Lateral patellar hyperpression syndrome (LPHS): treatment abroad

Causes of SLGN

There are a number of main provoking factors leading to LGN.
Bone formation deformities:

• high position of the kneecap;
• hallux valgus;
• X-shaped arrangement of the lower extremities;
• Osgood–Schlatter disease;
• hypoplasia of the external femoral condyle;
• foot deformity;
• pathological changes in the cells of the patella.

Mechanical damage to the kneecap:

• excessive tension of the lateral ligaments;
• damage to the medial ligaments of the knee joint;
• infantility or weakening of the medial muscles of the thighs.

Diagnostics

Diagnosis of diseases in which patellar protrusion is observed is carried out by orthopedic traumatologists or rheumatologists. If necessary, consultations with other specialists are prescribed. The fact of running is determined during an objective examination. To clarify the diagnosis, perform the following procedures:

• Radiography.
  Confirms the violation of bone integrity during fractures, the presence of degenerative changes in arthrosis, damage to bone structures in specific and nonspecific infectious arthritis.
• Ultrasound of the knee joint.
  Detects fluid in the joint cavity and articular inversions. Effective in detecting intra-articular bodies, tears and ruptures of ligaments.
• and MRI.
  Prescribed to clarify the results of ultrasound and radiography. Computed tomography shows in detail the condition of hard structures, MRI is effective mainly in the study of soft tissues.
• Puncture of the knee joint.
  Carried out for diagnostic or therapeutic purposes. Allows you to confirm hemarthrosis or synovitis and determine the nature of the fluid.
• Arthroscopy.
  The most reliable and informative research method. Provides the possibility of visual inspection of articular structures and collection of material for laboratory research. In some cases, it includes therapeutic measures.
• Lab tests.
  Microscopic examination is performed to determine the composition of the liquid, culture is carried out to determine the nature of the pathogenic microflora, cytological and histological examination of the liquid or biopsy specimens is carried out if tumor processes are suspected. For systemic pathologies, special tests are prescribed.

Ultrasound of the knee joint

Lateral patellar release: treatment

In the vast majority of cases (over 70%), drug treatment, in combination with physiotherapeutic methods, is a very effective approach against lateral patellar hyperpression syndrome. Treatment, however, is a rather lengthy process and consists of the development, application of individual physical exercises and massage, which can improve the condition of the vastus medialis muscle and the external fixator of the patellofemoral joint. Among other things, fixing bandages, splints and bandages are prescribed to immobilize the limb.

Surgical treatment is aimed at solving the problems that caused the displacement of the patella, in other words, the purpose of the operation is to relieve tension in the stabilizers of the patella, increase the tone of the medial ligaments, and also correct defects. In some cases, the operation is performed using an arthroscope.

Treatment

First aid

For all injuries and illnesses accompanied by fluid accumulation, it is necessary to give the leg an elevated position and ensure rest. In case of traumatic injuries, cold should be applied to the damaged area to reduce swelling. For fractures, complete ligament ruptures, and purulent arthritis, immobilization is performed using a splint. In other cases, it is enough to apply a fixing bandage.

Intense pain is an indication for taking an analgesic. A large amount of fluid or blood in the joint always takes a long time to resolve and with the formation of adhesions. Therefore, a patient with balloting should be taken to a specialist even if other symptoms are mild.

Conservative therapy

Conservative treatment for diseases with patellar tendon includes the following measures:

• Puncture
  . Produced upon admission. Subsequently, it is performed on an outpatient basis or in a hospital setting as fluid accumulates.
• Protective mode
  . Patients are advised to limit the load on the limb. If indicated, a plaster cast is applied and the use of crutches or a cane is advised.
• Drug therapy
  . Taking into account the nature of the pathology, NSAIDs, antibiotics, painkillers, and other medications are prescribed.
• Non-drug methods
  . UHF, medicinal electrophoresis, laser therapy, magnetic therapy and other physiotherapeutic techniques are used. Physiotherapy is complemented by exercise therapy and massage.

