The term "Koenig's disease" refers to a pathological process, the development of which is accompanied by a gradual exfoliation of cartilage from the bone. According to statistics, the most common ailment is diagnosed in men under the age of 30 years. If the first alarming signs appear, consult a doctor. Ignoring the problem can lead to complete destruction of the joint. Currently, the treatment of Koenig's disease is carried out using both conservative and surgical methods.
Development mechanism
The surface of the bones in the joints is covered with smooth cartilage. There are no blood vessels in it. Cartilage is nourished by the intake of necessary substances from intraarticular fluid and bone. Its task is to facilitate the process of sliding surfaces. Despite the fact that the bone and cartilage tissue are heterogeneous, they are connected extremely tightly.
Under the influence of various adverse factors, a pathological condition develops. It is characterized by a gradual separation of the cartilage from the bone. Over time, it can exfoliate completely and freely move along the knee joint, thereby causing pronounced unpleasant sensations.
Causes
At present, the etiology of the occurrence of Koenig's disease (diseases of the knee joint) has not been fully studied. There are several versions of its appearance.
Scientists are inclined to believe that the following conditions and pathologies are the main causes of the development of the disease:
- Hereditary predisposition.
- Coronary artery disease, in which a certain area of bone tissue receives an insufficient amount of blood.
- Abnormal structure of the knee joint.
- Frequent injuries, including osteochondral nature.
- Diseases of the pineal gland.
Probably, the trigger for the development of pathology is the simultaneous impact on the knee joint of the above adverse conditions. In ICD-10, Koenig's disease is assigned the code M93.2 - “dissecting osteochondritis”.
Severity
Pathology is conditionally divided into 2 forms: adult and juvenile. In the first case, the disease occurs in young and mature individuals, in the second - in children and adolescents. The adult form is considered the most severe, since it is difficult to treat. Most patients are shown surgery to get rid of the disease. The juvenile form is characterized, as a rule, by damage to both knee joints. Nevertheless, it is well treatable. In children, Koenig's disease is easier and ends in complete recovery.
Pathology develops slowly. There are 4 degrees of its severity:
- I. At the initial stage, the cartilage tissue in the affected area is slightly softened. In this case, the boundaries of the pathological focus are absent.
- II. The area of softened cartilaginous tissue is stationary. However, the focus of the pathology already has clear boundaries.
- III. Cartilage is slightly displaced relative to the bone to which it is attached.
- IV. Exfoliation of the tissue site occurs. A cartilage fragment forms a free body moving inside the knee joint.
Most often, Koenig's disease affects the knee joint, less often - the ulnar, hip and ankle.
Symptoms
A feature of pathology is its slow progression. At the initial stage, a person practically does not feel any disturbing signs. At an early stage, an accurate diagnosis is difficult to make, since mild pain can be a sign of many pathologies of the musculoskeletal system.
Over time, the following symptoms appear (gradually their intensity increases):
- Limitation of motor activity, up to the inability to move a limb.
- Pronounced painful sensations, aggravated at a certain position.
- Edema localized above the patella.
- Lameness.
- Wilson's symptom. When walking, the patient turns his leg out. By reducing the load on the inside of the knee joint, the pain becomes less pronounced.
In some cases, doctors manage to find a freely moving area of cartilage.
Which specialist to contact
If alarming symptoms occur, you must make an appointment with the therapist. Based on the results of the initial diagnosis (examination and medical history), the specialist will refer you to a consultation with an orthopedic traumatologist. In some cases, an examination by a rheumatologist is required.
Diagnostics
The symptoms of Koenig's disease are not specific. The presence of none of the symptoms gives reason to assume the development of this particular pathology.
In order to identify an ailment and draw up the most effective treatment regimen for the knee joint (Koenig's disease), the doctor directs the patient for examination, including both laboratory and instrumental diagnostic methods:
- Analysis for rheumatic tests. The biomaterial is venous blood. In the presence of Koenig's disease, the indicators do not deviate from the norm. The study is appointed in order to exclude the presence of many other ailments.
- Roentgenography. At the initial stage of the development of pathology, this method is not informative. On the radiograph it is impossible to see a slight softening of the cartilage. At stages 3 and 4, necrotic areas with clear boundaries are clearly visible.
- CT scan. Uninformative only at stage 1. Allows you to detect a pathological lesion with clear boundaries. In the process of conducting a study, it is also possible to assess its depth and size.
- Magnetic resonance imaging. It can be carried out with or without contrast. Using this method, it is possible to detect the disease even at the earliest stage of its development.
