Chondromatosis of joints and osteoarthritis

Features of osteochondrosis of the knee joint

Osteochondrosis of the knee joint is a fairly common pathology, occurring in 60-70% of all known cases of the lesion.

The vast majority of patients diagnosed with gonarthrosis achieve a successful result, however, there are cases of pathology becoming chronic.

The clinical picture of the disease is quite variable and depends on the existing form of pathology. Symptoms may not appear immediately, which makes it difficult to identify pathology at the initial stages of development.

An interesting fact is that with the development of pathologies during puberty, the disease can recede on its own, without the use of additional therapeutic agents, which is due to the completion of the stage of bone tissue formation.

Main symptoms

Let's return to the clinical symptoms. The older the disease, the more pronounced they will be. So, the disease manifests itself:

• crunching in the joint and other sounds (creaking, clicking, etc.) at the moment of making a certain movement (sounds are not typical for the last stage);
• painful syndrome of varying nature and color on the front and/or back side of the knee when moving;
• pain at rest , which indicates the neglect of the medical problem;
• muscle weakness, stiffness of the affected area, inability to move the joint correctly, limited range of motion;
• paresthesia in the form of numbness, tingling , etc. sensory disturbances;
• an increase in the size of the joint, which in severe pathogenesis can be seen visually; the affected knee is larger than the healthy one;
• periodic jamming (blockade) of the knee joint with a simultaneous feeling of sharp pain, which is explained by the entry of a necrotic fragment of cartilage into the space between the articular surfaces;
• instability of the leg (loss of support), and therefore the patient experiences frequent dislocations and subluxations.

An interesting feature: while there is no pain, we do not pay attention to the steps. But when the pain comes, we realize that we overcome a huge number of steps every day.

The initial signs of gonarthrosis primarily include morning stiffness and mild pain, which disappear immediately after the person moves normally. Additionally, at an early stage, weakness in the legs and clicking in the knee may be observed.

Pain symptoms and movement disorders are not always alarming at the onset of the disease or are mild in nature, which often prevents a person from paying attention to the problem in time and coming to the hospital. As practice shows, often the case already has to deal with 2nd degree of severity and higher.

Pathological forms

Today, it is customary to distinguish three forms of pathology, differing not only in symptoms, but also in the course of pathological changes:

1. Koenig's disease

   – inflammation of the cartilage tissue with subsequent detachment from the bone, which leads to difficulty in moving the knee. The form is most often found among adolescent and elderly patients.

2. Osgood-Schlatter disease

   – damage to the tibial tuberosity with subsequent thickening of the cartilaginous tissue of the knee, as well as the formation of a painful formation that limits the mobility of the leg. The pathology is most often diagnosed in adolescents who are actively involved in various sports (athletics, figure skating, etc.).

3. Larens-Johansson disease

   – characterized by a structural disorder of the patella, expressed in ossification. The damaged area is visible visually due to the appearance of edema. On palpation the patient experiences severe pain.

Diagnostics

Most often, if chondromatosis is suspected, radiography is prescribed in frontal, lateral and other projections. In addition to shadows from the cartilaginous bodies, the image will show changes characteristic of secondary osteoarthritis - bone growths and narrowing of the joint space. To clarify the diagnosis, you may need (at the choice of an orthopedist):

• CT;
• Ultrasound;
• arthrography;
• MRI;
• thermography;
• arthroscopy (performed simultaneously and for therapeutic purposes).

With the above symptoms, it is very important to distinguish chondromatosis from other joint diseases with similar symptoms. This may be primary osteoarthritis, neurogenic osteoarthropathy, Koenig's disease, or primary bone neoplasm. Depending on the diagnosis, treatment tactics will be developed.

What is arthroscopy and how can it help diagnose joint diseases?

60-75% of people with chondromatosis are men aged 20-60 years

Probable causes

Among the likely causes of the development of pathological processes in the knee, it is worth highlighting:

• age characteristics

  – mechanical wear and natural aging of tissues causes the destruction of cartilage in patients over 60 years of age;

• increased body weight

  – the more weight, the faster the joints wear out. The risks of pathology with excess body weight are several times higher;

• hereditary factor

  – causes the development of pathological processes mainly for young people;

• increased physical stresslanguages

  – the main reason for the development of pathology in people whose work involves increased stress on the lower extremities.

It is also worth noting the existence of increased risks of musculoskeletal diseases after operations and injuries.

Factors provoking pathology

If a person’s general health status is good, he leads a healthy lifestyle, usually his joints function well and are not bothered day after day with or without painful sensations, even in old age. Otherwise, degenerative changes may arise that will begin to aggressively destroy important articular components that provide motor, support and shock-absorbing functions of the lower extremities at any age.

This is a real photo of the surface of the knee joint with gonarthrosis. Pay attention to damage that should not be there, the cartilage should be smooth as glass.

