Inflammation of synovium or fat pads is often ignored or taken lightly and which can be the cause of OA

I agree with your opinion about the important role of inflammation in cartilage degradation. But, what is the cause the inflammation?

Like a physical therapist, I think that excluding direct traumatic event, inflammatory process is a consequence caused by a biomechanical imbalance, for example. I have seen in my clients with knee problems (i.e. inflammation in synovium, pes anserinus, tendons,) that treating these imbalances like improve stabilization and mobilization of the lower back, hip and ankle joints, we have symptoms resolutions 

What I can say about OA of the knee is that is not a homogeneous condition.  There are those who have absolutely no cartilage at all, yet have not symptoms.  There are individuals who minimal to no changes radiographically, yet have intractable symptoms.  Why is there a difference.  As others have mentioned biomechanical issues, inflammation, muscle imbalances and dysfunction...of which I believe all play a role.  Another area of which may be a part of the milieu is the knee system microenvironment that consists of joint capsule and synovium, synovial fluid, and the bone.  The microenvironment may be indeed the most important of all, because therapies such as HA, PRP and or BMAC injections seem to work independently of alignment, muscle function, and BMI.  

Dear William... I agree with your statement but if the patient have one of these causes such as biomechanical issues, muscles imbalance, articular dysfunction.... these therapies above mentioned, will temporarily relieve the symptoms. In my opinion and practice, biomechanical and articular analysis, and muscles tests, are fundamental for a good treatment and with therapy such as PRP, etc, we will have excellent results.

Dear Rodolfo, I agree with you as well.  We try to address all that we can do first...systemic problems like vitamin d deficiency, dietary intake, addressing tendinopathies, muscle imbalances, postural dysfunction.....really a very holistic approach.  Although there are limited published trials concerning biologicals, in my anecdotal experience, when these therapies work, they seem to work independently of all things, and agree with you.....temporarily....just like everything else in the universe...temporary.  Maybe when we are able to cut through the redtape of getting IRB approvals for the trials, we can actually answer these questions experimentally.  Thanks for the great constructive comments.

I think like you as well... A combination of therapies will provide better results.

Thanks a lot for your comments 

Warm regars

Sorry, gentlemen. I think my original question has been misleading you. I've revised it to make it more clear: Do you have similar observation about "medial abrasion syndrome" in middle and old age bothering by chronic knee pain?

According to my observation, It's a quite common cause of knee pain in middle and old age and is always intermingled with knee OA. The important point is that it is curable by both conservative treatment or arthroscopic medial release.

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