König's disease of the knee joint. What is it, treatment, stages in children, athletes, adults, X-ray picture, operation

Koenig's disease is a rather rare degenerative-dystrophic diseasecharacterized by necrosis of a specific area of ​​the cartilage of the femoral condyle, which is part of the knee joint. In this case, the necrotic focus can gradually separate from the bone and move into the synovial bursa of the articular joint. Pathology is considered dangerous, affects children and adults.

Disease types

The pathological condition is quite rare. It is also called osteochondritis dissecans, which is associated with the free movement of a separated section of cartilage in the synovial bursa. Experts identify several forms of pathology, depending on the course, age of the patient and the presence of complications.

The main classification divides the disease into juvenile, that is, adolescent, as well as the classic form, which more often affects athletes and adult patients. The first is considered more severe, but prone to self-healing when a person reaches 18 years of age. However, this type of pathology in most cases affects both limbs at once, which complicates the course and prolongs the course of therapy.

The classic course develops in adult patients, as well as professional athletes. It is usually accompanied by the onset of symptoms in only one limb. In this case, self-healing does not occur, and therapy involves the use of several techniques. In most cases, the operation is carried out precisely in the classic course of the disease in adults.

In addition, the pathology is divided into complicated and uncomplicated. The first is considered severe, can lead to a complete loss of mobility of the affected limb, often progresses rapidly. The second form often affects adolescents, rarely provokes complications and is characterized by a benign course, and the prognosis is almost always favorable.

Additionally, experts distinguish acute and chronic illness. In the first case, the symptoms grow rapidly, the pain is severe, it is difficult to stop with analgesics and significantly worsens the patient's condition. In the second case, the manifestations are mild, they do not reduce the patient's working capacity and do not provoke severe pain.

It should be noted that the acute course is more typical for athletes and adults, and the chronic course is more typical for adolescents. Often, the juvenile form proceeds with less pronounced symptoms, and also heals on its own after the patient reaches 18-20 years of age.

Stages and degrees

König's disease of the knee joint occurs in 4 stages, regardless of the type and form of the pathological condition, as well as the age of the patient. The only difference is that in the juvenile form, both limbs are almost always affected, and in the classical course, only one.

Stage	Features of the course of pathology
Stage 1	At the initial stage, the symptoms of pathology are poorly expressed. If you examine X-rays, you can see a clear outline of the necrotic lesion, which is slightly separated from the bone. The pain at this stage is minor. Mobility is almost not impaired. If the patient is actively involved in sports, then a decrease in endurance and physical strength may be noted. However, he does not attach importance to these changes.
Stage 2	At this stage, symptoms of inflammation may join, since the necrotic focus is further separated from the head of the bone and can damage the synovial bag. As a result, external signs appear in the area of ​​the affected joint of one or both limbs. Adults may associate external manifestations with trauma; patients under 18 also consider trauma to be the result. On the X-ray, the specialist notes an increase in the area of ​​the affected tissues.
Stage 3	At this stage, the necrotic focus is almost completely separated from the head of the bone, is attached only due to a small area that has not yet separated. All the symptoms of the pathology are aggravated, the patient tries to spend more time in bed in order to reduce the load. External symptoms are also more pronounced. Periodic joint blockages force the patient to limit their activity and consult a doctor
Stage 4	This stage is considered the most severe, since the necrotic focus is completely separated from the head of the bone and gradually moves into the synovial bag, where it interferes with the normal functioning of the articular connections. It should be noted that the juvenile form rarely progresses to this stage. In most cases, such manifestations are typical for adult patients and professional athletes.

It is important to remember that children and adolescents rarely have severe symptoms. Motor activity is almost always preserved, and the progression of the pathology is slow.

Symptoms

Koenig's disease is manifested not only by symptoms of the knee joint. There are also general manifestations that worsen the course of the pathology.

In the initial stages, the patient is worried about minor discomfort in the area of ​​the affected joint or both joints. When bending the limb, unexpressed pain appears, which disappears after a short period of time. After a long stay in one position, the extension of the leg becomes painful, but this discomfort also does not persist for a long time.

