What is chondropathy of the knee joint: basic methods of diagnosis and treatment

Chondropathy of the knee joint.
Chondropathy of the knee joint is a pathology that develops due to malnutrition of cartilage and bone tissues and their further aseptic necrosis. There are several types of this disease, but the causes of their occurrence have not yet been fully elucidated. Clinically, knee chondropathy is manifested by joint pain, aggravated by walking, and limitation of movements. Treatment is often conservative, but in severe cases of pathology, surgical intervention is indicated for patients.

Description of the disease

Chondropathy begins to develop in childhood or adolescence, affecting the tubular bones of the legs and cartilage tissue. It is characterized by a benign chronic course. The pathology responds well to treatment and rarely causes complications from the musculoskeletal system.

Destructive changes in the knee occur due to disruption of metabolic processes against the background of deteriorating blood circulation. A deficiency of nutrients occurs, which leads to the destruction of that part of the bone that is subject to the greatest static and dynamic loads. The destructive process occurs in several stages:

• over the course of several months, gradual necrosis of bone tissue occurs, manifested in mild pain when bending or straightening the knee;
• for about six months the bone seems to “sag,” and its beams (structural elements of the bone) shift relative to each other, causing a decrease in the height of the epiphysis and an increase in the joint space;
• over the course of several months or years, dead areas of bone are resorbed, and in their places granulation tissues, osteoclasts, are formed, which causes a decrease in bone height;
• within 5-18 months, the shape and structure of the bone is restored.

In total, chondropathy lasts about 3 years. But only in rare cases does complete regeneration of bone tissue occur in the absence of medical care - usually more or less pronounced residual deformation is detected. And with timely diagnosis of the pathology and treatment, it is possible to completely restore the bone that forms the knee joint.

Diagnosis

To assess the biomechanical condition of the foot, pelvic area and legs, a number of examinations are carried out:

• Examination of load distribution between feet.
• Assessment of the relief of the sole.
• Identification of areas of functional overload.
• Assessing the severity of the arches.
• Study of the relationship between the axes of the foot and legs.

The main goal of diagnosis is to discover the original cause of the pathology and identify the optimal biomechanical position of the spinal column, pelvis and legs, which helps ensure the most physiological load.

Main types

Most often, the knee joints are affected by Osgood-Schlatter disease and patellar chondropathy. Not only the severity of clinical manifestations, but also therapeutic tactics depend on the type of pathology. Despite the similarity of pathogenesis, the diseases differ in the duration of the course and the location of the damaged areas of the bone.

Osgood-Schlatter disease

This is chondropathy of the tibial tuberosity, which develops in children 12-15 years old, mainly in boys. At the initial stage of the pathology, there is a slight swelling in the knee area. The child then feels pain that increases with movement, especially when going up or down stairs. It also occurs when leaning on the knee, bending or straightening the joint. But in general, the knee joint functions normally, there is no restriction of movement. Osgood-Schlatter disease responds well to conservative treatment and resolves without consequences.

Patellar Chondropathy

The disease is also most often diagnosed in boys 10-14 years old. Patellar chondropathy develops in the area where the tendons attach to the kneecap, preventing the flow of nutrients from the synovial fluid to the cartilage tissue. The leading symptoms of the pathology are spontaneous pain, the severity of which increases with movement or palpation of the kneecap. If effusion accumulates in the joint cavity, the skin over it smooths out, turns red, and becomes hot to the touch. The duration of this type of chondropathy is several months. The intensity of the pain syndrome gradually decreases, and then complete restoration of the damaged structures occurs.

Chondropathy of the patella.

Features of the clinical picture

Symptoms of the disease have similar features in both children and adult patients. Initially, when the pathology is just emerging, a person does not pay attention to slight changes in his well-being.

