Do you often experience pain in the patella area? Do you experience a feeling of instability of the kneecap, or does the patella frequently dislocate when walking? It is possible that you have a disease called high patella. Patella syndrome, or high position of the patella (patella alta) is a condition when, for a number of reasons, the kneecap is displaced higher relative to the knee joint. In this condition, the patella is raised higher relative to the femur, to which it is connected by its own patellar ligament. Patella alta syndrome is known in foreign literature as “High Ridding Patella”. This is a rather rare disease, which is more common in people of tall stature and asthenic physique. Usually combined with lateroposition of the patella, which results in its displacement outward from the knee when walking.
Knee joint of a 25-year-old female patient. I had previously consulted specialists for pain in the knee area. The diagnosis was reduced to “initial signs of arthrosis.” Obviously high kneecap
Patella, or kneecap. The largest sesamoid bone in the body. It is an oval formation (like sea pebbles) with a point at the lower pole. Like all sesamoid bones, during development it is formed from the thickness of the tendon, in this case from the quadriceps femoris muscle. The lower pole faces the lower leg, the patellar ligament is attached to it, the upper pole passes into the tendon of the quadriceps femoris muscle. Most of the fibers of the quadriceps tendon run along the front of the kneecap to the ligament propria (however, the patellar ligament is its continuation).
The patella is involved in the complex mechanism of the knee joint. It forms a lever that transmits the force of the thigh muscle to the lower leg. The patella is involved not only in flexion and extension of the knee, but in stabilizing the knee joint.
So what is high patella?
There is currently no clear understanding of the etiology of patella alta, although a number of factors can be claimed as the cause of this disease. — Features of a person’s physique. A tall and thin person is more prone to this disease. — Arthrosis of the patellofemoral joint. A change in the structure of the cartilage between the inner surface of the patella and the patellar surface of the femur. — Injuries of the knee joint. Violent physical activity (sports involving jumping and rapid changes of direction) can cause damage to the patellar tendon and the stabilizers of the kneecap (patellofemoral ligaments). - Sharp bending of the knee joint. This could be for any reason, not necessarily sports. — Congenital pathology of the knee joint. This knee structure is acquired during prenatal development. In this case, a person has a high position of the patella already from birth.
Prevention measures
Since this disease is congenital and inherited genetically, breeding a dog with a similar problem is undesirable. The mechanism of its inheritance is not fully understood.
If the dog has a predisposition, the patella is located in the wrong place, the likelihood of dislocation is very high. It is necessary to monitor heavy physical activity and, if possible, limit it to avoid injury.
Walking to strengthen muscles will be more beneficial. Strong muscles are better able to fix the patella in the correct position.
If your dog is overweight, it puts additional stress on the joint. It is worth changing the dog’s diet, putting it on a special diet.
Signs of Patella alta
A high position of the patella has several quite noticeable signs: - Pain in the kneecap area. In fact, this is the most common reason for a patient to see a doctor. The symptom is very nonspecific, as it accompanies many problems with the knee joint. — Patellofemoral arthrosis and chondromalacia of the patella cartilage. The cartilage of the patella has microcracks and erosion due to the displacement of the patella relative to the axis and the redistribution of the load between the surfaces of the block.
- Unsteady gait. As already mentioned, the patella plays an important role in stabilizing the joint. — Lateroposition of the patella. Its displacement outward. Grasshopper eye symptom. - Symptom of “camel humps” - with a fairly high position of the patella. - Pain when moving the kneecap with your fingers.
Synovitis
Synovitis is an acute inflammation of the synovial membrane of the joint, which is accompanied by the accumulation of fluid in the joint cavity. The collected transudate or exudate causes a feeling of fullness, severe pain, and limited mobility of the knee. Because of all this, it becomes difficult for the patient to walk.
