Osteochondropathy of the patella refers to a 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 who visit orthopedic doctors. Pathology affects children, adolescents and men under 30 years of age. 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 take a closer look at the symptoms, treatment and causes of osteochondropathy of the patella.
What is this?
Osteochondropathy refers to several ailments that occur in the knee area. All diseases differ in localization in the knee joint and symptoms. These include:
- Koenig's disease. It is characterized by inflammation of the cartilage tissue. Damaged parts of cartilage separate or flake off from the bone. Their random movement along the articular bag disrupts the movement of the joint itself. The inflammatory process occurs in the cartilage tissue. In a neglected form, its deeper parts die off. Pathology is common at the age of 10 to 20 years. Moreover, it occurs 3 times more often in boys than in girls.
- Larsen-Johansson disease (osteochondropathy of the patella). With this disease, an incorrectly ossified patella causes pain, causes swelling, leads to hydroarthrosis, and limits mobility. The affected area is fragmentation of the patella. The risk group includes teenagers involved in sports between the ages of 10 and 15.
- Osgood-Schlatter disease. It is characterized by pathological changes in the tibia. A growth appears in the tuberosity, which causes pain in the area of the patella. The disease causes microtrauma to the bones. It occurs in children and adolescents, aged 8 to 16 years. Like Larsen's disease (osteochondropathy of the patella), it most often affects boys.
- 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 medium strength. The movements in the joint are preserved in full, but at the same time they are painless. Usually the process is one-sided. Leven's disease (osteochondropathy of the patella) develops with age12 to 14 years old.
Reasons
The most common causes of knee disease are excessive exercise and knee injury. That is why active children and adolescents most often suffer from OCP. In addition, this pathology can occur in men under 30 years of age. OCP is much less common in the elderly. Symptoms of osteochondropathy of the patella can also occur for other reasons:
- Flat feet.
- Scoliosis and other forms of curvature of the spine.
- Hereditary predisposition.
- Wrong metabolism.
- Obesity.
- Impaired circulation in the legs.
Symptoms
Usually, there are no obvious signs at the very beginning of the disease. The first call is the appearance of short painful sensations during physical exertion. In a calm state, the patient, as a rule, does not experience discomfort. After a while, the pain intensifies and she develops a focus.
Painful sensations in the patella may indicate that the patient suffers from Larsen-Johansson disease. If the focus is located in the area of the medial condyle, then it is osteochondritis dissecans of the patella.
Pathology in children is more common than in adults. In the first and second stages of the disease, the patient experiences a 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 one, 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 tissues are destroyed, pain becomes very strong, the joint becomes inflamed and deformed, swelling of the knee can be seen with the naked eye, muscle tissue atrophies.
While walking, the patient limps very badly, and a constant crunch is heard when bending the knee.
Diagnosis
You can't diagnose yourself. Only an experienced doctor, depending on the symptoms and neglect of the disease, can choose the appropriate type of diagnosis. The five most commonly used methods are:
- Ultrasound. It can only be done by a highly qualified specialist. He is able to see a reliable clinical picture of the disease. Ultrasound with high accuracy determines the diagnosis and stage of the disease.
- Scintigraphy. Another highly effective method. Unfortunately, it only applies to children. Osteochondropathy of the patella using this method is determined at any stage.
- Magnetic resonance imaging helps to better examine the joint affected by Koenig's disease. With the help of MRI, pathology is determined even at the initial stage. An objective assessment of the standing of the affected area at a given point in time is given. ACHF is diagnosed by magnetic resonance imaging in all four types of the disease.
- Relevant in the early stagesdifferential diagnosis.
- Arthroscopy. It is mainly used to recognize Koenig's disease. It is effective at all stages of the disease and helps to make a diagnosis with high accuracy, as well as to 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 most appropriate for each individual patient.
Therapy
Treatment of most existing pathologies includes two types of therapeutic measures:
- drug (conservative) method;
- surgery.
OHN is no exception. The method of treatment is selected individually and only after determining the disease, as well as possible complications.
Conservative treatment
Treatment of osteochondropathy of the patella is carried out according to one principle and basically gives a positive result with drug therapy. To relieve swelling and pain, ointments and analgesics with anti-inflammatory action are prescribed: Ibuprofen, Diclofenac. In this case, the patient is recommended to minimize the load on the affected knee and exclude any movement in the joint.
May be cast for up to two months. To activate the processes of restoration of cartilage tissue, chondroprotective drugs are used. In free sale, you can find many ointments with glucosamine and chondroitin: "Chondroitin sulfate","Glucosamine Maximum" and others. During the treatment, physiotherapy is also carried out - electrophoresis, paraffin applications. In addition, the intake of vitamins "Neuromultivit" is prescribed. Subject to all recommendations, OHP is cured in one year. In the absence of positive results after three months from the start of therapy, the issue of surgical intervention is discussed.
Surgical method
Surgical treatment involves the use of arthroscopic equipment to surgically repair a joint. During the operation, the cartilage formation is removed and a new cartilage plasty is performed. The reason for the operation may be a recurrence of the disease. In some cases, surgery may be performed to remove broken pieces of the joint. Often this treatment is the only way to keep the knee in good shape and function.
After the operation, you must remain calm and refuse any physical activity. Violation of the doctor's recommendation can lead to joint deformity and complications in the form of secondary osteochondrosis of the patella.
Exercise therapy for osteochondropathy of the patella
Therapeutic exercise is shown during the period of immobilization. While the diseased limb is fixed with a splint, the patient should apply general developmental exercises. These could be:
- dynamic movements (extensor, flexion, rotation) of a he althy limb;
- rhythmic muscle contractioninjured leg;
- holding a leg with a cast in weight;
- ideomotor exercises - visualization of movement in the joint.
It is necessary to start exercising a few days after surgery and plastering, but only with the permission of the doctor. Perform any movement with a he althy leg - take it to the side, lift it, make circular rotations, swings, statically strain the muscles.
The muscles of the body are also loaded - they raise their shoulders and head, fix the position for several seconds. A few days after the operation, the patient is recommended to briefly lower the sore leg from the bed, and then raise it above the body. Walking around the ward is allowed on crutches, without relying on the operated leg.
Complications
As already mentioned above, children and adolescents are most often exposed to AChN, who are characterized by an increased load on the legs and traumatization of the knee. Treatment of this disease takes a long time. Sometimes it takes more than one year. Most often, the disease resolves without any complications for patients. Children's cartilage and bones are quickly updated and restored. In older people, osteochondropathy is treated more difficult and longer. In advanced cases, the following complications may occur:
- Osteoarthritis of the knee.
- One leg can become a couple of centimeters shorter than the other.
- Due to the difference in the length of the limbs, the spine can be deformed and scoliosis can develop.
Without operationalintervention lameness can remain until the end of life. If a child, after a bruise or other injury to the joint, remains calm and does not load the joint, osteochondropathy of the patella can go away on its own. But this happens very rarely.
Prevention
It is impossible to prevent knee injury, but you can reduce the risk of developing pathological processes. It is necessary to follow simple rules in relation to all family members:
- For knee pain, be sure to visit an orthopedic surgeon.
- The child should know the safety rules and how severe bruises and falls can threaten.
- To detect the disease at an early stage, regular medical examinations should be taken.
- Excessive exercise should be avoided.
In addition, preventive measures that prevent the occurrence of osteochondropathy are swimming pool exercises and therapeutic massage. Athletes, in order to avoid Osgood-Schlatter disease, are recommended to use knee pads with soft inserts during training, or to sew foam pads on sportswear.
Conclusion
Having considered 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 pain in the knees, you should consult a specialist. The legs are part of the musculoskeletal system, which is actively involved ina fulfilling life. Properly selected treatment and compliance with all medical recommendations will help restore the knee joint within one year, and by following the rules of prevention, you can completely avoid the disease.
