Osteochondrosis Of The Knee Joint: Symptoms, Treatment, Degree, Prevention

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2024-01-15 19:51

Osteochondrosis of the knee joint (gonarthrosis)

The content of the article:

Features:
Classification
Degrees
Symptoms

Some special forms of knee osteochondrosis
How to treat
1. Drug therapy
2. Other methods of conservative therapy
3. Surgery
Prevention
Video

The formulation of the diagnosis "osteochondrosis of the knee joint" is not entirely correct, since the term "osteochondrosis" is applicable for lesions of the spinal column. For similar pathologies of large joints, the term osteoarthritis (osteoarthritis of the knee joint, or gonarthrosis) is more logical.

Osteoarthritis is a special group of heterogeneous degenerative diseases that are associated with damage to cartilage and all its elements, as well as with the involvement of surrounding tissues (cartilaginous parts of bones, ligaments, capsule, periarticular muscles) in the pathological process. Both definitions are in principle equivalent and describe the same degenerative process, but with different localization.

Gonarthrosis is one of the most common types of joint lesions, which is associated with increased stress on the knees

Features:

It accounts for up to 60-70% of all articular lesions.
In most cases, the outcome is favorable, but a transition to chronic forms is possible, which sharply limits the mobility of the joint (up to disability).
Elderly people suffer more often. There are also osteochondropathies, which are included in the classification of osteoarthritis, and they are congenital in nature (Larsen - Johansson, Osgood - Schlatter).
The clinical picture is extremely variable and depends on the specific form of pathology. Symptoms may not appear immediately, making it difficult to identify the disease early.
To establish an accurate diagnosis, an x-ray examination is often sufficient without the use of high-tech methods (CT / MRI).
Osteochondrosis (osteoarthritis) of the knee joint according to ICD 10 is coded as M17.

Classification

The American Association of Rheumatology presents a classification of all types of osteoarthritis, including the lesion of the knee joint. The classification is based on the cause of a particular form of ailment, and also takes into account the peculiarities of its localization.

View	Subspecies
Primary or idiopathic	The reasons for the occurrence are not clear, the division is possible only by the number of involved joints: · Local (feet, knees, hands); · Generalized (involvement of several joints).
Secondary	Due to the occurrence: · Post-traumatic; · Congenital diseases or developmental disorders; · Diseases accompanied by the formation of calcifications (for example, infectious genesis); · Other lesions of the osteoarticular system (for example, aseptic necrosis, Paget's disease). By localization: Local (this includes dysplasia of the hip joints, damage to the knee joint); Generalized (congenital chondropathies such as Osgood-Schlatter's disease).
Tertiary (as a symptom of the underlying disease)	Endocrine pathologies leading to bone damage (for example, acromegaly); · Neurogenic arthropathy (Charcot's arthropathy).

Degrees

The degree of osteoarthritis of the knee joint can be determined using different methods (clinically, radiologically).

Classification of the stages of the disease according to N. S. Kosinskaya:

Disease in the early stages of development, minor clinical manifestations (pain during physical exertion). At rest, a person experiences practically no discomfort from the knee. Active and passive range of motion is preserved. On the pictures in this period, you can see a slight narrowing of the joint space and mild subchondral osteosclerosis.
A person experiences all the classic manifestations of the disease (pain, limitation of movement, lameness). It is characterized by a narrowing of the joint space, clear signs of subchondral sclerosis. Bone tissue growth (osteophytes) occurs along the edges of the articular surfaces.
The period is kind of a permissive one. In the clinic, there are signs of contracture, lameness and severe deformity of the limb. The images show significant deformation and hardening of the articular surfaces, as well as foci of osteoporosis. The joint gap is practically not visible (complete overgrowth of the articular surface).

The Ahlbäck classification is traditionally used in the West and is built on X-ray data:

I degree - narrowing of the joint space (joint space <3 mm);
II degree - obliteration of the joint space;
III degree - minimal bone defect (0-5 mm);
IV degree - moderate bone defect (5-10 mm);
Grade V - pronounced bone defect (> 10 mm).

These degrees show how the disease develops, that is, progressive deformation of the articular tissues in the absence of proper treatment.

