Medical practice annually diagnoses a huge number of arthrosis, as well as other pathologies of joint tissues. However, it is known that most of them are accompanied by other chronic diseases, which include chondromatosis.
Chondromatosis of the joints is a complex process accompanied by the formation of a large number of cartilaginous bodies located in the tissues of the joint. Over time, there is the presence of pain of varying intensity, swelling of tissues close to the lesion, as well as a characteristic crunching sound when performing movements and severe limitation of joint mobility.
In order to establish an accurate diagnosis when chondromatosis of the hip, knee or other joints is suspected, ultrasound (ultrasound) and X-ray examination, magnetic resonance imaging (MRI) and computed tomography (CT) are used.
Treatment of the problem under consideration is predominantly surgical, combined with conservative and physiotherapeutic methods.
What is hidden under the concept of “chondromatosis of the joint”?
Chondromatosis is usually understood as the formation of tumor formations in the joint cavity, the diameter of which varies (from one millimeter to five centimeters).
Statistical data from clinical rheumatology indicate that the diagnosis in question is rarely made. Among the diagnosed cases, the vast majority of patients are men over 45 years of age. According to available information, there is evidence of the detection of congenital chondromatosis.
Large joints (hip, knee, elbow and shoulder) are most susceptible to damage. Lower risks of developing pathology in the ankle and wrist joints.
Mechanism of disease development
Pathological processes of various types provoke changes in the structure of articular tissues. A number of diseases create conditions for partial replacement of synovial membrane cells, which triggers the development of chondromatosis in the hip, knee or other joint.
At the most favorable moment for the development of pathology, the body activates a compensatory function and starts the process of partial replacement of synovial membrane cells with cartilage tissue, which separates into tumor formations that gradually increase in size.
Over time, the formations penetrate into the joint cavity and, moving freely inside, remain there. If left untreated, the surface of the particles ossifies, which leads to certain difficulties in realizing the functionality of the joint.
Reasons for activating processes
Due to the peculiarities of the development of pathology, it is almost impossible to determine the exact causes of its occurrence.
There is an assumption that a congenital pathological process is formed as a result of a violation of the embryonic differentiation of articular tissues.
The acquired form is usually associated with external causes that have a negative impact and disrupt metabolic processes within the tissues of the joint.
Additionally, it is noted that joint injuries of various sizes, as well as excessive loads and previous infections can act as a risk factor.
Current classification
There are several criteria by which the classification of chondromatosis is formed. First of all, this is the type of pathology by which they determine:
- congenital - heads the category of true articular dysplasia and progresses with the formation of tumors;
- postnatal – benign or malignant (chondroma/chondrosarcoma, respectively).
The second criterion for classification is the form:
- stable - occurs with a small number of formed bodies (single or multiple), after which their formation slows down greatly or stops altogether;
- progressive – the development process is accompanied by the continuous formation of tumors (the number is not limited);
- rare.
Pain on the front of the knee
Surgical treatment may be indicated in cases where conservative treatment has proven ineffective. There are several types of surgical interventions used for osteoarthritis of the knee.
Chondroplasty . This operation is performed arthroscopically, i.e. through small incisions using special instruments, and consists of smoothing articular surfaces deformed due to arthrosis. Chondroplasty is indicated for minimal to moderate changes in cartilage.
Correction of the position of the patella . Restoring tissue tension or, conversely, relaxing them on one side or another of the patella to return the latter to the trochlear groove.
Osteochondral transplantation . Removal of a damaged area of knee joint cartilage and replacing it with healthy cartilage taken from another part of the knee joint. This operation is usually performed only on younger patients with small cartilage changes.
Relocation of the tibial tuberosity . This surgery may be effective when certain areas of the patella are affected. The patellar tendon attaches to a bony protrusion on the front surface of the tibia called the tuberosity. Moving this tuberosity in one direction or another allows you to change the position of the patella. This operation allows you to restore the normal sliding of the patella in the trochlear groove, reducing the load on the altered areas of the cartilage and the associated pain.
Endoprosthetics of the patellofemoral joint . During this “partial” knee replacement, damaged areas of cartilage and bone are removed and replaced with metal and polyethylene components. The area of the trochlear groove is replaced by a thin metal plate, and the surface of the patella articulating with it is replaced by a polyethylene “button”. These components are usually secured with bone cement.
( Left ) X-ray of the patellofemoral joint. The patella and trochlear groove are deformed due to a degenerative process. There is no joint space and the bone surfaces touch each other. ( Right ) Radiograph after patellofemoral joint replacement. The patellar implant is made of polyethylene and is not visible on x-rays.
Endoprosthetics of the patellofemoral joint is not indicated in cases where other parts of the knee joint are also degeneratively changed. In such cases, total knee replacement is performed.
Total knee replacement . During this operation, all articular surfaces of the knee joint are replaced with prostheses. The articular ends of the femur and tibia are replaced with metal components, between which a polyethylene liner is installed, allowing one component to slide relative to the other. The articular surface of the patella is also replaced with a plastic “button”.
( Left ) Patellofemoral joint replacement. This “partial” knee replacement can be used for degenerative lesions limited to the articular surface of the patella and the trochlear groove. If other parts of the knee joint are also affected, total arthroplasty is indicated ( Right ).
Treatment results
For most patients, treatment for patellofemoral arthritis can effectively reduce pain and improve knee function. Treatment results, however, vary and depend on the individual characteristics of the patient and the nature of the treatment performed. With your doctor, you can discuss in detail the possible results of certain treatment methods in your specific situation.
Symptomatic picture of chondromatosis of the joints
Knowledge of the key features of the symptomatic picture allows you to form a certain understanding, which makes it possible to promptly seek qualified medical help.
Despite the seriousness of the ongoing pathological process, the symptoms are not at all obvious. The patient may suspect arthrosis or arthritis, but in fact receive a completely different, no less comforting diagnosis.
The main symptoms of chondromatosis: pain localized in the joint, swelling and local redness of the tissues, limited mobility.
Synovial chondromatosis: types, symptoms and treatment
It consists in the fact that many cartilaginous nodes are formed inside the joint. The number of such nodes can be very diverse - from a few pieces to hundreds. The size of the nodes can also be different: from a few millimeters to fifteen centimeters.
Despite the name, it is the hip joint that is least often affected. Basically, this pathology occurs in the elbow and knee joints. One of the features of chondromatosis is the complete absence of any symptoms for a long period of time. Accordingly, detection of this disease is not an easy task and, as a rule, occurs randomly.
Types of chondromatosis
The first thing you should pay attention to is the rate of progression and whether it exists at all. Most often, it happens that the formation of nodes occurs once, and new ones may appear several years later.
If the formation of cartilage “balls” occurs with a certain frequency and the patient experiences other symptoms, then this is a sign that the disease is progressing. In such cases, surgery is required to avoid the appearance of new nodes.
Depending on the appearance, chondromatosis can be classified into:
- acquired;
- congenital.
The latter, as a rule, occurs during the prenatal period, when the child’s cartilage is formed incorrectly, and as a result, the child is born with this pathology.
Acquired chondromatosis is most often the result of injury. However, it is still not clear how injuries and fractures cause the formation of these cartilage “balls” in the joints.
Three phases of this disease can be distinguished:
- Initial phase. There is cartilage metaplasia directly in the synovium.
- Transition phase. Cartilaginous nodes are separated from the synovium and form into free cartilaginous bodies.
- Rest phase. New bodies are not formed, but the old ones do not disappear anywhere. There is also synovial fluid in the joint, the amount of which may vary.
Symptoms
If the disease does not progress, there are no symptoms at all, which makes it difficult to detect. When new nodes appear, the old ones begin to thicken. The reason for this is calcium fouling. This can already be seen using x-rays. This is the only way to identify this pathology.
Symptoms begin to appear much later. Typically, patients complain of:
- joint pain
when walking; - discomfort in the lower extremities (sometimes only in one leg);
- sensation of a foreign body inside the joint;
- swelling and redness of the skin of the affected area of the body;
- clicking sounds;
- temperature increase;
These symptoms should not be ignored. Taking timely measures and consulting a doctor will help avoid an increase in the inflammatory process. If the inflammation spreads to the synovial membrane, this contributes to the formation of arthritis of the joints. Then it smoothly flows into arthrosis. In the end, everything ends in failure - the joint is destroyed.
How is synovial chondromatosis diagnosed?
Primary complaints of patients, as a rule, are not specific. Most pathologies of the musculoskeletal system have similar symptoms. Therefore, magnetic resonance imaging (MRI) is performed in order to make a correct and accurate diagnosis.
X-ray will be effective only if the pathology progresses. In the absence of other symptoms, the image will not show anything, since the X-ray machine does not see the cartilage tissue and the formations on it, respectively.
Treatment
The only treatment method that is effective in combating this disease is surgery. Medicines, injections, and even more so traditional medicine will not bring any results.