The progression of the disease initially leads to the appearance of unpleasant sensations in the ankle joint. They intensify when walking, with sudden movements, if you take an uncomfortable position. Initially, the discomfort subsides at rest, but as osteochondritis dissecans progresses, their duration and intensity increases, and they begin to bother you even with minimal or no exercise. In some cases, swelling of the affected joint is noted, and pain appears when trying to palpate the problem area.

The necrotic area of ​​bone tissue is gradually separated from the main bone mass. Such particles are called “joint mice.” After the separation occurs, the person will begin to complain of a crunching sound when moving, a feeling as if the joint is “stuck” in the middle of some action.

Some patients develop joint blockage due to the presence of articular mice. In this case, the joint “jams” and the ability to move in any direction is lost. All this is accompanied by an acute pain attack that is difficult to ignore.

Causes of pathology

The etiology of chondropathy of the knee joint has not been established. The disease is most often diagnosed in male adolescents who are actively involved in sports. Therefore, traumatologists suggest that the impetus for the development of chondropathy is excessive physical stress on the not yet fully formed bone and cartilaginous tissues and the ligamentous-tendon apparatus. Pathology does not occur in all children attending sports training. Doctors identify several factors that provoke damage to the knee joint:

• increase and decrease in the functional activity of the pituitary gland, thyroid gland, adrenal glands;
• metabolic disorders;
• poor circulation in the knee area;
• nutritional deficiency of microelements, water- or fat-soluble vitamins;
• standing on your feet for a long time.

Versions have been put forward about a genetic predisposition to the development of chondropathy, but so far there is no evidence base for such theories.

Danger of the pathological process

The chondropathic process of the articular joints can lead to permanent transformations of the anatomical structure and functional activity of the foot. Planovalgus deformity and flat feet often develop. Characteristic is valgus deformity of the first finger and deforming arthrosis of the articular joints. The changed anatomy will negatively affect its shock-absorbing function, as a result of which the physical load on the ankle and knee will increase. In this situation, the spinal column is subjected to increased compression.

In childhood and adolescence, this pathology can lead to a lag in physical development and abnormal development of the axial skeletal frame. Flat feet and a disorder in the biomechanics of walking lead to a distortion of the pelvis, curvature and deformation of the spinal column, and scoliotic changes. For adults, the main danger is limited motor activity of the joints and transformation of the motor stereotype. The patient tries to reduce the load on the injured leg, redistributes the weight of his body while walking upright and while standing. As a result, the risk of injury, severe arthritis and arthrosis of the joints of the lower extremities increases.

Symptoms of the disease

Each type of knee chondropathy has its own specific signs, which often help diagnose the pathology at the first visit to the doctor. But there are general clinical manifestations that are similar to the symptoms of many musculoskeletal diseases:

• crunching, clicking, crackling when bending or straightening the knee;
• swelling, hyperemia due to blood vessels overflowing, increased local temperature;
• discomfort, and then pain when moving.

The teenager begins to noticeably limp and tries not to put full weight on his foot in order to minimize pain. It is also possible for the muscles to weaken with further atrophy, and the legs to shorten by several centimeters. With the accumulation of exudate in the joint cavity and the development of the inflammatory process, a deterioration in well-being occurs, including dyspeptic disorders. The psycho-emotional state of the patient changes. He becomes lethargic, apathetic, drowsy or, conversely, irritable and hot-tempered.

Symptoms

Chondropathy is characterized by certain symptoms. It is possible to assume the development of a pathological process in the bone structure based on the manifestation of specific symptoms. A common symptom for all types of pathologies is pain.

1. Pain may appear in the affected area after exposure to various physical activities.
2. Swelling and tissue edema appear in the projection of the affected area;
3. Atrophy of muscle tissue is noted.
4. When moving, a joint crunch appears.
5. Characterized by stiffness and limited movement, lameness.

The nature of the severity of the pain syndrome developing in the area of ​​the pathological process is determined by the severity of the clinical picture. It tends to intensify during exacerbation of the disease and after physical exertion.

