses 5

Common Pitfalls to Avoid

• Overreliance on passive treatments without active exercise therapy 1
• Premature return to high-impact activities after improvement in symptoms 5
• Failure to address biomechanical factors such as weight and knee alignment 1
• Inappropriate use of opioids for long-term pain management 1
• Delayed surgical referral when conservative measures consistently fail 1

Monitoring and Follow-up

• Regular assessment of pain, function, and quality of life to evaluate treatment effectiveness 6
• Adjustment of treatment plan based on response and disease progression 1
• Consideration of advanced imaging (MRI) if symptoms worsen despite appropriate management 6