Patella osteochondropathy belongs to the group of diseases in which aseptic necrosis of bone tissue occurs. Destructive processes most often occur due to mechanical damage. The disease is quite rare and occurs in 3% of patients visiting orthopedic surgeons. Pathology affects children, adolescents and men up to 30 years. With timely treatment, the disease passes without a trace, but it can still lead to serious complications and even disability of the patient. Below we consider in more detail the symptoms, treatment and causes of osteochondropathy of the patella.
What it is?
Osteochondropathy refers to several ailments that occur in the knee. All diseases differ in the location of the knee joint and symptoms. These include:
- Koenig's disease. It is characterized by inflammation of the cartilage. Damaged parts of the cartilage are separated or flaked from the bone. Their random movement along the joint bag disrupts the movement of the joint itself. The inflammatory process occurs in the cartilage. In a neglected form, its deeper parts die. Pathology is common at the age of 10 to 20 years. Moreover, it occurs in boys 3 times more often than in girls.
- Larsen-Johansson's disease (patella osteochondropathy). With this disease, an incorrectly ossified patella causes pain, causes swelling, leads to hydroarthrosis, and limits mobility. The affected area is patellar fragmentation. The risk group includes adolescents involved in sports aged 10 to 15 years.
- Osgood-Schlatter disease. It is characterized by pathological changes in the tibia. In the tuberosity, a growth appears, which causes pain in the patella. The disease causes microtraumatization of bones. It occurs in children and adolescents aged 8 to 16 years. Like Larsen’s disease (osteochondropathy of the patella), boys are most often affected.
- Leven's disease. Causes negative changes in the knee joint. Over time, the disease develops into intractable synovitis. In the early stages, it is characterized by intermittent pain of moderate strength. Movement in the joint is preserved in full, but at the same time they are painless. Usually the process is one-sided. Leuven's disease (osteochondropathy of the patella) develops between the ages of 12 to 14 years.
Causes
The most common causes of knee disease are excessive exercise and knee injuries. That is why active children and adolescents most often suffer from ACP. In addition, this pathology can occur in men under 30 years of age. Much less commonly, acute respiratory infections are found in older people. Symptoms of the disease of the osteochondropathy of the patella can occur for other reasons:
- Flat feet.
- Scoliosis and other forms of curvature of the spine.
- Hereditary predisposition.
- Incorrect metabolism.
- Obesity.
- Circulatory disturbance in the legs.
Symptoms
Usually, at the very beginning of the disease, there are no obvious signs. The first bell is the appearance of short painful sensations during physical exertion. In a calm state, the patient, as a rule, does not experience discomfort. After some time, the pain intensifies and she has a focus.
Painful sensations of the patella may indicate that the patient is suffering from Larsen-Johansson's disease. If the focus is located in the medial condyle, then this is a dissecting patella osteochondritis.
Pathology in children manifests itself more often than in adults. In the first and second stages of the disease, the patient experiences dull aching pain in the knee. This period is characterized by the destruction of articular cartilage. It becomes difficult to bend and unbend it, uncomfortable sensations arise. The muscle corset becomes weak, swelling appears.
Over time, osteochondropathy of the lower pole of the patella as well as the upper causes a kind of crunch and the person begins to limp. At the third stage, the course of the disease is aggravated: bone and cartilage tissue are destroyed, pain becomes very strong, the joint becomes inflamed and deformed, swelling of the knee can be noticed with the naked eye, muscle tissue atrophies.
During walking, the patient is very lame, and when bending the knee, a constant crunch is heard.
Diagnostics
You can not establish a diagnosis yourself. Only an experienced doctor, depending on the symptoms and neglect of the disease, can choose the appropriate type of diagnosis. Five methods are most commonly used:
- Ultrasonography. It can only be done by a highly qualified specialist. He is able to see a reliable clinical picture of the disease. Ultrasound determines the diagnosis and stage of the disease with high accuracy.
- Scintigraphy. Another highly effective method. Unfortunately, it applies only to children. Patella osteochondropathy using this method is determined at any stage.
- Magnetic resonance imaging helps to well examine the joint affected by Koenig's disease. With the help of MRI, the pathology is determined even at the initial stage. An objective assessment of the standing of the affected area at a given time is given. OXN is diagnosed by magnetic resonance imaging for all four types of disease.
- In the early stages, differential diagnosis is relevant.
- Arthroscopy It is mainly used to recognize Koenig's disease. It is effective at all stages of the disease and helps to diagnose with high accuracy, as well as choose an effective method of treatment in the future.