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An extremely important advantage for every medical tourist is the assistance and support of a curator from Pacient.club, who will stay with the patient throughout the entire period of treatment and recovery.

Clinical manifestations and complications

The main clinical manifestation of SLGN is constant aching pain in the anterior part of the knee joint (increased with flexion), caused by secondary chondromalacia, as well as irritation of the nerve fibers located directly in the lateral retinaculum of the patella. There is swelling of the joint, recurrent synovitis, and crunching when moving. As hyperpressure progresses, a feeling of instability, joint laxity, and painful pseudo-blocking of the joint may appear.

Complications of SLHN can include chondral and osteochondral fractures of the lateral femoral condyle, medial and lateral facets of the patella; with a long-term course with traumatic episodes, habitual dislocations of the patella can be observed. To prevent complications in patients with LGN, it is necessary to pay special attention to a thorough examination of patients in order to early identify signs of this pathology.

In diagnosing SPHN, careful collection of anamnesis of the disease, assessment of pain syndrome and the results of special clinical tests are important. From the point of view of determining the etiology of the disease and choosing a treatment method, it is important to conduct a test for limiting the elevation of the lateral edge of the patella: for example, the inability to raise to a neutral position of 0° indicates a tight lateral retinaculum of the patella.

Also important in the diagnosis of SLGN is the measurement of the Q angle, or the quadriceps angle formed between the lines, one of which is drawn from the superior anterior iliac spine to the patella, the other from the center of the patella to the tibial tubercle. Values ​​of this angle exceeding 20° must be regarded as pathology.

X-ray examination

, CT, MRI, myography m. quadriceps femoris (detection of dysfunction of the lateral and medial heads of the muscle) and diagnostic arthroscopy make it possible to verify the diagnosis.

Countries where lateral patellar hyperpression is treated

When choosing a country for treatment, things are a little more clear-cut than at other stages of organizing your treatment. Statistics and monitoring data on quantitative indicators of success unanimously highlight the following leading countries:

• Israel and Finland;
• Türkiye and South Korea;
• Germany and Switzerland.

However, you should not pay attention only to the ranking achievements of countries. With this choice, the more important aspect is the specialist, the best of whom, as a rule, practice in the above-mentioned countries.

Other European clinics (Latvia, Greece), as well as medical centers of countries originating from the USSR (Ukraine, Belarus, Russia) can also offer a decent level of surgical intervention to eliminate LGN.

Prices for treatment of lateral patellar hyperpression

Before withdrawing the cost of treatment, any professional clinic assigns the patient a consultation with a specialist (in our case, an orthopedist) from the same clinic, and a series of standard diagnostic procedures.

A consultation with a doctor may cost the patient the following amount:

• Israel (consultation with an orthosurgeon from 350 USD);
• Switzerland (consultation with an orthosurgeon from 400 USD);
• Germany (consultation with an orthosurgeon from 400 USD);
• Türkiye (orthosurgeon consultation 80-140 USD);
• South Korea (consultation with an orthosurgeon from 70 USD).

Pathogenesis

The pathogenesis of the progression of SLGN can be represented as follows: as a result of overload of the lateral sections of the MCP joint, the level of tension in the osteochondral and soft tissue elements of the joint increases, which leads to the development of chondromalacia, asymmetric wear of the joint with the development of dystrophic changes in the osteochondral structures. Then, dystrophic disorders are replaced by the stage of cartilage degeneration, its destruction, which ultimately leads to the formation of deforming arthrosis of the patellofemoral joint.

Patella fracture: rehabilitation and treatment

The complexity and duration of the recovery process depends on the severity of the injury. The determining factor is the number of fragments, as well as the degree to which they are displaced. If the components diverge by no more than 5 mm, and the ligamentous apparatus has not been damaged, only conservative treatment can be used. To do this, the following procedures are carried out:

• puncture;
• washing;
• administering medications directly into the joint;
• applying plaster (most often it needs to be worn for no more than 1 month).