After a few weeks, the pain intensifies, appears not only when bending and extending the leg, but also at rest, especially at night. In the area of ​​the affected joint, redness and swelling appear, which indicates the development of inflammation in the synovial bag.

The pain becomes unbearable, especially in adults. Children tolerate pathology more easily, but with its progression, they also speak of severe discomfort. Mobility is more limited in adults, children often ignore the symptom and continue to lead an active lifestyle.

As the pathological condition progresses and the necrotic area separates from the bone tissue, the joint is blocked. This is manifested in the inability to bend or unbend the limb in the affected joint. After several attempts, the patient may hear a characteristic click. It is after this that the patient is able to bend the limb.

The progression of the pathology is accompanied by frequent inflammation of the bursa, but the frequency of joint blockage decreases. When the necrotic focus begins to spontaneously move in the synovial bag, the frequency of exacerbations of the disease increases.

At the advanced stage, knee blockages are almost not observed, but the pain becomes unbearable, disrupts night sleep. At the same time, general symptoms are added in the form of irritability, increased fatigue, and decreased performance.

The patient loses sleep and appetite, body weight decreases, the skin becomes pale. In addition, the work of the sweat glands increases, the development of a nervous disorder is possible against the background of the lack of effect from taking analgesics.

Other symptoms of the nervous system include dizziness and headache. In addition, the body temperature rises, nausea, indigestion, and sometimes vomiting are observed. The combination of symptoms significantly worsens the patient's condition. At the advanced stage of the pathological process, complications develop from the muscles and joints.

Reasons for the appearance

König's disease of the knee joint occurs as a result of several predisposing factors. However, it is worth noting that experts have not been able to determine the exact reason to date.

It is believed that the main cause of pathology in professional athletes is an increased load on the articular joint.. But it was not possible to prove this theory, since in many cases the connection between stress and tissue necrosis is not traced.

Experts suggest that the main reason for the development of the disease in children and adolescents can be called a violation of the processes of formation of bone and cartilage tissue during the period of intensive growth.

There are common provoking factors that can presumably lead to the development of pathology in an adult and a child:

• Violation of blood circulation in the joint area, provoked by various factors.
• Frequent dislocations or bruises of the articular joint, sprains.
• Fractures of bones near a joint that interfere with the flow of blood and nutrients.
• Insufficient intake of minerals and vitamins into the patient's body with food, chronic vitamin deficiency.
• Hereditary predisposition to pathologies of articular joints.
• Disruption of metabolic processes, in which nutritional components from food do not enter the cartilage.
• Atherosclerotic vascular changes, in which cholesterol plaques interfere with the normal flow of blood to bone and cartilage tissue.
• Vascular pathologies of the lower extremities, for example, varicose veins, thrombophlebitis.

Despite these factors, they do not provoke the development of the disease in all patients. Doctors also could not determine why in some patients such causes lead to tissue necrosis, while in others they do not.

Diagnostics

To diagnose pathology, various methods are used to differentiate the condition from other disorders of the joints.

The most effective survey methods:

• General patient survey and examination of the knee joint. In this case, the doctor not only listens to the patient's complaints, but also tries to determine the presumptive cause of the violation, as well as the conditions for its development. After that, he draws up a further survey scheme. When interviewing, it is important to clarify all the diseases that the patient has had throughout his life. Usually, the patient does not need to pay for such a diagnosis, but it is carried out in a state clinic.
• Clinical and biochemical blood test is considered a standard diagnostic method, it is carried out free of charge in every state clinic. In this case, the study helps to assess the general condition of the patient, to detect deviations, signs of inflammation. In biochemical research, the level of rheumatic test is important. The indicator allows you to differentiate pathology from rheumatoid arthritis, which is accompanied by similar symptoms.
• X-ray examination the affected limbs is considered one of the most effective diagnostic methods. It is carried out in clinics with the appropriate equipment, the cost usually does not exceed 300-500 rubles. During the examination, the doctor pays attention to the head of the femur and the synovial bag of the knee joint. At the initial stage, you can see a slight detachment of the necrotic area in the form of a white stripe. As the pathology progresses, this band in the picture increases, and at an advanced stage it is clear that the necrotic focus has completely separated and moved into the joint capsule.
• MRI is another most effective diagnostic method. It is used when other methods have not helped to clarify the diagnosis. Research is being carried out in clinics where the appropriate equipment is available, the cost is approximately 2000-5000 rubles. During the study of tissues, the specialist pays special attention to the synovial bag, the heads of the bones and the cartilaginous tissue of the articular junction.