Symptoms

Gonarthrosis, depending on the cause of its occurrence, has features:

hereditary forms arise in childhood and are more prone to the formation of limb deformities;
post-traumatic forms, as a rule, are combined with signs of trauma.

There are common clinical symptoms of knee osteochondrosis:

Joint pain is the most common and classic symptom. The intensity of manifestation directly depends on the degree.
Local manifestations. Mild swelling and swelling of the joint may occur. Flushing, redness and other signs of inflammation are usually absent.
Restriction of movement. Has a direct relationship with the degree of the disease. The first are limited to active movements of the patient (walking, running), and a little later passive ones are also connected (inability by the attending physician to bend or unbend a limb).
Crunching sound when walking. It occurs more often after sleep and disappears during the day.
Lameness, which is initially transient. As the lesion progresses, it becomes permanent (the main reason is the occurrence of flexion-extension contractures).

Some special forms of knee osteochondrosis

Disease	Clinical picture
Koenig's disease	It affects the cartilage with the formation of foci of necrosis. In the future, areas of dead tissue are separated from the articular surface and lead to the appearance of all the characteristic symptoms of the disease, but in a more vivid manifestation.
Larson-Johansson disease	Refers to osteochondropathy and is associated with ossification of the patella. Causes dropsy of the joint (accumulation of fluid in the joint cavity). The clinical picture is very poor.
Osgood-Schlatter disease	It is one of the types of osteochondropathy, associated with the growth of the tibial tuberosity. Leads to the appearance of bone growth and thickening of cartilage. The clinical picture is primarily represented by pain.

These diseases are included in a separate group, since they can be conditionally attributed to true osteochondrosis.

How to treat

Treatment of osteochondrosis of the knee joint can be carried out by conservative or surgical methods.

Drug therapy

Drug group	A drug	Characteristic
Non-steroidal anti-inflammatory drugs	Nimesulide, Diclofenac.	They relieve swelling and inflammation, which leads to the normalization of blood circulation and the launch of regenerative processes. They have a pronounced analgesic effect.
Chondroprotectors	Chonroitin sulfate	Provide protection of cartilaginous surfaces from destruction. They have a weak effect on regeneration.
Analgesics	Analgin	They relieve pain syndrome for a while (NSAIDs are more effective).
Local therapy (gels and ointments with NSAIDs, irritating or analgesic effects)	Nise, 911 with bischofite.	They allow to slightly improve the general condition of the patient, but they do not have a special therapeutic effect.
Multivitamin complexes	Calcium d3 nycomed.	General strengthening effect, improvement of metabolic processes in tissues.

Other methods of conservative therapy

Physiotherapy (phonophoresis, iontophoresis, magnetotherapy, UHF, myostimulation). The main action is aimed at eliminating inflammation in the tissues. Provides a faster recovery period.
Exercise therapy. A special set of exercises aimed at restoring motor function. The method is especially relevant when contractures occur.

Surgery

Operative methods of treatment are resorted to in extreme cases:

lack of effect from conservative therapy for 2-4 months;
intractable pain syndrome;
progressive thinning of bone tissue and severe loss of motor function.

Replacement of the knee joint with an artificial one is indicated in case of its inability to perform its function

Surgical techniques used:

Puncture of the joint. The main goal is to reduce the pressure in the articular cavity. The aspirated liquid is sent for research to identify the nature of the process (aseptic, purulent) and differential diagnosis.
Arthroscopy. Refers to minimally invasive techniques that allow, without much intervention in the anatomical integrity of the joint, to perform excision of the affected cartilage or remove osteophytes.
Osteotomy. It is carried out using wide access with total excision of all affected tissues. Refers to traumatic types of operations.
Endoprosthetics. It is used as a logical continuation of osteotomy in the case of severe destruction of bone elements and cartilage. It consists in replacing the destroyed joint with an artificial one, thereby allowing the limbs to return to mobility. Requires long-term rehabilitation.

Prevention

There is no specific prophylaxis, but you can reduce the risk of the disease by observing the general rules:

Regular preventive examinations for people at risk (especially the elderly).
Preventive course of vitamin and mineral complexes.
Weight normalization.

Establishing a balanced diet. A fractional meal with a predominance of vegetable and dairy foods is recommended.
Moderate and regular exercise.