Does Hyaluronic Acid Add Benefit to Exercise Therapy in Patellar Chondromalacia? A Narrative Review of Current Evidence

Abstract

Background:

Patellar chondromalacia is a common cause of anterior knee pain, particularly among young and physically active individuals. Conservative treatment remains the first-line approach and typically includes exercise-based physiotherapy, activity modification, and, in selected cases, intra-articular injections.

Objective:

To summarize current evidence regarding the effectiveness of physiotherapy and hyaluronic acid (HA) supplementation in the management of patellar chondromalacia.

Methods:

A narrative review of the literature was performed using PubMed database. Studies evaluating exercise therapy, rehabilitation protocols, intra-articular HA injections, and oral HA supplementation in patients with patellar chondromalacia or patellofemoral pain associated with chondral degeneration were considered.

Results:

Exercise-based physiotherapy consistently demonstrated improvements in pain and function and remains the cornerstone of conservative management. Strengthening of the quadriceps and hip musculature appears particularly beneficial. Evidence supporting intra-articular HA injections is mixed: some studies report reductions in pain and functional improvement, whereas randomized controlled trials have failed to show clear superiority over sham injection in all patient populations. Evidence for oral HA supplementation remains limited and of lower methodological quality.

Conclusions:

Current evidence supports physiotherapy as the primary treatment modality for patellar chondromalacia. Intra-articular HA may be considered as an adjunctive option in selected patients who do not respond adequately to rehabilitation, while evidence for oral HA remains insufficient for strong recommendations. Further high-quality comparative trials are needed.