In some cases, the pathology is determined by x-ray. Osteochondropathy of the patella is diagnosed by the method that the doctor considers the most suitable for each individual patient.
Therapy
The treatment of most existing pathologies includes two types of therapeutic measures:
- drug (conservative) method;
- surgical intervention.
OHN is no exception. The treatment method is selected individually and only after determining the disease, as well as possible complications.
Conservative treatment
The treatment of osteochondropathy of the patella is carried out according to one principle and basically gives a positive result precisely with drug therapy. To relieve swelling and pain, ointments and analgesics with an anti-inflammatory effect are prescribed: Ibuprofen, Diclofenac. In this case, the patient is recommended to minimize the load on the sore knee and exclude any movement in the joint.
Plaster can be applied for up to two months. To activate the processes of restoration of cartilage, chondroprotective drugs are used. In free sale you can find many ointments with glucosamine and chondroitin: "Chondroitin sulfate", "Glucosamine Maximum" and others. During treatment, physiotherapy is also carried out - electrophoresis, paraffin applications. In addition, the intake of vitamins "Neuromultivit" is prescribed. Subject to all recommendations, OHP can be cured in one year. In the absence of positive results after three months from the start of therapy, the question of surgical intervention is discussed.
Surgical method
Surgical treatment involves the use of arthroscopic equipment for surgical restoration of the joint. During the operation, the cartilage formation is removed and the plastic of the new cartilage is produced. The reason for the operation may be a re-manifestation of the disease. In some cases, surgery may be performed to remove splinter elements of the joint. Often, such treatment is the only way to maintain the shape of the knee and its full functioning.
After the operation, it is necessary to maintain peace and abandon any physical activity. Violation of the doctor’s recommendation can lead to joint deformation and complications in the form of secondary patella osteochondrosis.
Exercise exercises for osteochondropathy of the patella
Physiotherapy exercises are indicated during the period of immobilization. While the diseased limb is fixed with a splint, the patient should apply general developmental exercises. It can be:
- dynamic movements (extensor, flexion, rotational) of a healthy limb;
- rhythmic muscle contraction of a damaged leg;
- keeping the leg with gypsum in weight;
- ideomotor exercises - visualization of movement in the joint.
It is necessary to start the exercises a few days after surgery and casting, but only with the permission of the doctor. With a healthy foot, perform any movement - take it to the side, lift, make circular rotations, swing, statically strain the muscles.
The load on the muscles of the body is also performed - raise the shoulders and head, fix the position for several seconds. A few days after the operation, the patient is recommended to briefly lower the affected leg from the bed, and then raise it above the torso. Walking around the ward is allowed on crutches, without relying on the operated leg.
Complications
As mentioned above, children and adolescents, who are characterized by an increased load on the legs and trauma to the knee, are most often affected by CHF. The treatment of this disease takes a lot of time. Sometimes it takes more than one year. Most often, the disease goes away without special complications for patients. Children's cartilage and bones are quickly updated and restored. In older people, osteochondropathy is more difficult and longer to treat. In advanced cases, the following complications may occur:
- Osteoarthritis of the knee.
- One leg may be shorter than the other by a couple of centimeters.
- Due to the difference in limb length, the spine may become deformed and scoliosis may develop.
Without surgery, lameness can remain until the end of life. If the child, after a bruise or other joint injury, remains calm and does not burden the joint, osteochondropathy of the patella can pass on its own. But this happens very rarely.
Prevention
It is impossible to prevent a knee injury, but the risk of developing pathological processes can be reduced. You must follow simple rules for all family members:
- If you have knee pain, be sure to visit an orthopedic surgeon.
- The child must know the safety rules and what might cause severe bruises and falls.
- To identify the disease at an early stage, you should regularly undergo a medical examination.
- Excessive physical exertion must be avoided.
In addition, preventive measures that prevent the occurrence of osteochondropathy include swimming in the pool and therapeutic massage. In order to avoid Osgood-Schlatter’s disease, athletes are recommended to use knee pads with soft inserts during training, or to sew foam pads on sportswear.
Conclusion
Having examined all forms of osteochondropathy of the knee joint, we can conclude that the disease is very dangerous, but the diagnosis is not a sentence. It should be understood that it is not worth treating this disease on your own. At the first symptoms of soreness in the knees, it is necessary to consult a specialist. The legs are part of the musculoskeletal system, which is actively involved in a full life. Properly selected treatment and compliance with all medical recommendations will help restore the knee joint within one year, and observing the rules of prevention, you can completely avoid the disease.