- Ultrasound The method is one of the most highly informative.
- Arthroscopy This is a method that allows you to assess the condition of bone and cartilage tissue from the inside. It is considered the most informative.
Based on the diagnostic results, the doctor draws up a treatment plan for the knee joint (Koenig's disease). The issue of the advisability of surgical intervention is also being addressed.
Conservative Therapies
Non-surgical treatment of the disease is successfully carried out in children and adolescents. It is important to consider the severity of the pathology. In some cases, conservative methods are also applicable to adult patients who have a slight lesion of the knee joint (Koenig's disease in the initial stage).
The treatment regimen includes the following items:
- Resting the limbs. In some cases, the leg is immobilized by an orthosis or plaster cast. Until the pain disappears completely, it is recommended to move around with crutches.
- Physiotherapy. If there is no pain, the patient should perform simple exercises daily, training the quadriceps and hind muscles of the thigh.
- Taking non-steroidal anti-inflammatory drugs. Medications temporarily relieve the patient's condition. It is important to understand that the active ingredients of the drugs stop pain, but do not affect the cause of the disease.
- Reception of the means improving cartilage tissue nutrition.
- Physiotherapeutic procedures.
In advanced cases and with the ineffectiveness of conservative methods of therapy, surgical treatment is indicated.
Surgical intervention
Before its implementation, the doctor discusses with the patient the choice of methodology. In addition, the operation requires the implementation of preparatory measures.
These include:
- Wearing compression products.
- Diet and cleansing enema on the eve of surgery.
- Quitting smoking and drinking alcohol.
With Koenig's disease, surgery can be performed in 2 ways:
- Open.
- Endoscopic (arthroscopy).
Currently, doctors prefer method 2. It is less traumatic, due to which the duration of the rehabilitation period is reduced.
Having made 2 or 3 incisions, the surgeon inserts endoscopic instruments into them. Initially, the doctor removes the dead bone fragment. After that, the surgeon removes scar tissue and granulation. The final step is to smooth the surface of the bed. Over time, the affected area is restored.
If the removed bone fragment is very large, the surgeon performs arthroplasty using a collagen matrix. It also happens that the entire condyle is involved in the pathological process. This is the extremity of the bone of a spherical type, providing mobility to the joint. In this case, unicompartmental arthroplasty is performed.
After a successful surgical intervention, the incisions are sutured, and the knee joint is immobilized with a plaster cast or orthosis. In the postoperative period, it is necessary to ensure limb rest. To restore joint mobility, doctors recommend taking a course of physiotherapeutic procedures and regularly perform a set of physiotherapy exercises.
Effects
When a knee joint is damaged ( Koenig's disease ), a person's gait changes. This is due to the fact that he tries to twist his leg to reduce the severity of pain. In addition, lameness appears. All this significantly reduces the level of quality of life, as motor activity turns into a test.
Over time, the quadriceps femoris atrophies. This is due to the lack of load on it. The thigh of the affected limb becomes thinner than the second.
If you ignore the need to seek qualified medical help, Koenig's disease progresses - the knee joint is gradually destroyed. This leads to disability and disability. In addition, the risk of involving other joints in the pathological process increases. Often in patients in the intervertebral disc hernias are formed.
The likelihood of developing degenerative-dystrophic changes directly depends on the duration of the disease and the location of the focus of the pathology.
Forecast
With timely access to a doctor, the outcome in most cases is favorable. In almost all people, after a successful surgical intervention, unpleasant symptoms disappear and joint function is restored, that is, the quality of life returns to its previous level.
Prevention
Currently, the causes of Koenig's disease are not fully understood. In this regard, no specific preventive measures have been developed to prevent the development of pathology.
In any case, everyone should try to avoid getting injured, especially the same area. In addition, it is necessary to minimize the risk of vascular disease. To do this, it is recommended to quit smoking and drinking alcohol-containing drinks, as well as adjust the diet in accordance with the principles of a healthy diet.
Finally
Koenig's disease is a pathology characterized by a gradual separation of the cartilage tissue from the bone. A feature of the disease is its slow progression. Diagnosis of the disease at an early stage is of some difficulty, since a person has no specific symptoms. In addition, during the examination, it is rarely possible to identify a focus of pathology. In order to avoid serious complications, it is necessary to consult a therapist or orthopedist-traumatologist when the first alarming symptoms appear. Treatment of pathology is carried out both by conservative and surgical methods. In the ICD of Koenig's disease, code 93.2 is assigned.