Signs of the disease may vary depending on the age of the patient and the type of chondropathy.

Diagnostic methods

The diagnosis is made based on patient complaints, medical history, results of external examination, and instrumental studies. General clinical blood and urine tests are required to assess health status. A number of functional tests are carried out to determine the range of motion in the knee joint and muscle strength. The most informative are the following instrumental studies:

• radiography. The resulting images clearly show a decrease in bone height, alternation of dark and light fragments in the area of ​​affected bone tissue, and changes in the size of the joint space;
• MRI or CT. Using tomography, damage to connective tissue structures, destruction of hyaline cartilage are detected, and blood circulation in the knee area is assessed.

At the initial stage of development of chondropathy, ultrasound is used. If necessary, doctors of narrow specializations - a neurologist, an endocrinologist, an orthopedist - can be involved in the diagnosis.

Stages of the disease and principles of diagnosis

In modern medicine, there are 4 main stages of the disease. The division occurs on the basis of the x-ray picture, as well as the severity of the symptoms of the disease.

1. First stage

It is characterized by a complete absence of symptoms or complaints ignored by the patient in most cases. The discomfort is mild, the pain is not clearly localized. On an x-ray image during this period, the doctor will note the presence of an oval body, which is separated from the main bone mass by a thin strip of light color.

1. Second stage

The disease is progressing. The patient complains of moderate pain in the ankle joint. Your doctor may want to look for signs of synovitis. During this period, X-rays show an expansion of the clearing band. The endplate in the problem area ceases to be integral.

1. Third stage

During this period, patients first begin to complain about blockades of the joint, its “sticking” when moving. A person pays attention to the intensification of pain, their presence even if the injured limb remains at rest. The x-ray shows the presence of a necrotic area, which is only partially connected to the main bone.

1. Fourth stage

The person notes an increase in pain. However, at stage 4, joint blockades develop less frequently than at stage three. Synovitis intensifies, and even a change in the configuration of the joint is possible. An x-ray reveals the presence of an intra-articular body, which is the main source of the patient’s problems.

In most cases, radiography is used as an instrumental method. The method is simple, accessible, and has high diagnostic value.

CT scan reveals osteochondral damage to the talus.

However, sometimes necrotic bone particles are not visible on an x-ray due to their small size. In this case, the diagnosis is supplemented with MRI or CT techniques. Both methods make it possible to make a diagnosis in the early stages of pathology.

MRI reveals osteochondritis dissecans with separation of the osteochondral fragment from the talus.

Effective Treatments

Chondropathy of the knee joint responds well to conservative therapy. Surgical intervention is usually indicated for developed complications, for example, severe bone deformation. Patients are recommended to wear orthoses that fix the joint structures, preventing their displacement or damage. In some cases, a plaster cast may be applied.

Knee brace.

Drug therapy

To eliminate pain, patients are prescribed non-steroidal anti-inflammatory drugs. In case of knee chondropathy, they are not very pronounced, so drugs in the form of tablets and ointments are used - Nimesulide, Celecoxib, Ketorol, Fastum, Voltaren. Since the pathology in most cases affects children and adolescents, the doctor calculates daily and single dosages taking into account age, weight, listed in the annotation of contraindications.

Physiotherapy

Pain in the knee joint of mild to moderate severity, characteristic of chondropathy, can be eliminated by physiotherapeutic procedures. Healing activities also stimulate blood supply to cartilage and bones, preventing the spread of the pathological process to healthy tissues. The following physiotherapy procedures have proven themselves to be particularly effective in the treatment of chondropathy:

• UHF therapy;
• magnetic therapy;
• laser therapy;
• shock wave therapy;
• galvanic currents.

UHF session.
It is practiced to apply applications with ozokerite or paraffin to the knee. Under the influence of heat, the regeneration of damaged structures, the removal of waste, toxins, and harmful salts are accelerated. At the rehabilitation stage, electrophoresis or ultraphonophoresis with chondroprotectors, B vitamins, and calcium chloride solution are used.