After the cast is removed, rehabilitation therapy is carried out.

If the fragments have dispersed to a significant extent, you will have to seek the help of a specialist. An osteosynthesis procedure is performed. This operation is divided into several types. The choice of a specific method depends on the characteristics of the fracture. In particularly difficult cases, open reduction is used.

It should also be remembered that damage to the knee joint is not limited to just a fracture of the patella. Other injuries are possible, so seeking medical attention is a must.

Recovery period

The most important stage is rehabilitation. It should be started as early as possible, preferably immediately after the limb has been immobilized. Of particular importance are the early stages of rehabilitation, during the beginning of the restoration of the limb. Therapeutic gymnastics should be carried out taking into account some nuances:

• At first, the duration of the exercises should not exceed 10 minutes, later the time is increased to 30 minutes, several times a day;
• you should start with lightweight positions or exercises in water to prevent excessive stress;
• only active gymnastics makes it possible to ensure high-quality results;
• the specialist is obliged to select movements of such an amplitude that will not lead to pain when stretching the muscles;
• during the first stages of rehabilitation, massage and other passive movements in relation to the damaged knee joint are not allowed;
• It is possible to massage the undamaged area of ​​the limb, as well as the healthy leg and lower back.

After the cast is removed, you can perform a light massage. Its purpose is to restore range of motion and prevent the appearance of atrophy. In addition, the procedure will help quickly get rid of hemorrhages.

A physiotherapy specialist will select the optimal amount of exercises. Too many of them can lead to negative consequences. It is good if exercise therapy is accompanied by ultrasound and thermal procedures.

Important! Without undergoing a rehabilitation period, there is a risk of serious consequences - for example, damage to ligaments, nerves and blood vessels. In especially severe cases, this leads to lifelong disability.

Chondromalacia patella

Chondromalacia of the patella is a common pathology of athletes, which must be treated.

Our clinic employs highly qualified doctors who will quickly and correctly make an accurate diagnosis and prescribe adequate treatment.
We have our own diagnostic facilities and the necessary equipment of the latest generation - CT , MRI , ultrasound . The patient can undergo the necessary diagnostics without leaving the clinic and immediately visit a specialist.

What is chondromalacia patella?

Chondromalacia patella is an abnormality of the articular cartilage at the bottom of the kneecap, causing it to wear out or soften. This leads to an inflammatory process, accompanied by limited mobility and pain in the knee.

Most often, this pathology is diagnosed in young people, especially females. As a rule, chondromalacia of the patella begins in adolescence or young adulthood, and is almost always asymptomatic in the initial stages.

The disease is characterized by wear and tear of the cartilage of the joint under the kneecap due to friction between the kneecap and the femur. As a result of degenerative changes, cartilage tissue loses its elasticity, while hyaline cartilage becomes thinner, worn down to the bone.

Kinds

In total, there are 4 stages of chondromalacia of the patella, which replace each other depending on the severity of the process:

— The cartilage softens in the knee area. — The cartilage softens and its surface is damaged. This stage is a sign of the beginning of tissue destruction. — The cartilage becomes thinner and its condition is actively deteriorating. — Severe damage to cartilage, which exposes bone tissue.

Causes

The following factors can cause wear and tear of the patella:

- weak muscle tone; - congenital pathologies, for example, congenital displacement of the patella; - injuries of the femur and tibia; — dysfunction of the abductor and adductor muscles; - foot deformity; - weakness of the quadriceps femoris muscle; - acute injuries of the kneecap.

At risk are professional athletes who experience increased stress when jumping, during direct blows to the patella, etc. Chondromalacia of the patella is also diagnosed in people with flat feet, arthritis, or a removed meniscus.

Symptoms and signs

The main symptom of the disease is pain. It is present on both sides of the kneecap and is chronic or acute in nature. During flexion-extension movements, characteristic clicks are heard.

