Standalone Ayurvedic Management of Grade IV Chondromalacia Patella Integrating Panchakarma and Agnikarma: A case report

Background: A Chondromalacia patella (CMP) is a painful knee condition of the patellar articular cartilage resulting in pain, swelling, and functional limitation. Grade IV CMP, characterized by cartilage loss with exposure of subchondral bone, is an uncommon (~0.3% of knee disorders) and usually surgical condition. CMP can be equated in Ayurveda with Janu Sandhigata Vata (degenerative disorder of knee joint), in which aggravation of Vata Dosha leads to degeneration, obstruction, and impairment of knee joint function. Ayurvedic treatment comprises pacification of Vata, tissue nourishment, and facilitation of function through Shodhana (purificatory) and Shamana (palliative) therapies. Severe CMP is a challenge in the sense that cartilage destruction is permanent. This case illustrates the successful Ayurvedic treatment of Grade IV CMP without surgery. Clinical findings: A 51-year-old woman visited KLE Shri BMK Hospital, OPD No. 7, presenting with pain, swelling, and restricted mobility of the left knee following trauma. MRI showed Grade IV CMP with Grade II tear of ACL and mild effusion. Interventions: Sarvanga Abhyanga with Brihat Saindhavadi Taila followed by Dashamoola Parisheka, Janu Basti with Mahavishagarbha Taila, Matra Basti with Dhanwantari Taila (60 ml), Erandamoola Niruha Basti, Sthanika Lepa, and Agni Karma with Suvarna Shalaka, in addition to oral medications, was administered for seven days and Raktamokshana (bloodletting) was performed on the first day. Outcomes: Post-treatment, the Kujala score improved from 36/100 (poor) to 76/100 (fair) at 40th day, after 80th day it has reached 90/100 (good) and clinically, pain, swelling, tenderness, and stiffness resolved; mobility also improved. Conclusion: Ayurvedic Shodhana (purificatory) and Shamana (palliative) therapies, along with Raktamokshana (bloodletting) and Agnikarma (therapeutic cauterization), showed excellent results in the management of Grade IV chondromalacia patella without surgical intervention within a follow-up period of 80 days of treatment.