The course of the operation is that the resulting bodies are removed from the joint. The wound is then sutured. This option is acceptable if the disease does not progress. If the “balls” continue to appear, then not only they are removed, but also part of the synovial membrane itself. Sometimes it is necessary to remove the cruciate ligaments and the synovial bursa if nodes were also found on them.
After the operation, regular x-ray monitoring is needed to make sure that all cartilage bodies have been removed. It often happens that some time after a successful operation, nodes are detected in the patient again. In fact, these are not new bodies. At the time of the operation, the surgeon physically could not notice them, because they were still located in the thickness of the shell, and then they moved beyond its limits.
Relapse
A more serious situation is when the nodes form a tumor, united into one. This tumor is called chondroma. The symptoms are similar to arthritis, but the course of this pathology is not uniform. At first there may be an exacerbation, then a period of remission occurs. Chondroma is difficult to see on an x-ray because it is not covered with calcium. But the main symptom is present - pain. Subsequently, the patient complains that he feels limited movement of his leg.
This tumor can also be malignant (chondrosarcoma). After the tumor appears, metastases begin. Signs of cancer become more pronounced. By the way, the hip joint is in first place in the number of requests for such a diagnosis.
In such cases, during surgery it is necessary to either completely remove the diseased joint or install an endoprosthesis.
Then only part of the joint is removed. In very advanced cases, limb amputation is the only way out. However, such cases are rare, and most often the prognosis is favorable. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr
Features of treatment of joint chondromatosis
Treatment begins with a thorough diagnosis and diagnosis, for which instrumental methods such as ultrasound, MRI, CT, etc. are used. The main goal of diagnosis is to exclude the possibility of other diseases with similar symptoms.
The treatment process for chondromatosis is complex and very radical. The only correct solution is surgical intervention to excise the formations.
As an additional therapy, a complex of physiotherapeutic methods and medication are used.
Features of drug therapy
Drug treatment of chondromatosis is ineffective, and therefore drugs are prescribed solely to consolidate the effect of surgery or maintenance therapy.
During the implementation of the treatment regimen, antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), painkillers and chondroprotectors can be used.
Chondroprotectors are a special group of medications that help joint tissues recover. Prophylactic use of drugs in this group makes it possible to reduce the risks of developing pathological conditions. The drug “Artracam” has proven itself to be excellent, distinguished by its reliability, quality and availability.
Radical methods
Surgical intervention as a treatment for chondromatosis can be implemented by one of two available and widely used methods:
- arthrotomy - dissection of the joint capsule in order to open it and remove formations;
- arthroscopy is a minimally invasive intervention that involves cleaning the internal cavity of the joint.
The determination of the optimally suitable method is based on the patient’s medical history, the characteristics of the course of the disease and other factors influencing the decision of the attending physician (the general health of the patient, his age, etc.).
Chondromatosis of the hip, knee or other joints is not a death sentence. Monitor the general state of your own health and strive to promptly eliminate emerging diseases, regardless of their complexity.
Benefits of Arthroscopy
Knee arthroscopy has many advantages over routine open arthrotomy (extensive skin incision and opening of the joint cavity). It should be noted that today arthroscopy has almost completely replaced open surgery from practice, which today is performed only in isolated and severe cases, for example, malignant tumors.
Indications for knee arthroscopy:
- meniscal damage;
- Baker's cyst;
- damage to joint ligaments (anterior, posterior cruciate ligaments, collateral ligaments);
- damage (including dislocation) of the patella
- osteochondritis dissecans;
- patellofemoral instability;
List of operations performed on the knee joint using arthroscopy:
- diagnostic arthroscopy of the knee joint;
- meniscus resection;
- suturing the meniscus;
- removal of meniscus cyst;
- plastic surgery of the anterior cruciate ligament;
- plastic surgery of the posterior cruciate ligament;
- revision plasty of the anterior cruciate ligament;
- revision plasty of the posterior cruciate ligament;
- plastic surgery of the medial collateral ligament;
- plastic surgery of the lateral collateral ligament;
- removal of free chondromic bodies;
- resection of damaged cartilage (shaving/ablation);
- microfracture (tunnelization) of the damaged cartilage area;
- refixation of cartilage in osteochondritis dissecans;
- autocartilage transplantation (OATS);
- surgeries for habitual dislocation of the patella: lateral capsule release, Yamamoto operation, medial capsulorrhaphy, MPFL reconstruction, transposition of the tuberosity of the b/w bone;
- osteosynthesis for intra-articular fractures of the femur and tibia;
- arthroscopic arthrolysis of the knee joint;