The clinical picture is more pronounced when going down stairs, during squats and running. The intensity of pain increases slowly - from mild discomfort to severe pain. This process usually takes about a year.

Which doctor treats you?

Chondromalacia of the patella is diagnosed by an orthopedist. He develops a treatment strategy individually in each specific case. Our clinic employs

Treatment methods

Before starting treatment for pathology, the patient must undergo a thorough diagnosis. The disease is diagnosed using special tests, and the following are also used:

— X-ray in three projections;
- CT; — MRI; — arthroscopy; - radioisotope scanning - if it is difficult to make a diagnosis. Conservative treatment of chondromalacia of the patella is as follows:

— anti-inflammatory therapy and prescription of chondroprotectors to the patient; — intra-articular injections of sodium hyaluron preparations; - wearing a special fixing knee brace; - physiotherapy.

It is important to know that:

— Chondroprotectors are best used in combination with physiotherapy, massage and exercise therapy. — Osteopathy and reflexology can trigger restoration processes in damaged cartilage using the body’s hidden reserves. — Surgical intervention is carried out endoscopically, that is, using minimally invasive techniques.

Important! The choice of treatment tactics depends on the stage of the disease. If there is no effect from conservative treatment, the patient is indicated for surgical intervention.

results

Chondromalacia patella is not a death sentence. By starting treatment in a timely manner, you can achieve stable positive dynamics. Of course, you will have to make a lot of effort, but it is quite possible to achieve progress - correctly selected treatment and adequate physical education will allow you to restore lost elasticity to cartilage tissues, and lost elasticity to muscles. A comprehensive approach to solving the problem, as well as strict adherence to all the doctor’s recommendations, will lead to almost complete restoration of cartilage.

Rehabilitation and lifestyle restoration

Rehabilitation of chondromalacia patella begins immediately after diagnosis. The inflammatory process in the cartilage stops quickly, and since this pathology belongs to the category of degenerative-dystrophic changes, rehabilitation should be carried out in courses. In this way, the functionality of the joint can be maintained and maintained. That is, the patient must periodically consult with a doctor, undergo physical procedures and monitor the dynamics of his disease.

Reference! Depending on the treatment (conservative or surgical), rehabilitation can take 1–4 months.

The main goal of rehabilitation is to strengthen the ligaments of the muscles of the knee joint, so the patient is prescribed physical therapy, massage, physiotherapy, and kinesiotherapy.

Lifestyle with chondromalacia patella

Complications of chondromalacia of the patella are recurrent synovitis. If the disease persists for a long time, deforming arthrosis of the patellofemoral joint may develop. In order to prevent the occurrence of these complications, it is necessary not only to start treatment in a timely manner, but also to undergo further courses of it. In addition, it is recommended to wear shoes with orthopedic insoles, which compensate for problems with the knees and musculoskeletal system, and also to avoid overload and injury to the knee joint.

If chondromalacia of the patella is detected in a timely manner, the prognosis for the disease is favorable. Complete restoration of cartilage tissue or a significant slowdown in the progression of the pathological process is possible. The ability to work is preserved, and a number of patients can return to active sports.

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Hoff's disease. Symptoms, causes, treatment

Definition

Hoffa's disease or lipoarthritis is a disease caused by inflammation of the fat pads of the knee joint. May be caused by damage or impaired degeneration of adipose tissue.

In the normal state, in the knee between the femur and tibia there is an accumulation of fatty body, limited by the synovial bursa and the patellar ligament, which forms a fairly stable capsule.

This is necessary to reduce friction between bone joints and evenly distribute the incoming load across the entire supporting system of the lower extremities. Hoff's body also contains blood vessels and nerve endings. Therefore, trauma can cause disruption, and the body’s defense system can cause an inflammatory process, which leads to the replacement of shock-absorbing adipose tissue with hard fibrous tissue that does not perform a mobile and softening function.