The most informative method is radiography and magnetic resonance imaging. However, only a comprehensive diagnosis helps to establish a diagnosis.

When to see a doctor

Koenig's disease of the knee joint is considered a rather dangerous condition, therefore, when identifying the first signs, it is worth contacting an orthopedist. An adult and pediatric doctor deals with the treatment of such diseases. However, in the absence of such a narrow specialist, the patient should visit a therapist or pediatrician.

Prophylaxis

Since experts have not been able to pinpoint the cause of the disease, it is difficult to prevent it. However, compliance with certain rules will significantly reduce the likelihood of developing a violation.

It is recommended to normalize the mode of work and rest, subject the joints only to an adequate load, and avoid overwork. Professional athletes should visit a podiatrist regularly, who will detect any abnormalities at an early stage.

Additionally, it is worth adjusting the diet, including products based on gelatin, for example, jelly, jellied meat. This will saturate the cartilage tissue with important substances and prevent degenerative-dystrophic changes.

In addition, for patients who have a tendency to joint diseases, it is important to avoid prolonged and heavy loads, heavy lifting. However, this recommendation does not imply a complete rejection of activity. You need to walk or swim regularly.

If symptoms of the disease appear, you should immediately visit a doctor. This is the best way to prevent complications.

Treatment methods

Treatment of the disease involves the use of medications, as well as recipes for alternative medicine. Physiotherapy is also actively used by specialists. If the methods are ineffective, surgery is performed.

Medications

Chondroprotectors, vascular and pain relievers will help alleviate the patient's condition.

The most effective ones:

• Trental - a vasodilator medication that helps to improve blood circulation in the affected area and relieve symptoms. It is prescribed in courses of 10 days with a daily infusion of 5 ml of solution added to 200 ml of 0.9% sodium chloride. The solution is very effective, it helps to quickly achieve a therapeutic result and, if used correctly, does not provoke complications, but it is not prescribed for patients under 18 years of age. The cost of 1 ampoule of the drug is from 40 rubles.
• Naklofen - an effective non-steroidal anti-inflammatory drug that additionally has analgesic properties. It is prescribed for severe pain, helps to quickly stop the symptom. A day, the patient is injected with 3 ml of the solution intravenously, previously adding it to 100 ml of sodium chloride. The drip method of administration helps to quickly achieve a therapeutic result. The procedure is carried out no more than 7 days in a row, the remedy is not prescribed for children. The price of the product is from 30 rubles.
• Ketorol - an anesthetic medication with anti-inflammatory action, prescribed only for adults. Differs in efficiency and quickly relieves severe symptoms of pathology. The patient is prescribed pills, which must be taken 1 piece in the morning and in the evening for 5-8 days. The cost of the medicine is from 110 rubles.
• Alflutop - chondroprotector of natural origin, which can significantly improve the condition of the cartilage tissue and stop the progression of the disease. The patient is prescribed from 25 to 35 injections. The patient receives 1 ml of solution intramuscularly every day. The remedy is not prescribed for children. The price of the medicine is from 1100 rubles.
• Nise gel - a topical agent with high efficiency. It is necessary to apply the gel on the joint area with a thin layer, rub until absorbed, repeat 2-3 times a day. The medicine helps to eliminate pain, facilitate movement in the joint, and blocks substances that provoke inflammation. The course of therapy lasts up to 10 days. The drug is prescribed for adults and children. Price - from 300 rubles.
• Actovegin - a drug for improving tissue nutrition, which is prescribed for adults and children. It is highly effective and helps to stimulate blood flow to the affected area. Adults should take 2 tablets 3 times a day for 4 weeks. Children are prescribed 1-2 tablets per day, depending on age. The course lasts up to 6 weeks. The price of the medicine is from 300 rubles.
• Panadol - tablets with analgesic and anti-inflammatory action, which are prescribed for adults, children from 6 years old, are highly effective. An adult is allowed to take up to 6 tablets per day at regular intervals, children are prescribed up to 3 tablets per day. The maximum duration of the course is up to 7 days. The price of the product is from 250 rubles.
• Teraflex - chondroprotector to improve the condition of cartilage tissue. Possesses high efficiency and is prescribed for adults, athletes, adolescents from 15 years old. The course of treatment lasts at least 2 months, it is worth taking 2 tablets per day. The cost of the medicine is from 700 rubles.

The treatment regimen for adult patients and professional athletes does not differ. The dosage for adolescents and children is determined only by a doctor.

Traditional methods

König's disease of the knee cannot be cured with traditional medicine recipes. But it is quite possible to relieve pain by applying compresses and rubbing.

Cabbage leaf compress is the most popular recipe. To do this, you need to select a fleshy leaf, slightly beat it off until the juice appears and attach it to the joint, fixing it with a bandage. Leave the compress overnight, repeat for 2 weeks in a row. Such compresses can be done for adults and children.

Alcoholic infusion of propolis relieves inflammation and pain. It is necessary to insist 20 g of crushed propolis in 100 ml of alcohol for 2 weeks, filter and rub the affected joint before going to bed for 10 days. The method can be used for adults and children from 7 years old.

Operation

If conservative treatment is ineffective, surgery is performed. Usually, the operation is indicated for adults, only in some cases it is performed for children.

Manipulation requires general anesthesia and involves the removal of the separated necrotic lesion or its attachment using special fixators. The main goal of the intervention is to restore the bone surface in order to eliminate the symptoms of pathology and accelerate recovery.

The operation is carried out in an open way or using the endoscopic method, which involves small incisions and the introduction of instruments while observing the process on a monitor. It should be noted that the intervention is carried out only with complete or almost complete separation of the necrotic focus from the bone.

The rehabilitation period lasts from 2 to 6 weeks, depending on the method used and the patient's age. Children recover faster, but surgery is used much less frequently in their therapy.

Other methods

When using conservative therapies, specialists usually combine drugs with physical therapy methods to speed up the healing process. In most cases, such treatment is indicated for children, it is ineffective for adults.

Magnetotherapy is a method of accelerating tissue regeneration by exposing them to a magnetic field that improves blood circulation. The procedure lasts 20 minutes, it is carried out 3-4 times a week. The minimum course of therapy is 10 sessions. This treatment, in combination with drugs, helps to repair the affected area and avoid surgery.

Massaging the affected joint helps to stimulate blood circulation, tissue regeneration processes and improves mobility. The procedure is carried out after the relief of acute symptoms in the form of redness and swelling of tissues. The minimum number of sessions is 15, the duration of the massage is 25-35 minutes, it is carried out daily or every other day.

Possible complications

In the absence of therapy, complications develop.

The most common ones are:

• Spread of necrosis to the entire head of the bone.
• Development of purulent inflammation of the articular joint.
• The defeat of two limbs at once.
• The gradual destruction of the cartilage tissue of the joint.
• Decrease in the amount of synovial fluid.
• Atrophy of the muscles of the affected limb as a result of uneven distribution of the load.
• Complete blockade of the joint with the impossibility of flexion and extension.

With the development of ankylosis (complete immobility of the joint), surgery is considered the only treatment.

Koenig's disease is a rather rare disease of the articular joints that affects adults and children of all ages. Usually affects the head of the femur, which is part of the knee joint. For treatment, many methods are used that help avoid complications and improve the patient's condition.

Article design: Vladimir the Great

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