The term "Koenig's disease" refers to a pathological process, the development of which is accompanied by a gradual exfoliation of cartilage tissue from the bone. According to statistics, most often the disease is diagnosed in men under the age of 30 years. When the first warning signs appear, you should 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. It has no blood vessels. Cartilage is nourished by the intake of necessary substances from the intra-articular fluid and bone. Its task is to facilitate the process of sliding surfaces. Despite the fact that bone and cartilage tissues are heterogeneous, they are extremely firmly interconnected.
Under the influence of various adverse factors, a pathological condition develops. It is characterized by the gradual separation of a section of cartilage tissue from bone. FROMover time, it can peel off completely and move freely along the knee joint, thereby causing pronounced discomfort.
Reasons
Currently, the etiology of Koenig's disease (disease of the knee joint) has not been fully studied. There are several versions of her appearance.
Scientists are inclined to believe that the main causes of the development of the disease are the following conditions and pathologies:
- Hereditary predisposition.
- Ischemic disease, in which a certain area of the bone tissue does not receive enough blood.
- Abnormal structure of the knee joint.
- Frequent injuries, including osteochondral.
- Diseases of the pineal gland.
Probably, the starting factor for the development of pathology is the simultaneous effect on the knee joint of the above unfavorable conditions. In the ICD-10, Koenig's disease is assigned the code M93.2 - "dissecting osteochondritis."
Degrees of severity
Pathology is conditionally divided into 2 forms: adult and juvenile. In the first case, the disease occurs in young and mature persons, in the second - in children and adolescents. The adult form is considered the most severe, as 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 the defeat of both knee joints. However, it responds well to treatment. In children, Koenig's disease is milder and ends with completerecovery.
Pathology develops slowly. There are 4 degrees of severity:
- I. At the initial stage, the cartilaginous tissue in the affected area slightly softens. At the same time, the boundaries of the pathological focus are absent.
- II. The area of softened cartilage is immobile. However, the focus of pathology already has clear boundaries.
- III. The cartilage is slightly displaced relative to the bone to which it is attached.
- IV. There is an exfoliation of the tissue. A fragment of cartilage forms a free body that moves inside the knee joint.
Koenig's disease most often affects the knee joint, less often - the elbow, hip and ankle.
Symptoms
A feature of the pathology is its slow progression. At the initial stage, a person practically does not feel any alarming signs. At an early stage, it is difficult to make an accurate diagnosis, since mild pain can be a sign of many pathologies of the musculoskeletal system.
Over time, the following signs appear (gradually their intensity increases):
- Restriction of motor activity, up to the inability to move a limb.
- Strong pain, aggravated by position.
- Swelling above the kneecap.
- Lame.
- Wilson's symptom. When walking, the patient turns the leg outward. By reducing the degree of stress on the inside of the knee joint, painbecomes less pronounced.
In some cases, doctors can feel for a freely moving area of cartilage.
Which specialist to contact
If you experience anxiety symptoms, you need to make an appointment with a therapist. Based on the results of the primary diagnosis (examination and medical history), the specialist will refer you for a consultation with an orthopedic traumatologist. In some cases, an examination by a rheumatologist is required.
Diagnosis
Signs of Koenig's disease are not specific. The presence of any of the symptoms does not give grounds to assume the development of this particular pathology.
In order to identify the disease and draw up the most effective treatment regimen for the knee joint (Koenig's disease), the doctor sends the patient for an examination, including both laboratory and instrumental diagnostic methods:
- Analysis for rheumatic tests. The biomaterial is venous blood. In the presence of Koenig's disease, there is no deviation from the norm. The study is scheduled in order to exclude the presence of many other ailments.
- X-ray. At the initial stage of pathology development, this method is not informative. On the radiograph, it is impossible to see a slight softening of the cartilage tissue. At stages 3 and 4, necrotic areas with clear boundaries are clearly visible.
- Computed tomography. Uninformative only at stage 1. Allows you to detect a pathological focus with clear boundaries. During the course of the research,it is possible to estimate its depth and dimensions.
- Magnetic resonance imaging. Can be done 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. Considered the most informative.
Based on the results of the diagnosis, the doctor draws up a treatment regimen for the knee joint (Koenig's disease). The issue of the advisability of surgical intervention is also being decided.
Conservative therapies
Non-surgical treatment of the disease is successfully carried out in children and adolescents. It is important to take into account the severity of the pathology. In some cases, conservative methods are also applicable in relation to adult patients who have minor damage to the knee joint (Koenig's disease at an early stage).
The treatment regimen includes the following items:
- Ensuring limb rest. In some cases, the leg is immobilized with an orthosis or a plaster cast. Until the complete disappearance of pain, it is recommended to move around with crutches.
- Therapeutic exercise. If there is no pain, the patient should perform daily light exercises that train the quadriceps and hamstring muscles.
- Taking non-steroidal anti-inflammatory drugs. Medicines temporarily alleviate the patient's condition. Importantunderstand that the active ingredients of the drugs stop the pain, but do not affect the cause of the disease.
- Taking drugs that improve the nutrition of cartilage tissue.
- Physiotherapy treatments.
In advanced cases and with the ineffectiveness of conservative methods of therapy, surgical treatment is indicated.
Surgery
Before its implementation, the doctor discusses with the patient the choice of technique. In addition, the operation requires preparatory measures.
These include:
- Wearing compression garments.
- Diet and cleansing enema before surgery.
- Quit smoking and drinking alcohol.
In case of Koenig's disease, the operation can be performed in 2 ways:
- Open.
- Endoscopic (arthroscopy).
Currently, doctors prefer the 2nd method. It is less traumatic, due to which the duration of the rehabilitation period is reduced.
After making 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 granulations. 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 tip of the bone of a spherical type, providing mobility to the joint. In this case, unicondylar arthroplasty is performed.
After a successful surgical intervention, the incisions are sutured and the knee joint is immobilized with a cast or orthosis. In the postoperative period, it is necessary to ensure the rest of the limbs. To restore joint mobility, doctors recommend undergoing a course of physiotherapy procedures and regularly perform a set of physical therapy exercises.
Consequences
When the knee joint (Koenig's disease) is affected, 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 physical activity turns into a test.
Over time, the quadriceps femoris muscle atrophies. This is due to the lack of load on it. The thigh of the affected limb becomes thinner than the other.
When ignoring the need to seek qualified medical help, Koenig's disease progresses - the knee joint is gradually destroyed. This leads to incapacity and disability. In addition, the risk of involvement in the pathological process of other joints increases. Often, patients in the intervertebral discs form hernias.
The likelihood of developing degenerative-dystrophic changes directly depends on the duration of the disease andlocation of the focus of pathology.
Forecast
With timely access to a doctor, the outcome is favorable in most cases. In almost all people, after a successful surgical intervention, unpleasant symptoms disappear and the function of the joint 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, certain preventive measures have not been developed to prevent the development of pathology.
In any case, each person should try to avoid getting injured, especially in the same area. In addition, it is necessary to minimize the risk of vascular diseases. To do this, it is recommended to stop smoking and drinking alcohol-containing drinks, as well as adjust the diet in accordance with the principles of a he althy diet.
In conclusion
Koenig's disease is a pathology characterized by the gradual separation of a portion of cartilage tissue from bone. A feature of the disease is its slow progression. Diagnosis of the disease at an early stage is a certain difficulty, since a person does not have specific symptoms. In addition, during the examination, it is rarely possible to identify the focus of pathology. In order to avoid the occurrence of 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 conservatively andoperational methods. The ICD code for Koenig's disease is 93.2.
