The joint spaces (AS) of the knee are often narrowed due to pathologies such as gonarthrosis (in other words, osteoarthritis of the knee joint). Sharpening of the intercondylar eminences of the knee joints is a fairly common disease of the joints. The age of patients susceptible to this phenomenon is usually 20-45 years.
Many people who suffer from narrowing of the knee joint do not seek medical help in a timely manner, which leads to the progression of the disease and serious complications for human health (disability, loss of motor function).
Characteristics of the disease
Gonarthrosis begins to develop after unnatural changes in cartilage tissue. The gradual destruction of articular cartilage leads to pain.
If you take a closer look at the statistics, it turns out that every sixth inhabitant of the planet suffers from sharpening of the intercondylar elevations of the joints.
The main danger of gonarthrosis, or osteoarthritis of the knee joint, lies in the asymptomatic course of the pathology at the initial stage of its development. Pain in the joint does not appear immediately; severe, sharp pain will occur in the later stages of the disease. When diagnosing the disease, special attention should be paid to osteophytes: their presence allows us to judge the first signs of osteoarthritis of the knee.
Treatment methods
Narrowing of the joint space of the knee joint
During the examination, the doctor reveals a narrowing of the joint space of the knee joint, deformation of the patella, and unevenness of the surface of the joints on both knees. Treatment should be started immediately.
Objectives of therapeutic measures:
- relieve the patient from severe pain caused by narrowing and sharpening of the intercondylar elevations;
- restore the integrity of cartilage;
- restore range of motion to the damaged joint.
Symptoms of the disease can be relieved with medications, exercise therapy, massage, and folk remedies. It is important to strictly follow your doctor's recommendations.
Drug treatment:
- analgesics – relieve pain;
- non-steroidal anti-inflammatory drugs – relieve inflammation and swelling;
- chondroprotectors – restore articular cartilage tissue;
- hormonal medications - used for intra-articular injections in case of unbearable pain.
Comprehensive treatment for narrowing of the joint space of the knee joint includes a special diet. The diet should contain foods high in chondroitin and collagen: greens, seafood.
Additionally, physiotherapeutic procedures and sanatorium treatment are indicated.
Why does the joint space of the knee narrow?
There are many causes of osteoarthritis of the knee joint. This disease affects 15% of the world's inhabitants.
Factors that contribute to the development of the disease include:
- Excess body weight - medical practice proves that deformation of the knee joints is more often observed in mature patients suffering from obesity. Women are more susceptible to the disease than the male half of the population. Excess weight puts stress on the knee, leads to metabolic disorders and hormonal imbalance. All this provokes the development of arthrosis.
- Aging of the body - most medical professionals believe that narrowing of the knee joint appears due to the age of the patient. Elderly people (from 60 to 70 years old) are susceptible to age-related changes, which provoke the progression of the disease due to the sharpening of the intercondylar protrusions of the knee joint.
- Hereditary connection - in certain situations, the disease develops not only in old people, but also affects young people who are not obese. The cause of this phenomenon is a genetic factor (congenital pathologies, including joints). Often the development of the disease at a young age is facilitated by reduced production of intra-articular lubrication and various defects acquired by “inheritance”.
- Intense physical activity - excessive physical activity puts pressure on the knee joints, which leads to premature narrowing of the joint. For most professional athletes, knee osteoarthritis is a frequently observed pathology.
- Surgery, damage to the condyles and injuries to the knee ligaments often lead to the subsequent development of gonarthrosis.
- Blood circulation disorders - circulatory dysfunction leads to a lack of oxygen and nutrients in the cartilage tissue, which causes the knee joint to wear out faster.
The cause of knee osteoarthritis cannot always be identified, but this is rare.
If severe, unreasonable pain appears in the knee joint, then it is worth immediately conducting a medical examination to prevent the development of gonarthrosis.
Subchondral sclerosis of the hip joint
Subchondral sclerosis of the hip joint is manifested by stiffness of movement in the morning. Patients are concerned about pain in the lower back and pelvis, which worsens at night and when walking. The functioning of the intestines and genitourinary organs may be disrupted, a feeling of difficulty in breathing, chest pain and tachycardia may appear. Over time, lameness occurs; the patient cannot do without a cane, and then without a wheelchair.
If you have signs of illness, call. At the Yusupov Hospital, they treat not the manifestation, but the underlying pathology. To reduce pain, doctors prescribe analgesics, anti-inflammatory drugs and physiotherapeutic procedures. The condition of tissues is improved with the help of medications containing chondroitin and glucosamine. Joint mobility is partially restored with the help of manual therapy, exercise therapy, massage and swimming. The integrated approach used at the Yusupov Hospital will help improve the patient’s quality of life.
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Stages of disease development
The course of the disease directly depends on the degree of narrowing of the joint space of the knee. Gonarthrosis occurs in 3 main stages.
The pathology leads to pain in the knees, usually the pain intensifies after movements and exertion. Over time, problems arise when walking, and a specific crunching sound is observed in the affected joints. The disease is chronic and develops gradually.
Let us consider in detail all the stages of development of knee osteoarthritis:
- The first stage is characterized by the appearance of unpleasant sensations in the area of the joint cavity of the knee after a long walk or a long stay in a standing position. Pain occurs during intense physical activity, and fatigue is felt in the lower extremities. At this stage, the pathology does not lead to deformation of the knee bone, but X-ray images show a growth on the bone tissue (osteophyte) and a slight decrease in the thyroid gland.
The initial stage of the disease rarely manifests itself with any obvious symptoms - usually the disease is recognized accidentally when visiting a doctor about another pathology or during diagnostic procedures.
- The second stage - at this stage it is difficult not to notice the signs of gonarthrosis. The pain is constant, disturbing both in the morning and in the evening. At rest, the pain in the knee subsides, but does not disappear completely. It becomes difficult for a person to walk independently; he has to use a crutch or a cane. Movements in the joint are accompanied by a specific crunching sound, bone deformation develops, and the distance between the ligaments of the knee joint is significantly reduced.
With stage 2 osteoarthritis of the knee, swelling often appears on the surface of the skin, and the inflammatory process also begins. After contact with the affected area of the body, pain and discomfort occur.
An X-ray image shows a strong narrowing of the gap of the knee joint, modification and thickening of the bone are observed.
At this stage, the pathology begins to constantly disturb the person, which is why most patients consult a doctor precisely during this period of progression of gonarthrosis.
- The third stage indicates the neglect of the disease. At stage 3, a person often becomes disabled and loses all ability to move independently. Pain in the knee joints becomes severely painful. Climbing and descending stairs further aggravates the patient's situation; such actions become a test for him.
Stenosis of the intercondylar space of the knee joint
Stenosis of the intercondylar space is its excessive narrowing. There are primary and secondary stenosis of the intercondylar space.
Etiology
There are primary and secondary stenosis of the intercondylar space.
Primary stenosis of the intercondylar space is a constitutional feature often found in women, the cause of which is not trauma. In some cases, extreme narrowing of the intercondylar space (a “Gothic arch” appearance) is an incidental finding.
Secondary stenosis of the intercondylar space is a chronic insufficiency of the anterior cruciate ligament , often leading to stenosis of the intercondylar space due to the formation of osteophytes. Even if notchplasty was performed during anterior cruciate ligament reconstruction, recurrence of the stenosis is possible. A predisposing factor is failure to achieve full extension during rehabilitation. With degenerative changes in the joint, the formation of osteophytes in the intercondylar space is possible even in the absence of insufficiency of the anterior cruciate ligament.
Clinical picture
There are no pathognomic symptoms. In severe cases, limited extension is observed. Clinical symptoms are determined by concomitant pathological changes ( osteoarthritis , ACL failure , etc.)
Diagnostics
Clinical diagnosis depends on associated changes (osteoarthritis, previous ACL repair, etc.).
X-rays in the Rosenberg projection in a standing position can reveal a narrowing of the intercondylar space. Due to the involvement of the intercondylar space of cartilage in the stenosis, radiological data in most cases are not as informative as arthroscopic data.
MRI provides little additional information, but can be very useful in identifying associated pathological changes.