As a result of this change, the lipid layer between the bones becomes thinner, blood vessels are damaged, and adipose tissue increases in size due to inflammation. With prolonged absence of treatment, the cartilage and bone structure may begin to deteriorate, which provokes a chronic course of the disease.

Symptoms of the disease can often be misleading to the patient because they resemble meniscus damage. The danger of untimely identification of the disease is that lipoarthritis can contribute to the development of arthrosis and gonarthrosis.

Symptoms

There are 2 forms of the disease, and therefore different symptoms.

In the acute form of the disease, a person may notice the following changes:

• Clicking in the knee when moving;
• Pain when trying to move the joint;
• Edema;
• Local increase in temperature;
• Severe pain and, as a result, the inability to fully extend the knee.

In a chronic condition, symptoms occur:

• Decreased tone of the thigh muscles and their volume (quadriceps, sartorius, biceps);
• Aching pain when supporting the leg;
• Pain at night, causing awakening;
• Palpable friction when palpating the joint;
• With prolonged absence of treatment and medical intervention, the development of various pathologies, dystrophy or curvature of the spine is possible.

Factors influencing the occurrence of the disease

The causes of lipoarthritis are most often excessive physical activity, which contributes to the development of chronic damage to fat bodies. Injuries to the knee joints can also contribute: dislocations, impacts, ligament damage, and even just an awkward sudden movement of the leg.

Less commonly, swelling of this nature is provoked by frequently repeated monotonous movements; for example, there are cases where lipoarthritis was caused by prolonged kneeling. Sometimes the cause may be metabolic and hematopoietic disorders.

Diagnostic methods

Hoffa's disease is quite difficult to detect, but doctors can use the following: collecting a detailed medical history of the patient, clarifying his lifestyle and the nature of pain symptoms, drawing up a full clinical picture to identify injuries, magnetic resonance imaging, ultrasound.

Such measurements and examination make it possible to determine the stage of changes and the degree of development of the disease. Radiography helps treating physicians distinguish this dystrophy from pathologies of bones, ligaments and cartilage.

It is important at the diagnostic stage to accurately identify lipoarthritis and not confuse it with rheumatoid, infectious and reactive arthritis, synovitis or bursitis.

Treatment methods

Once the cause of pain in the joint is determined, it is necessary to reduce swelling as much as possible, reduce the Hoffa body under the patella and restore normal mobility of the joint.

Depending on the stage of the inflammatory process, the recovery program may change, however, there are basic methods that are used in both acute and chronic forms:

• Stopping or limiting the mobility of damaged joints and reducing the load on them, as well as the use of orthopedic braces and bandages. Semi-rigid orthoses may be indicated;
• Massage (classical, acupuncture, vacuum massage using cupping);
• Physiotherapy, ultraphonophoresis;
• Galvanic currents;
• Therapy through the use of ultra-high frequencies;
• Magnetic therapy;
• Anti-inflammatory treatment with medications;
• Oxygen therapy inside the joints (oxygen is injected into the synovial bursa, which pushes out excess fatty tissue, reducing resistance when bending and extending the knee);
• For moderate pain, painkillers and ointments for external use may be indicated;
• For acute pain, injections into the muscle or under the patella into the joint may be prescribed;
• A complex of therapeutic physical training to restore the functions of the knee joint. It is especially effective if complications have already occurred, that is, the lipid layer has developed into fibrous, and muscle strength has weakened.

If such methods are ineffective for the patient, then arthroscopic surgery should be prescribed to remove the accumulated fatty tissue.

At the rehabilitation stage, traditional medicine can be effective: compresses, paraffin applications, teas with anti-inflammatory properties, various decoctions.

Prevention

In order to avoid such a violation, it is recommended to promptly find out the cause of pain from a doctor in order to prevent the development of metabolic and endocrine abnormalities, and engage in exercise therapy and gymnastics.
It is also useful to quit smoking, since nicotine negatively affects the condition of blood vessels and blood supply to the joint. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr