Recently we received an email from a potential patient: "I have been experiencing knee pain since May. I had a cortisone shot in May and when it wore off my pain was worse. I have had two MRIs and the second one showed that I have delamination on the femoral condyle. I know have been told that it probably won't heal and it was recommended that I try HA (Hyaluronic acid) injections. Thus I am in the middle of 5 weeks of injections. The first injection was very painful, the second better but I have not experienced much relief yet. Is there anything I can do to heal my knee? I am a runner and am suffering because I can no longer run. Lisa

We wanted to give you some additional information on the topic of delamination of articular cartilage see also

Articular Cartilage Growth

What is delamination? As you probably know, delamination of the articular cartilage occurs when articular cartilage basically “peels off” of the subchondral bone. Once that happens, it no longer has access to the subchondral bone. While the articular cartilage receives most of its nutrition from the joint fluid (because the articular cartilage has no blood supply), it is thought that stem cells and other factors come from the bone marrow through the subchondral bone to the articular cartilage to help it repair, such as when it is torn or injured. A delamination of the articular cartilage, like other chondral lesions, can cause knee pain and instability. It is typically seen on MRI, but can also be found on arthroscopy.

Delamination or “peeling off” of the articular cartilage can be treated with rest, radiofrequency thermal treatment, removing the lesion (to prevent further cartilage from delaminating), or arthroscopic repair (done infrequently). With all chondral lesions, it is best for the patient to get several opinions. If it appears the orthopedic surgeon is just going to remove the lesion or the surgical options are not appealing to the patient, then another option to consider is Prolotherapy.

Prolotherapy: An Alternative to Surgery for Delamination: We find Prolotherapy is a great treatment option for subchondral and chondral lesions at Caring Medical. Prolotherapy is an injection technique that stimulates the body to repair injured musculoskeletal tissues, such as ligaments, tendons and cartilage. Some of the substances used by our Prolotherapy doctor Ross Hauser, MD at Caring Medical with Hackett-Hemwall Prolotherapy include dextrose, sodium morrhuate, human growth growth hormone, testosterone, as well as platelet rich plasma (PRP) and bone marrow or stem cells. More serious articular cartilage lesions like delamination are often treated with either human growth hormone or bone marrow or a combination.


Why treat the delamination? Why not leave the delaminating articular cartilage alone? Generally, it is not left alone because it is symptomatic to the point when the patient either cannot walk up and down stairs or play the sports they love. Typically if left alone, the delaminating articular cartilage eventually breaks off on one side forming an unstable flap. When the other side breaks off you now have a loose body. Loose bodies cause locking of the knee.

Realize delamination of the articular cartilage is common with femoroacetabular impingement and occurs concomitantly with anterior superior labral tears. It is common for a patient to come to our office after an arthroscopy or other orthopedic surgical procedure with the complaint that they still have pain or immobility. Let’s be honest. If you had one orthopedic procedure and the results were not great, would you go and sign up for another one? We certainly would not! We don’t even frequent restaurants a second time after bad food!

What are you to do with a delamination injury to the articular cartilage? Perhaps the best approach is to see what the surgeon says and then see what the Prolotherapy doctor says. Typically when folks come to Caring Medical to see Dr. Hauser, if they have decent range of the motion of the involved joint, have a good attitude, and are sports-minded versus couch potatoes, then Prolotherapy will be offered.

What is the response rate of Prolotherapy for delamination injuries? Caring Medical has about an overall 85% rate of keeping patients away from surgeons when the surgeons have said, “What date do you want for your surgery?” If you do not desire surgery for your hip, knee or whatever joint that has delamination of the articular cartilage, then get an evaluation for Prolotherapy at our office!

The type of Prolotherapy required and the number of visits typically required for your condition will be discussed. Most folks with chondral lesions are seen for 4-6 visits. Again, it depends on the severity of the case, the patient’s goals, and the starting range of motion among other things. Prolotherapy definitely offers a great alternative to surgery for delamination injuries to the articular cartilage!