Types of synovitis:
- serous. Characterized by the accumulation of non-inflammatory transudate. Develops after minor injuries, bruises, falls on the knee. May be of an allergic nature or occur against the background of chronic degenerative-destructive diseases of the joints;
- purulent. Accompanied by accumulation of inflammatory exudate in the articular cavity. The cause of purulent synovitis is infection (usually from the external environment). The development of pathology can be provoked by penetrating wounds of the knee, inflammatory diseases of the skin and soft tissues of the lower extremities;
- serous-fibrinous. Accompanied by the formation of serous effusion, which contains fibrin threads. Develops after severe bruises, hemarthrosis, dislocations, subluxations of the knee joint;
- pigment-villus. It occurs as a result of minor injuries and leads to proliferative-dysplastic changes in the synovial membrane. Up to 200 ml of effusion can accumulate in the joint cavity.
When a small amount of non-inflammatory fluid accumulates, synovitis is treated conservatively. The diseased joint is tightly bandaged, and the lower limb is immobilized, giving it an elevated position. The patient is prescribed UHF, electrophoresis with novocaine or UV irradiation. If there is a lot of effusion in the joint cavity, the person undergoes a therapeutic puncture to remove it.
Diagnosis of high patella
This disease is not easy to diagnose. Clinically, it is quite difficult to assess the height and position of the patella relative to other bone structures. An important diagnostic test is radiography.
When the kneecaps are laterally positioned, the “grasshopper eye” symptom is observed. The high location of the patella is manifested by the symptom of “camel humps”. The upper hump is the calyx itself, and the lower hump is the infrapatellar bursa and adipose tissue.
Periarthritis
The pathology is characterized by inflammation of the periarticular tissues (tendons, ligaments, muscles, capsule) without involving the joint itself in the process. Pathology is more common in people over 50 years of age. The disease is often accompanied by the deposition of calcium salts in ligaments and muscle tendons.
Factors contributing to the development of periarthritis:
- constant hypothermia;
- hard physical work;
- long daily stay on your feet;
- frequent knee injuries;
- sedentary lifestyle;
- endocrine and hormonal disorders;
- atherosclerosis;
- chronic arthritis, arthrosis.
For this disease of the knee joint, a chronic course is more typical. Pathology is treated with medications, thermal and physiotherapeutic procedures. In severe cases of the disease, surgical intervention is indicated. During the operation, doctors remove adhesions and calcifications that limit joint mobility.
Complications of a high patella
There are two main complications: instability of the patella and patellofemoral arthrosis.
Instability of the patella is manifested by frequent displacement of the patella outward and pain. With pronounced displacement, subluxation and dislocation of the kneecap occurs. Arthrosis of the patellofemoral joint is accompanied by pain in the area of the kneecap.
Damage to the patellofemoral ligaments. The movement of the main stabilizers in foreign literature is described as the “effect of windshield wiper blades”. With a high position of the cup, the ligaments are subject to more pronounced stress and are stretched more strongly
Establishing diagnosis
If your dog is lame from time to time or constantly present, your veterinarian will first check the patella luxation. It includes:
- visual inspection, which gives an idea of how correctly the dog places its hind legs;
- palpating the joint, determining the presence of swelling, checking its location;
- determining the severity of the dislocation. To do this, an X-ray is taken not only of the knee, but also of the hip joint. An X-ray in a direct projection will allow you to see the deviation of the bone in one direction or another.
Surgical treatment of patella alta
The purpose of the operation is to restore the anatomical relationship of the kneecap in the joint. For this purpose, an osteotomy of the tibial tuberosity is performed. There are many options for surgery, depending on the severity of the patient’s condition.
Arthroscopy - arthroscopic instruments with optics are inserted into the joint cavity through small punctures. Additional diagnostics and minor interventions are carried out.
Patellectomy - The kneecap is surgically removed. This may help reduce pain, although the anatomy of the joint is disrupted.
Surgery on the inner head of the quadriceps femoris muscle to stabilize the kneecap.
Tibial osteotomy in the area of the tibial tuberosity. The method is used quite often.
Rehabilitation after surgery, as well as healing time, are individual and depend on the operation performed.
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Tags: joint pain
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Bursitis
Bursitis is an acute, subacute or chronic disease characterized by inflammation of the joint capsules of the knee joint. The subcutaneous, subfascial or subtendinous bursa may be affected. According to the nature of the effusion, bursitis can be purulent, serous, hemorrhagic and fibrinous. The clinical picture of the disease depends on its cause, the form and nature of the accumulated fluid.
Typical symptoms:
- pain in the kneecap area, worsening with movement;
- pain when bending and straightening the knee;
- swelling, redness of the skin, increased temperature in the knee joint;
- decreased ability to work, worse sleep;
- headache, fever, weakness, apathy, loss of appetite and other signs of intoxication (with purulent bursitis).
What is the treatment strategy for bursitis? In case of mild disease, a pressure bandage is applied to the knee, and the lower limb is provided with complete rest. Along with this, medication and physical therapy may be used.
For acute purulent and severe chronic bursitis, a therapeutic puncture is performed. During the manipulation, the accumulated effusion is removed, and the joint cavity is washed with solutions of antiseptics and antibiotics. After the operation, the person undergoes a short rehabilitation.
Cyst.
Tendinitis
Tendonitis is an inflammatory lesion of the tendons with their subsequent degeneration. The process involves the patellar ligament. The pathology mainly affects athletes and people leading an active lifestyle. Tendonitis is considered an occupational disease of football players, tennis players, basketball players, track and field athletes, etc.
Symptoms of pathology:
- pain that intensifies with active movements and disappears after rest;
- discomfort when pressing on the patellar ligament;
- local swelling, redness of the skin;
- slight limitation of movements in the knee.
To get rid of tendinitis, the patient needs to temporarily give up physical activity and sports. The person is advised to rest, and the affected joint is immobilized using a plaster or plastic splint. Nonsteroidal anti-inflammatory drugs (Diclofenac, Ibuprofen) in ointments or tablets are usually prescribed as medications. After the inflammatory processes subside, exercise therapy, massage, and physiotherapy are added to the treatment.
Consequences of injuries
Traumatic injuries to the menisci, ligaments or other structures cannot be classified as diseases of the knee joints. As we have already found out, “injury” and “illness” are different concepts. However, the former can lead to the latter. For example, after a bruise or fall, a person may develop synovitis, tendonitis, bursitis, arthritis, osteoarthritis, etc. In young people, regular knee injuries can lead to the development of Koenig or Osgood-Schlatter disease.
Fracture of the kneecap.
Deforming osteoarthritis
The most common disease of the knee joints. According to statistics, every third person with knee problems suffers from this particular pathology. Osteoarthritis deformans usually develops at the age of over 40 years. Women, athletes, overweight people and people doing heavy physical work are most often affected.
Deforming gonarthrosis is a chronic degenerative disease leading to the gradual destruction of intra-articular cartilage. In the absence of adequate therapy, the pathology leads to a progressive decrease in performance and even disability. But proper timely treatment does not get rid of osteoarthritis, but only slows down its development.
In the initial stages, the symptoms of this knee disease are mild or completely absent. Over time, the patient begins to be bothered by aching pain in the joint that occurs after abruptly getting up from a chair, while walking, or when climbing stairs. Soon the disease leads to severe impairment of knee mobility.
Table 2. Degrees of development of gonarthrosis
| Degree | Clinical picture | Treatment | Course and prognosis |
| I | Periodic mild pain that disappears after rest. Minor, rapidly passing swelling. No deformation | Lifestyle correction, physical therapy, wearing orthopedic shoes. Anesthetic ointments, chondroprotectors in the form of tablets | Does not prevent a person from leading a normal lifestyle. Causes some discomfort during physical activity. With adequate treatment does not progress and does not lead to complications |
| II | Frequent severe pain, characteristic crunching. The appearance of stiffness, difficulty moving. Initial deformation of the knee joints | Exercise therapy, physiotherapy, massage. The use of painkillers, anti-inflammatory drugs, chondroprotectors, calcium supplements. Phonophoresis with hydrocortisone or intra-articular injection of corticosteroids | Makes it difficult to perform simple actions and prevents a person from leading a normal lifestyle. Correct conservative treatment improves the patient’s condition and stops the destruction of articular cartilage |
| III | Constant severe pain when walking, sharp deterioration in knee mobility. Noticeable increase in volume, joint deformation | Medicines, exercise therapy, and drug therapy are ineffective. They slightly improve a person’s well-being, but do not help completely get rid of unpleasant symptoms. | Causes a sharp decrease in working capacity. To get rid of constant pain and start walking normally again, a person needs surgery |
Osgood-Schlatter disease
The peculiarity of the pathology is its development at a young age. Koenig's disease affects men 15-30 years old. It is believed that the disease occurs due to local circulatory problems in the bones caused by heavy physical activity or injury. This leads to the appearance of a zone of necrosis (death) in the articular cartilage. Subsequently, the damaged section of cartilage breaks off and begins to migrate through the synovial cavity.
The main symptom of knee joint disease is arthralgia. At first, the pain appears periodically and is aching in nature. Over time it intensifies and soon becomes permanent. If left untreated, a person develops synovitis and osteoarthritis deformans.
The pathology refers to osteochondropathy – diseases of the knee joint, which are accompanied by aseptic destruction of bone tissue. The core of the tibia is damaged. The reason is frequent trauma to the lower extremities during the period of active skeletal growth. Osgood-Schlatter disease mainly affects boys and men aged 10-18 years. One or both knees may be affected.
Symptoms of pathology:
- sharp pain in the knee with extreme flexion/extension of the leg;
- discomfort when pressing on the tibial tuberosity;
- slight swelling of soft tissues, local increase in temperature;
- Difficulty climbing stairs, squatting, or riding a bicycle.
In most cases, the disease goes away on its own after 1-2 years. Children recover as soon as their skeleton formation is completed - by the age of 17-19 years. In some cases, the child requires treatment. With severe destruction of the tibia, surgical intervention is indicated. During surgery, doctors remove destroyed bone fragments.
Acute and chronic gonarthritis
The term “arthritis” covers a broad group of inflammatory lesions of the knee joint. Isolated gonarthritis is quite rare. They develop after traumatic injuries or against the background of other diseases of the knee joints. They can be a consequence of synovitis, hemarthrosis, meniscus tear, deforming osteoarthritis, etc.
Most often, gonarthritis occurs in people with polyarthritis - multiple lesions of joints of different locations. Acute inflammation can be caused by past infectious diseases and STIs (chlamydia, ureaplasmosis, mycoplasmosis). Chronic inflammatory processes usually develop against the background of rheumatoid arthritis, gout, osteoarthritis, and some other pathologies.
The main symptoms of this group of knee joint diseases:
- limited knee mobility;
- pain, the intensity of which depends on the severity of the pathology;
- mild swelling of soft tissues;
- redness of the skin around the knee;
- local temperature increase,
- unpleasant crunching in the knee when moving.
“Doctors are hiding the truth!”
Even “advanced” joint problems can be cured at home! Just remember to apply this once a day...
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Depending on the cause and mechanism of development, several types of gonarthritis are distinguished.
Occurs due to the penetration of pathogenic microorganisms into the joint cavity. Microbes can be introduced from the external environment during injuries or surgical interventions. They can also get there from foci of infection in the body by hematogenous or lymphogenous route. Infectious arthritis is usually accompanied by an accumulation of pus, which can be removed with a puncture.
Usually develops after urogenital and intestinal infections. The pathology most often affects men aged 20-40 years. The cause of reactive arthritis is damage to joint tissue by immune complexes. Non-purulent transudate accumulates in the articular cavity. Reactive gonarthritis usually responds well to conservative treatment.
Rheumatoid
It mainly affects women who have suffered from rheumatoid arthritis of the small joints of the hand for more than 10 years. This gonarthritis has a chronic, slowly progressive course. Drug therapy can make the patient feel better and slow down the progression of the disease. However, it is impossible to completely cure the disease.
Gouty
Gout is characterized by acute recurrent arthritis of the metacarpophalangeal joint of the big toe. In some cases, gonarthritis may develop. The reason is the deposition of uric acid salts in the tissues of the joints. To successfully combat the gouty form, a special diet and drug therapy are required.
Post-traumatic
Inflammation of the knee joint occurs due to hemorrhages into the synovial cavity, ligament ruptures, meniscus tears, damage to the cartilage or joint capsule. The immediate cause of the development of pathology is infection or mechanical trauma to the joint.