König's disease is a type of osteochondropathy, which most often affects young men between the ages of fifteen and thirty (sometimes older and younger patients are found). This condition is characterized by a limited area of necrosis of the region of the inner condyle of the thigh (articular cartilage + adherent bone tissue). With this disease, the bone covering The affected area of the cartilage begins to gradually peel off and eventually can completely separate from the bone
König's disease - the causes of development
The exact causes of this disease are not established. There is a suggestion that the development of necrosis is preceded by the blood circulation of the branches of the middle knee artery, broken for some reason, which develops as a result of a joint injury or excessive physical exertion. However, due to the fact that the rejection of the necrotic area occurs for a sufficiently long period of time, it is usually not possible to trace the clear relationship between the preceding joint lesion and Koenig's disease.
Even in spite of the fact that necrosis of the osseous-articular surface is observed after injuries, in people engaged in severe fiz. labor and athletes, there are often cases of observed detachment from non-members of these categories.
In addition, the following predisposing factors of the development of this disease are suspected: obliterating endarteritis, thromboembolism, thrombosis, certain diseases of internal organs and individual endocrine disorders .
The impact of all the above factors leads to a violation of the blood supply to bone tissue and the further formation of a foci of aseptic necrosis under the cartilage, which leads to blood clots in the vessels and bone destruction. Most often König's disease develops in the knee joint area, hip, ankle, elbow and radial joints are much less likely to be affected
König's disease - symptoms and manifestations
Symptoms of Koenig's disease in the early stages of volatility and inexpressive. Sometimes over the place of the lesion becomes hot and swollen skin, dull pain may appear and the mobility of the joint may be temporarily limited. At this stage, the disease is rarely detected, although it continues to progress. At the stage of necrosis, edema of the skin and joint pain become permanent.
The most striking symptom is a complete blockage of the joint with the impossibility of any movement in it. This indicates that the movement that began to separate the exfoliated site interferes with the movement. Completely it has not yet peeled off, but the process is already progressing. Sometimes the joint blockade passes independently, and sometimes leads the patient to a hospital bed due to pronounced edema and pain syndrome.
In the event that joint blockade and joint pain were ignored, complete separation of the necrotic area from the bone occurs, and necrotic tissue causes swelling, severe pain and sharp inflammation
Stages and Diagnosis of Koenig's Disease
1 stage. This stage is characterized by the appearance of mild soreness and a feeling of discomfort in the joint area associated with physical exertion or the transfer to a diseased leg of body weight. On the roentgenogram, the focus of bone disintegration is oval or wedge-shaped
2 stage. At this stage, pain in the joint increases, an inflammatory process is attached to it, which is expressed in its painfulness when bending or probing and pronounced edema. The radicogram does not clearly show the focus of bone disintegration
3 stage. At this stage, there is an incomplete separation of the affected area of the bone, which often leads to a stable joint contracture. On the roentgenogram, the shadow of the necrotic necrotic bone region (articular "mouse") is clearly visible
4 th stage. For the fourth stage, a complete separation from the bed of the necrotic area is characteristic, an increase in inflammation and pain sensations (associated with the movement of the osteoarticular fragments). On the roentgenogram, the intraarticular body is clearly defined
In addition to X-ray studies, to clarify the diagnosis of magnetic resonance imaging, computed tomography, radioisotope and ultrasound studies. Also, according to indications, arthroscopy is carried out, which consists in the examination by means of an arthroscope (introduced through micro cuts on the skin) of the internal surfaces of the joint
König's disease - treatment
Treatment of König's disease in the initial stages is carried out by conservative methods, which include massage, the use of blood-supplying joints and metabolic processes in the cartilage and bone tissues of certain medications, physiotherapy (electrostimulation, etc.). It is absolutely necessary to unload the joint as much as possible. The duration of such treatment takes up to one and a half years, and all this time it is necessary to completely eliminate physical stress on the affected joint, after which in the absence of pain, therapeutic gymnastics joins.
Conservative treatment of Koenig's disease usually has little chance of a positive outcome. The disease, despite everything, will continue to progress and a fragment of the cartilage with the adjacent bone will separate sooner or later.
Unfortunately, most often conservative treatment is effective in adolescents and children; in adults, operative (surgical) treatment is usually used in which the joint cavity is opened, the necrotic fragment is removed, followed by plastic reconstruction of the tissue defect.
Indications for surgical treatment:
- Despite the conservative treatment, the mobile fragment is preserved
- Even a disciplined patient does not have the effect of conservative treatment
- On MRI or X-ray, there is a strengthening or preservation of changes
- There is almost complete or complete closure of the epiphyseal growth zones. In such cases, the surgical intervention (in adults) is shown regardless of the current stage of the disease.
The choice of surgical treatment option is determined by the current stage of the disease. There are two treatment options - removal of the fragment and subsequent implementation of chondroplasty (chondroplasty - an attempt to restore cartilage: superstructural transplants, mosaic chondroplasty, tunneling, etc.) and fixing the fragment back.
Osteoarthritis of the knee joint is the main complication of Koenig's disease. The likelihood of its development depends on the size of the fragment, the location of the disease, and the adequacy and timeliness of the treatment.