Patellofemoral syndrome Chondromalacia Calcium chloride by Iontophoresis

1. IONTOPHORESIS
PATELLOFEMORAL PAIN
SYNDROME AND
CHONDROMALACIA
Introduction
A syndrome characterized by retropatellar or
peripatellar pain resulting from physical and
biochemical changes in the patellofemoral joint. The
pain is most prominent when ascending or
descending stairs, squatting, or sitting with flexed
knees, and about 40 percent following conservative
care, last more than one year
Chondromalacia patellae, sometimes part of or
confused with the pain syndrome.
Among the available techniques to facilitate the
absorption of drugs in chronic pain, Iontophoresis is
an internationally recognized method, which
provides therapeutics effects with few systemic side
effects
Objective
To evaluate the effectiveness of topical calcium
chloride applied by iontophoresis in patellofemoral
syndrome.
Ana Oyarzabal Zulaica

2. Methods
The sequential study was carried out in an outpatient
rehabilitation clinic from February 2015 to March
2016. The subjects selected for inclusion were all
men and women who consecutively came to
consultation sent by specialist doctors from the same
centre or Primary Care.
The inclusion criteria were: chronic retropatellar or
peripatellar pain and chondral injury (based on
Nuclear magnetic resonance or arthroscopy).
The exclusion criteria were: Synovitis. Systemic
inflammatory joint diseases. Pregnancy.
Physiotherapy during the previous 2 months.
Cognitive or language deficit to self-complete
questionnaire in Spanish.
(n: 7). Age (years): mean 44. Sex: male 3, female 4
The mean baseline pain intensity was 6 (3-9) .
IONTOPHORESIS
PATELLOFEMORAL PAIN
SYNDROME AND
CHONDROMALACIA
Ana Oyarzabal Zulaica

3. Treatment
All patients were instructed to perform exercises,
from the first day of consultation and during
treatment. They received 15 sessions of calcium
chloride by iontophoresis (5 days a week), instilling
it at the anode (+ charge) with an intensity of 0.4 mA
/ cm2 for 20 minutes. The electrodes were self-
adhesive and were applied in the anterior area of the
patellofemoral.
Evaluation
Assessment of pain using a visual analogue scale
(0-10) and a questionnaire on the need for
coadjuvant analgesic treatment (by auxiliary
personnel, blind), verification of exercises, mobility
and function according to the International Functional
Classification (ICF) for a Medical Rehabilitation.
(d4501).
Registration of treatment assistance and adverse
effects, by the physiotherapist who applies the
treatment.
IONTOPHORESIS
PATELLOFEMORAL PAIN
SYNDROME AND
CHONDROMALACIA
Ana Oyarzabal Zulaica

4. Outcomes
All patients reduced the pain intensity by more
than 50 per cent. The average pain intensity at
discharge was 2 (2-4). They remained without
analgesics orally or could reduce the dose.
All achieved functional recovery d4501.0.
There were no adverse effects and no loss of
cases
Conclusion
The application of calcium chloride by
iontophoresis, combined with exercises, can
reduce the intensity of pain of patellofemoral
syndrome an facilitates to achieve functional
recovery, after 15 sessions, without
complications. Implications: These results would
optimize the treatment to shorten the recovery
time.
-Resultados: Todos redujeron su intensidad de dolor y en 5 casos hasta nivel leve (incluso condropatía
grado 4 y dolor 8, persistente tras cinesiterapia e infiltración). Analgésicos: ocasionalmente; 2 casos de
condroprotector oral. Ortesis:1 caso rodillera
-Conclusión: La iontoforesis con cloruro cálcico puede ser útil como analgésico en la lesión condral
patelar.
-Resultados: Todos redujeron su intensidad de dolor y en 5 casos hasta nivel leve (incluso condropatía
grado 4 y dolor 8, persistente tras cinesiterapia e infiltración). Analgésicos: ocasionalmente; 2 casos de
condroprotector oral. Ortesis:1 caso rodillera
-Conclusión: La iontoforesis con cloruro cálcico puede ser útil como analgésico en la lesión condral
patelar.
IONTOPHORESIS
PATELLOFEMORAL PAIN
SYNDROME AND
CHONDROMALACIA
Ana Oyarzabal Zulaica

5. -References
-Cutbill JW, Ladly KO, Bray RC, et al. Anterior knee
pain: a review. Clin J Sport Med 1997; 7:40.
–Indermun S, Choonara YE, Kumar P, et al. Patient-
controlled analgesia: therapeutic interventions using
transdermal electro-activated and electro-modulated
drug delivery. J Pharm Sci. 2014 Feb;103(2):353-66.
doi: 10.1002/jps.23829. Epub 2013 Dec 20.
-Gurney B, Wascher D, Eaton L, Benesh E, Lucak J.
The effect of skin thickness and time in the absorption of
dexamethasone in human tendons using iontophoresis.
J Orthop Sports Phys Ther. 2008 May;38(5):238-45. doi:
10.2519/jospt.2008.2648. Epub 2008 Jan 22.
-Witvrouw E, Callaghan MJ, Stefanik JJ, et al.
Patellofermoral pain: consensus statement from the 3rd
International Patellofemoral. Pain Research Retreat held
in Vancouver, September 2013. Br J Sports Med 2014;
48:411.
-Resultados: Todos redujeron su intensidad de dolor y en 5 casos hasta nivel leve (incluso condropatía
grado 4 y dolor 8, persistente tras cinesiterapia e infiltración). Analgésicos: ocasionalmente; 2 casos de
condroprotector oral. Ortesis:1 caso rodillera
-Conclusión: La iontoforesis con cloruro cálcico puede ser útil como analgésico en la lesión condral
patelar.
-Resultados: Todos redujeron su intensidad de dolor y en 5 casos hasta nivel leve (incluso condropatía
grado 4 y dolor 8, persistente tras cinesiterapia e infiltración). Analgésicos: ocasionalmente; 2 casos de
condroprotector oral. Ortesis:1 caso rodillera
-Conclusión: La iontoforesis con cloruro cálcico puede ser útil como analgésico en la lesión condral
patelar.
IONTOPHORESIS
PATELLOFEMORAL PAIN
SYNDROME AND
CHONDROMALACIA
Ana Oyarzabal Zulaica