Introduction

Post-traumatic injuries, microtrauma wear and tear, and iatrogenic medication injections can lead to chondromalacia development. Chondromalacia occurs in any joint and is especially common in joints with trauma and deformities, which is why knee joint is common.^[1]

Chondromalacia Patellae is a disease in which the hyaline cartilage of patella is genetically softened and  easily tears or wears away. The posterior articular surface of the patella starts losing its density and becomes softer with subsequent tearing, fissuring and erosion of the articular cartilage. It is commonly recognized as involving the extensor mechanism of the knee and, accordingly, is often referred to as chondromalacia of the patellae, patellofemoral syndrome, or runner's knee.^[2] Chondromalacia patellae is found in 36.2% patients, with just 0.3% of Grade IV. Thus, it is one of the rare cases.

In Ayurveda this condition can be correlated with Janusandhigata Vata. Symptoms of Janusandhigata Vata like Shoola (~pain), Shopha (~swelling), Vedana (~pain) during Akunchana (~contraction) of left knee^[3] are similar to the ones described in chondromalacia.

Case Report

Patient information

A 46 year old male patient came to the OPD of Panchakarma department with pain in the anterior part of left knee joint along with crepitus and difficulty in walking since nine months, and hip joint pain. He had history of blunt trauma to the left knee nine months ago. He had no ongoing medications and no concurrent disease. He had no any history of addiction. He consulted allopathic doctor and took medicines, and got symptomatic relief by that. As he discontinued medicines, the symptoms were aggravated. Thereafter, his MRI was taken and reported as chondromalacia patellae and he was suggested surgery. Avoiding it, he approached to Ayurveda OPD for further management.

Clinical Findings

Appetite of patient was normal, bowel movement was once per day in normal consistency. Micturition was normal with four to five times per day.

Jeevanti [Leptadenia reticulata (Retz.)] and Yashtimadhu (Glycyrrhiza glabra); as well as Sandhaniya mahakashaya, viz. Guduchi [Tinospora cordifolia (Willd.) Hook.f.], Prushniparni (Uraria picta), Paatha (Cissampelos pareira), Lajjalu (Mimosa pudica Linn.), Mocharasa [Salmalia malabarica DC Schott &Endl.)], Dhataki [Woodfordia fruticosa (L.)Kurz.,], Lodhra (Symplocos racemosaRxb.), Priyangu (Callicarpa MacrophyllaVahl.), Katphala (Myrica nagi).

Outcome and follow-up: Outcome is described in [Table 3].

Table 3: Comparison of local examination of left knee joint before and after treatment.

No any adverse events were noted during the treatment period.

MRI changes during follow-up: (dated 09.08.22)

MRI changes are depicted in Figure [3] and [4].

Discussion

The patient was reported of chondromalacia in MRI. In chondromalacia, the softening of articular cartilage occurs, followed by degeneration. The degeneration can be understood as Shoshana (~drying up) and Kshaya (~depletion) of Shleshaka Kapha, by Vata Vruddhi (~aggravation), due to its reasons.

In this case, it was local injury. Shleshaka Kapha is meant for lubrication of joints, where its Kshaya (~depletion) and Vata Vruddhi (~aggravation) suggests increase of Ruksha (~dry) Guna, and reduced Snigdha (~unctuous) Guna. The symptoms were also similar to classical symptoms of Janu Sandhigata Vata like swelling, i.e., Shopha (~swelling), Vedana (~pain) during Akunchana (~flexion). Along with these symptoms, patient was having stiffness. The case was thus, finally diagnosed as Janusandhigata Vata, without any Avarana.

Acknowledgement

The authors are thankful to patient for consent of data publication. Hospital management and staff is acknowledged for their timely assistance in management of patient.  

Figure 1: BT MRI of Left knee joint and hip joint

Figure 2: BT MRI of Left knee joint and hip joint