Patellofemoral Arthritis

What it involves

The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis, and corticosteroid is used sparingly, for the reasons set out below.

What the evidence shows

Almost all knee injection trials enrol people with arthritis of the main knee compartment, so the kneecap joint has little evidence of its own; a search in November 2026 found no placebo-controlled injection trial in established patellofemoral osteoarthritis. The one trial of corticosteroid there randomised 60 people, double-blind, to a single injection of triamcinolone or of hyaluronic acid: both groups improved from 48 hours through to six months, the corticosteroid group had better pain relief in the first week, and by six months there was no difference in pain or in the Kujala knee score (Mekariya, J ISAKOS 2025). There was no placebo arm, so how much of that improvement was due to the injection is not known. The injection goes into the same joint cavity as any other knee injection, where placebo-controlled trials show a benefit that fades within three to six months (Jüni, Cochrane Database Syst Rev 2015) and where corticosteroid repeated every three months for two years cost cartilage without helping pain (McAlindon, JAMA 2017). That cartilage concern is why the authors of the patellofemoral trial suggest hyaluronic acid as an alternative when the rest of the knee is still well preserved; the hyaluronic acid trials at this joint are set out in the viscosupplementation row.

Pairing reviewed 2026-11-05.

Where it fits

Reasonable to discuss for a flare that is blocking the quadriceps and hip strengthening that carries the evidence in this condition. Expect weeks rather than months of help, and not something to repeat routinely: see the note on cortisone.

What it involves

A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.

What the evidence shows

No published clinical trial of this device in this condition. It is a vibration handpiece delivered from the same console as radial shockwave, and the rationale is myofascial rather than tendon- or bone-directed.

Pairing reviewed 2026-08-30.

Where it fits

A comfort measure used within a session where muscular tightness is limiting movement. Never the reason for the appointment, and not a substitute for the treatments that do have evidence.

What it involves

A focused system generates an acoustic shock wave that converges at a focal point set at a defined depth, concentrating the energy where the target is. This is the form used for tendon, joint, ligament and bone. Typically four to six sessions about a week apart, no anaesthetic and no formal downtime.

What the evidence shows

The shockwave trials at the knee are in osteoarthritis of the main weight-bearing joint, where pooled results favour it over sham for pain and function (Tang, Int J Surg 2024; Silva, Clin Rehabil 2022). No human trial has tested it specifically for arthritis behind the kneecap; reviews list it among the non-surgical options there while noting that the research is limited (Katz, Curr Rev Musculoskelet Med 2024; Kuwabara, Curr Rev Musculoskelet Med 2022). In a rat model of patellofemoral osteoarthritis, shockwave reduced cartilage breakdown, inflammation and bony change (Jhan, Int J Med Sci 2026), which supports the rationale but is not evidence that it helps people.

Pairing reviewed 2026-10-04.

Where it fits

A reasonable option to try on the strength of the trials in the rest of the knee, with the gap for this compartment explained. Used alongside the quadriceps and hip strength work that changes how the kneecap is loaded.

What it involves

You sit with the applicator positioned over the area for a short session. It is usually painless and needs no gel or skin contact. It is usually given as a course, commonly alongside shockwave.

What the evidence shows

There are no published randomised trials of EMTT in this condition, or in any musculoskeletal condition, that could be identified. The supporting work is laboratory work: EMTT increased tenocyte proliferation, migration and collagen expression in cultured human tendon cells (Mancini, Int J Mol Sci 2025). The nearest human evidence for a related electromagnetic therapy is negative. A randomised trial of pulsed electromagnetic field therapy added to eccentric exercise for Achilles tendinopathy found no improvement in outcome scores or tendon neovascularity over eccentric exercise alone (Ko, Orthop J Sports Med 2024).

Pairing reviewed 2026-08-30.

Where it fits

Offered only as an adjunct alongside treatment that does have evidence, never as the plan itself, and only after that gap is explained. Much of the EMTT literature is manufacturer-affiliated, which is part of why it is described this way.

What it involves

Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.

What the evidence shows

No trial in established kneecap-joint arthritis. The closest is in chondromalacia patella, softening and wear of the cartilage under the kneecap: 54 people were randomised to injections around the kneecap of 5% dextrose, which the authors call prolotherapy, or saline, three times over six weeks, and at 24 weeks the dextrose group was 1.67 points lower for pain out of 10 and 9.3 points better on the Kujala knee score (Bayır, PM R 2026). That concentration is the one used for perineural injection, and the same trial is counted in that row. A retrospective report of 61 people with chondromalacia given 15% dextrose injections at one clinic described lasting improvement, by self-report and without a comparison group (Hauser, Clin Med Insights Arthritis Musculoskelet Disord 2014). A 2026 review of randomised trials in chondromalacia, which did not include the saline-controlled trial, found no prolotherapy trial against placebo or no treatment and could draw no conclusion (De la Cerna-Luna, Am J Phys Med Rehabil 2026).

Pairing reviewed 2026-10-12.

Where it fits

Prolotherapy is offered here and can be discussed where kneecap pain persists despite quadriceps and hip strengthening, taping or bracing and load changes, which carry the evidence. The one controlled trial is in earlier cartilage wear rather than established arthritis, and that is explained. Not expected to regrow cartilage.

What it involves

One or a short series of hyaluronic acid injections into the joint under ultrasound guidance.

What the evidence shows

Trialled at the kneecap joint several times, never against a dummy injection in established arthritis, and the results do not agree. In 60 people with isolated patellofemoral osteoarthritis randomised, double-blind, to a single injection of hyaluronic acid or triamcinolone, both groups improved and there was no difference in pain or the Kujala knee score at six months, with the corticosteroid ahead in the first week (Mekariya, J ISAKOS 2025). In 126 people randomised to five weekly hyaluronic acid injections or four weeks of tui na massage, pain improved equally and the massage group did better on the WOMAC score a week after treatment (Gu, Complement Ther Med 2025). In 70 younger adults with grade II to III kneecap cartilage damage, hyaluronic acid added to physiotherapy gave less pain and better Kujala and Lysholm scores at three and six months than physiotherapy alone, with no difference on MRI and no dummy injection (Astur, Rev Bras Ortop 2019). The one sham-controlled trial enrolled 86 younger people with patellofemoral pain rather than arthritis, and found a single injection no better than sham at six months (Hart, Orthop J Sports Med 2019). In the main knee joint, the largest placebo-controlled analysis found an average effect too small for patients to feel (Pereira, BMJ 2022).

Pairing reviewed 2026-10-08.

Where it fits

May be discussed as a non-steroid option when kneecap-joint pain is blocking the strengthening work and cortisone is unsuitable or has already been used, with it stated that it matched cortisone at six months in one trial but has never been shown to beat a dummy injection in this condition. Any benefit should be expected to be modest.

What it involves

Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.

What the evidence shows

Nothing has been published on hydrodissection for patellofemoral arthritis specifically. Knee osteoarthritis appears in this literature, but as fluid spread around or into the joint rather than as nerve treatment: a scoping review of 21 included studies pools hydrodissection with hydrodilatation and calls the evidence early and heterogeneous (Leahy, Front Pain Res 2026), and the only prospective knee work is an uncontrolled series of ten people given three monthly posteromedial fascial injections of 5% dextrose, with WOMAC scores roughly halved at twelve months and the authors themselves noting that placebo and natural fluctuation cannot be excluded (Lam, Diagnostics 2026).

Pairing reviewed 2026-09-15.

Where it fits

Only where the assessment finds a nerve contributing separately to the front-of-knee pain, most often the infrapatellar branch of the saphenous nerve. The arthritis itself is treated by the options higher up this page.