Physiotherapy

Since it is active sports training that often leads to the development of chondropathy, doctors recommend that patients reduce physical activity. During therapy, you should prefer swimming, physical therapy, and gymnastics. Daily exercises help strengthen the muscle-tendon system of the knee without putting stress on the bones and cartilage.

It is allowed to perform isometric exercises to maintain strength and muscle mass. Physical therapy doctors, after studying the diagnostic results, often allow training with a barbell or dumbbells, but not in a standing position. But jogging is strictly prohibited. Subsequently, after complete recovery, the teenager can return to running, football, and basketball.

Surgery

The ineffectiveness of conservative therapy over several months becomes an indication for surgical intervention. Arthroscopic surgeries performed in a minimally invasive manner make it possible to restore damaged bones and cartilage, while avoiding severe damage to connective tissue structures. The surgeon inserts instruments through small punctures or cuts in the skin above the knee. Manipulations are carried out with miniature arthroscopic instruments, and the progress of the operation is visualized on the monitor.

After minimally invasive surgery, the patient remains in the department for a short time under the supervision of medical staff. A few days later he is discharged for further rehabilitation. At the recovery stage, massage, physiotherapeutic procedures, and exercise therapy are indicated.

Folk remedies

It is not advisable to use products made according to traditional medicine recipes in the treatment of chondropathy. Firstly, they do not contain ingredients that can prevent deformation of cartilage and bone tissue. Secondly, folk remedies contain components that often provoke the development of local or systemic allergic reactions. Thirdly, most medicinal plants are prohibited for use in the treatment of children and adolescents.

Treatment of chondromalacia of the knee joint.

Therapeutic methods for treating chondromalacia are aimed at reducing inflammation and restoring joint mobility. Conservative actions would be as follows:

• Anti-inflammatory therapy and taking chondroprotectors;
• Prescription of sodium hyaluronate preparations (Fermatron or Gialgan) intra-articularly;
• Wearing a special knee brace to fix the joint;
• Physiotherapeutic procedures.

The substances included in the drug Fermatron restore synovium (intravascular fluid that reduces friction and absorbs shocks in the joint). Thanks to this, pain is eliminated, joint mobility increases and the ability of self-regulation in cartilage tissue is restored. Unfortunately, the drug has contraindications: when the skin around the joint is inflamed and infected, Fermatron cannot be administered. If other therapeutic methods of treatment have been exhausted, chondromalacia requires surgical intervention. And one of the surgical methods is arthroscopy. This is a minimally invasive method of treating and diagnosing any joints, and it is indispensable for athletes, as it guarantees a quick recovery. The operation does not require large incisions; two small holes are made: one for the arthroscope (optical instrument), the other for the surgical instrument. The surgeon observes the joint area on the monitor and uses the instrument to perform the necessary manipulations. Arthroscopy allows you to operate on complex injuries such as ruptures of ligaments, menisci, and cartilage. Recovery after arthroscopy is quick because the process is low-traumatic. And postoperative scars are subsequently barely noticeable.

When to see a doctor

If complex therapy begins at the initial stage of any chondropathy, it does not last long and always leads to a complete recovery of the patient. Therefore, it is necessary to consult a doctor for medical help at the first signs of damage to the knee joint.

Parents should be wary if their child complains of pain more frequently after sports training or long walking. Swelling of the knee, redness of the skin, and even a slight limp are also signals to see a doctor.

Prevention measures

Since the causes of the development of chondropathy have not yet been established, there are no specific measures for its prevention. Doctors recommend avoiding traumatic situations, excessive physical exertion, and not standing on your feet for long periods of time. Fried, smoked, and fatty foods should be excluded from the diet. The daily menu should include fresh vegetables and fruits, lean meat, cottage cheese, kefir, and Varenets. This will normalize body weight and replenish vitamins and microelements.