It is the progressive destructive processes in the knee joint that are commonly called gonarthrosis in medicine. It leads to the death of hyaline cartilage, which covers all surfaces of the articular bones, and as it becomes thinner and fibered, it leads to exposure and deformation of the latter and, as a consequence, to an extreme decrease in the quality of life.

An astroscope view of the destroyed cartilaginous surface in the joint cavity.

Arthrosis pathogenesis is often secondary, that is, when it becomes a consequence of certain pathologies, injuries, increased physical activity, etc. Anatomical and functional changes, as we have found out, mainly develop and become more complicated due to various negative factors. Among them, the most common ones are:

• congenital anomalies of the joints of the limbs (shortening of one of the legs, dysplasia, O-shaped and X-shaped deformities of the lower leg, etc.);
• post-traumatic consequences (complications of bruises, fractures, dislocations, sprains, etc.);
• joint hypermobility (JHM);
• rheumatoid arthritis, systemic lupus erythematosus, gout and pseudogout;
• local chronic infections and inflammations;
• obesity and metabolic diseases;
• endocrine diseases, especially diabetes and hypothyroidism;
• hormonal imbalances during menopause;
• excessive physical activity on the lower limbs;
• lack of physical activity, physical inactivity;
• constant overload of the legs associated with professional activities (sports, weight lifting, etc.);
• sitting for long periods of time in incorrect positions, for example, with your legs tucked under you;
• vascular pathologies of the extremities, hypothermia.

By the way, age-related physiological changes in bones, cartilage, and muscles occur in everyone as the body ages. These components wear out over time, becoming weaker, less flexible and elastic. This is not a paradox, but a natural phenomenon provided by nature, which begins approximately from the period when a person crossed the forty-year mark. Normally, it develops at a very slow pace, so nothing globally terrible happens to the joints. But there is one “but”. If the wear and tear of biological tissues significantly dominates the processes of metabolism and cellular nutrition, which is observed with the above factors, the joint begins to be progressively damaged.

It is enough to provoke the disease even by starting abruptly, without preparation, to engage in physical exercise, which you have never done before. Often, in pursuit of health, older people decide to radically change their lifestyle, for example, start running in the morning. Unprepared knee joints, which, as we noted, have some deviations due to age, are easily injured, and micro-tears appear in their structures and nearby areas. Such traumatization at the micro level, especially in people of retirement age, entails the development of gonarthrosis, not to mention more serious injuries.

The knee and hip joints are most often affected. The picture shows the dynamics of destruction from left to right, from the complete absence of the disease to the last stage.

The disease can develop not only in the older generation (after 40 years or more), but also in young people 25-40 years old. Periods of mature and old age certainly provide more chances for complex pathology, because the natural elements of the joint are no longer as strong as they were before. In addition, women have a greater predisposition to pathomorphological phenomena in the joint, which is mainly explained by the hormonal characteristics of the female body.

Symptoms of the disease

Among the general clinical symptoms of osteochondrosis of the knee joint, it is worth highlighting:

• painful sensations

  – a classic sign, the intensity of manifestation of which is determined by the degree of development of pathological processes;

• local manifestations

  – slight swelling;

• limited mobility

  – initially there is a limitation of active movements (walking and running), and then passive ones (bending/extending a limb with outside help);

• characteristic crunching sound when performing movements

  – mainly in the first hours after waking up, disappearing as daytime activity increases;

• transient lameness

  , turning into a permanent one.

Classification

Research by American rheumatologists has made it possible to develop a classification of existing types of lesions, which takes into account not only the causes of the pathology, but also the features of its localization.

1. Primary/idiopathic

• local;
• generalized (involving several areas of the musculoskeletal system).

2. Secondary knee

Because of:

• post-traumatic;
• congenital;
• caused by damage to the bone tissue system.

By localization:

• local;
• generalized.

3. Tertiary

• caused by endocrine pathologies;
• caused by neurogenic arthropathy.

It is important to note that the variability of forms and the similarity of the clinical picture necessitate a diagnostic consultation with several specialists, including: a rheumatologist, a traumatologist, and an orthopedist.

Degree of development of pathology

The intensity of the lesion is determined by three degrees of osteochondrosis of the knee joint, each of which is characterized by a specific set of symptoms.

Osteochondrosis of the knee joint 1st degree

The initial stage of development of the disease. Symptoms at this stage are practically absent.

Physical activity provokes minor painful sensations.

Due to the fact that the tissues are just beginning to deform, it is quite difficult to visually identify abnormalities on an x-ray image.

Osteochondrosis of the knee joint 2nd degree

Due to the progression of tissue destruction, pain intensifies, muscles weaken, and spasms occur.

When the deformation becomes visually noticeable, the patient experiences quite severe pain and crunching when walking.

Osteochondrosis of the knee joint 3rd degree

Pathological processes progress, accompanied by pronounced pain, which is caused by the almost complete destruction of cartilage tissue and exposure of bone.

The progress of the pathology forces the patient to place the lower limb in a certain way, which impairs motor activity.

Painful sensations do not leave the patient even at rest.

Symptomatic picture

At first, chondromatosis of the knee does not manifest itself in any way. Later, pain appears during physical activity, crunching and clicking in the affected area, and in some cases, joint blockade. There is mild swelling, redness and swelling in the area of ​​the affected joint.

The symptoms of chondroma of the knee joint are determined by the location of the formations that appear. When they are located between the surfaces of the bones, pain occurs and joint blockade is possible. Over time, other signs appear:

• crunching knees;
• synovitis, which involves the accumulation of fluid in the joint area;
• tissue swelling in the knee area;
• increased temperature in certain areas;
• severe limitation of mobility.

When tumors appear in a synovial joint, its blood supply and synovial fluid synthesis are disrupted. The consequence of this is the development of gonarthrosis. The “joint mouse” syndrome, characteristic of chondromatosis, leads to pinching of its structures, and this provokes regular injury to the menisci and joint surfaces.

Treatment of osteochondrosis of the knee joint

Regardless of the degree of the disease, measures to eradicate pathological processes must be comprehensive.

Only a specialist can determine the optimal treatment plan, taking into account the patient’s medical history and the characteristics of the pathological processes.

IMPORTANT! Self-medication can cause the situation to worsen and lead to irreversible consequences.

Drug therapy in the treatment of osteochondrosis of the knee joint

Treatment of osteochondrosis of the knee joint

determined taking into account an individual plan developed by a specialist.

NSAIDs (non-steroidal anti-inflammatory drugs), including the drug Artradol, are considered to be particularly important and effective in drug therapy.

In addition, the following drugs may be prescribed in combination:

• analgesics;
• chondroprotectors;
• muscle relaxants.

Physical therapy (physical therapy) as a method of complex treatment of osteochondrosis of the knee joint

Physical education classes occupy a special place in complex therapy.

The use of gymnastic exercises helps improve blood circulation and activate metabolic processes, relieving spasms and strengthening the ligamentous and muscular apparatus.

Physiotherapy

It comes in handy in the subacute period, when pain subsides.

An important point in the use of physical therapy is strict adherence to the recommendations of the attending physician and limitation of sudden movements, as well as monotonous loads.

Physiotherapy in the treatment of osteochondrosis of the knee joint

Physiotherapy helps relieve pain and also improves blood circulation.

Among the most effective physiotherapeutic procedures, it is customary to highlight the following:

• electrotherapy

  – electric shock, which provides a warming effect and improves blood flow;

• shock wave therapy

  – targeted impact with acoustic waves, which helps to activate metabolic processes and reduce swelling;

• vibration therapy

  – exposure to vibration on affected tissues, the use of which is possible only for grades 1 and 2 osteochondrosis of the knee joint;

• laser exposure

  – improves blood flow, relieving inflammatory processes.

It is important to note that physiotherapeutic procedures are only an integral part of complex treatment, and also help speed up the healing process and shorten the period of drug exposure.

Surgical treatment of osteochondrosis of the knee joint

Can the last degree of osteochondrosis of the knee joint be corrected? Definitely.

In a situation where conservative methods do not give the desired results, surgical intervention comes to the rescue, the key task of which is to preserve functionality.

The choice of surgical technique is based on the degree of development of pathological processes and is determined taking into account the individual characteristics of a specific clinical picture:

1. Drilling out affected tissues

   – used in the absence of inflammatory processes. The method has a particularly high percentage of efficiency.

2. Fixation of bone tissue with screws

   – is implemented in the presence of semi-mobile fragments, however, it has a fairly high risk of complications.

3. Securing large pieces using accessible methods

   – tissue plastic surgery, using your own cartilage tissue, which allows you to restore the functionality of the limb.

Features of treatment

For a disease such as chondromatosis of the knee joint, treatment without surgery is usually ineffective: it does not help at all or gives only a short-term effect. Therefore, surgical intervention is necessary. The volume and complexity of the operation depends on the characteristics of the pathology.

If the disease has a stable form with a single chondromic body of the knee joint, then arthroscopy is used. It involves removing broken sections of cartilage. In some cases, excision of the affected areas of the synovium is performed. If the stage of the disease is advanced, its complete removal may be required. If surgical intervention turns out to be ineffective and the pathology recurs, removal of the affected joint and its further replacement with an endoprosthesis may be indicated.

Surgery requires rehabilitation. After it is carried out, the patient must perform exercises on special simulators. Therapeutic exercise and gymnastics help restore muscle tone and help strengthen ligaments without causing harm to tissues that are in the process of recovery. Rehabilitation may include physical therapy, compresses and heating, and laser techniques. Its main task is to normalize blood supply to the joint tissues, as well as stimulate the production of synovial fluid.