When Chase Utley left Phillies camp Monday to see a specialist for his chronically injured knees, it raised questions about his short- and long-term prognosis. At various times in the past, the Phillies have said Utley is dealing with two conditions - patella tendonitis and Chrondromalacia patella. We asked Christopher C. Dodson, M.D., a sports medicine surgeon at the Rothman Institute at Jefferson, to provide some insight into those conditions. Dodson, an assistant professor of orthopaedic surgery at Thomas Jefferson University, specializes in sports related injuries of the shoulder, elbow and knee. He serves as an assistant team physician for the Philadelphia Flyers and as an orthopaedic consultant for the Los Angeles Dodgers. Here is what he had to say:
Could you explain what patella tendonitis is:
Is it something that is fairly common in baseball?
Sure, it's very common in a lot of sports; anything where you have a lot of change of direction. It's obviously extremely common in basketball, maybe less common in baseball. Anything where a lot of running, jumping or explosiveness is required.
How is Chondromalacia patella different?
That's very different. Chondromalacia patella is the softening of the cartilage of the tendon underneath the kneecap. Patella tendonitis is the patella itself. Chondromalacia patella is when the cartilage under the kneecap gets kind of soft or it can get swollen and it leads to pain, particularly underneath the kneecap
So is the treatment for patella tendonitis different?
Actually, they are not that different. Rest or conservative treatment is the hallmark of both. They can be somewhat related. The mechanism that goes from your quad, to your patella to your patella tendon is all related. So any condition involving one of those three things, the treatment is pretty straightforward - rest, ice, anti-inflammatories, and stretching of the quadriceps tendon, the hamstrings as well, and, ultimately, a strengthening program where you strengthen the muscles around the knee.
What is the typical prognosis?
Typically, it's very good. Both do respond to conservative treatment, both are not surgical issues. They both respond very well to conservative treatment like physical therapy, quad strengthening and rest, again with anti-inflammatories to reduce pain and swelling. And then rest and a gradual stretching and a strengthening program.
Utley has said that a stretching regime given to him last year helped him stay 'good enough' to be on the field. After the off-season he returns only to find it's worse … and in another knee. Do you think if that were the case, if he's keeping up with the physical therapy, that it could be something else?
It's a relatively straight-forward diagnosis. It's not one of those things where' you're like "what else could it be?" It's pretty classic in its location and its symptoms. I think it's one of those things where it'll be a long term-stretching and strengthening program to make this go away. The main idea is that if you strengthen your quad enough, it'll help hold the kneecap in the correct position and that kneecap cartilage sees less load and is therefore less painful. It's that simple. The more weakened the muscles are, the kneecap can sort of slide out of the groove ... and that causes more pressure and pain. It's an extremely common problem. I see it in my office every week.
Is it degenerative condition? Is there something that can be making it worse? Are there any other options?
There is no surgical treatment for this. It's really just pain control and with more activity come more symptoms. In the off-season when they're not stressing the knee as much, a lot of times the symptoms go away. So it can be a cyclical thing based upon how much you're using it and how active you are.
When you talk about there being no surgical treatment for this condition, are you talking about both conditions?
It's extremely rare to need surgery for either condition.
Is it fair to say Utley's not ever going to be over this? Is it possible that it just goes away?
Certainly with the proper treatment it can be something that completely goes away. It's a symptomatic diagnosis. It's much less a structural program. It's not like a ruptured ligament. This is more of a symptomatic, mechanical problem. If you can work on the strengthening and the stretching, often times it will just completely go away. It certainly can be something that flares up from time to time, but I don't think it's going to be a chronic problem that's really going to disable him from competing.
If [the pain] does not [go away], is it a fair assumption that it might be something else?
You have to remember what he does for a living. It's rare to be an elite athlete and not have some soreness. But it would be fair to say that with heavy activity it will be sore from time to time, but it should not be something that would prevent him from competing at the level he's used to.
For all of those people that are wondering if his career is over because of this, you are saying that no, it shouldn't be?
No. Absolutely not.
Are there other kinds of treatment, something experimental that might be on the horizon for this?
Certainly, for the Chondromalacia patella, some people have been using something called viscosupplementation, which is an injection of, for lack of a better word, lubrication into the knee which has some anti-inflammatory properties to help battle the inflammation associated with Chondromalacia. That's something that's sometimes used now. And with patella tendonitis, I am sure everyone is talking about this PRP [platelet rich plasma therapy] – it's been all over the news – you can certainly inject PRP into the patella tendon. A lot of professional teams are using that now. It still has mixed reviews, but those are other, more advanced things to do. But the reality is that none of them are going to work without a good stretching and strengthening program.
Alex Rodriguez said last year that he felt [PRP] enhanced his recovery time. Is that something you think is anecdotal or is something that really does help?
Based upon the literature, some people show that it works, some people show no difference. So to be honest with you, we really don't know. It's not standard care, but it's something we have tried with athletes at times to enhance healing.