Arthroscopic findings
During the inspection, a narrowing of the intercondylar space is revealed, which in some cases takes the form of a gap, which may interfere with inspection of the anterior cruciate ligament. Osteophytes are usually found on the roof and along the edges of the intercondylar notch. Osteophytes of the intercondylar space are sometimes likened to a “guillotine,” partially or completely damaging the prosthetic ligament.
Arthroscopy of notchplasty.
Treatment
If asymptomatic stenosis of the intercondylar space is accidentally detected, treatment is not required.
If there is limited extension or fibrotic changes in the posterior capsule, scars and adhesions in the anterior region of the knee joint should be excised at maximum extension of the limb (at least 3-4 mm) to create a space between the anterior cruciate ligament or posterior cruciate ligament graft and the roof of the intercondylar space. To create additional space in the joint, notchplasty can be performed to stretch the posterior capsule.
Adequate notching is an important step in anterior cruciate ligament reconstruction, but excessive expansion of the intercondylar space is not recommended in every procedure.
The more anteriorly the tibial canal is formed, the more notchplasty is necessary during revision surgery. Therefore, in any anterior cruciate ligament reconstruction, it is important to carefully shape the tibial tunnel.
Operation technique
Notch plastic:
Revision.
The intercondylar space is examined and its width is determined. The anterior cruciate ligament is also examined in the figure-four position. The instrumentation port should not be installed too medially, as this will cause access to the intercondylar notch to be tangential, which will significantly complicate the performance of adequate notchplasty.
Notch plastic.
The margins of notch repair depend on the thickness of the anterior cruciate ligament graft. Excessive plastic surgery should be avoided. Previously, it was common to remove large fragments of the lateral femoral condyle to create a large intercondylar space. The size of the notchplasty should be selected based on the need; you should not strive to expand the intercondylar space as much as possible.
Notch plastic is performed with a milling cutter or a special curved chisel. When using a cutter, there is a risk of damage to the ligamentous apparatus when it is pulled into the cutting window. If notchplasty is necessary after inserting an anterior cruciate ligament graft into the joint cavity, it is not recommended to use a cutter.
For the above reasons, the instrument of choice is a chisel, which is placed on the narrowed wall of the intercondylar space and advanced posteriorly. Individual fragments of cartilage and bone are removed using a clamp. Finally, the enlarged intercondylar space is treated with a small ball burr (no suction) or, preferably, an arthroscopic rasp.
Joint cleansing.
Small bone fragments are removed through an irrigation cannula. This instrument is particularly useful for flushing out bone fragments that may cause postoperative irritation from the posterolateral and posteromedial inversions.
Hemostasis.
Exposed areas of cancellous bone are treated with a spherical tip electrode, leveling the bone surface and achieving hemostasis. It is more effective when this is preceded by treatment of the surface of the cancellous bone with a rasp, since the impact of the resulting bone filings promotes hemostasis. One of the tasks of electrocoagulation is the formation of an area of deep necrosis of bone tissue, which helps prevent or at least delay the recurrence of stenosis of the intercondylar space due to the growth of bone tissue.
Impingement test.
The space between the intercondylar notch and the ACL or ACL graft is assessed at maximum knee extension. If this distance is less than 4 mm, the intercondylar space should be expanded.
Flexion test.
After the impingement test, a flexion test is performed. Because the notch repair is performed with the knee in 90° of flexion, the anterior portion of the intercondylar space is usually easily accessible. When the knee joint is flexed more than 90°, posterior osteophytes are detected that injure the ACL. These osteophytes also need to be removed.
Postoperative management
Notchplasty is not performed as a separate procedure, but is used during ACL reconstruction or revision arthroscopy for limited extension, so postoperative management depends on the type of primary surgery.
Causes of subchondral sclerosis
The main cause of the disease is a discrepancy between the mechanical load falling on the articular surface of the cartilage and its ability to resist this load. This occurs during heavy physical work with frequently repeated stereotypical movements that load the same joints during excessive sports and severe obesity.
The second reason is a violation of the normal congruence of the articular surfaces of healthy cartilage. This is caused by injury or contusion, impaired subchondral circulation, synovitis, arthritis, metabolic disorders, endocrine and nervous systems, or hereditary factors.