The disease Koenig (dissecting Legg): causes, symptoms and treatment
Koenig’s disease or osteochondrosis cleave
The disease Koenig (dissecting Legg) is limited aseptic necrosis (necrosis) of a portion of the bone close to the cartilage sostavnogo.
The disease is one of the varieties osteochondropathy, in which due to necrosis of the bone formed by bone and cartilage fragment that enters into the joint cavity.
Under the influence of various factors is an eating disorder of cartilage and underlying bone site. No meals formed an area of necrosis, and then there is rejection tissue with all the consequences.
Most often dissecting osteochondrosis affects the knee, less elbow, ankle and hip joints.
There is also a disease of Leuven, which is characterized by the development of dissecting Legg in the outer myselt of a hip bone or patella.
Anatomy of the knee
Before speaking about the causes of the disease, its course and methods of treatment, briefly describe the anatomy of the knee joint.
The knee joint like any other joint consists of the articular surfaces of bones, of the joint space, synovial fluid filling the joint, and ligaments.
The knee joint is formed by the condyles of the femur, upper articular surface of the tibia, menisci and patella. On the tibia there Misaki, but the disease Koenig only occurs on myselkf of the femur.
The ligaments of the knee represented by the ligaments that strengthen the joint and provide movement.
Causes and risk factors
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At the moment the exact cause of the disease Koenig is not installed.
It was found that most often the necrosis of the bone and the articular surface formed by individuals involved in sports, and people exposed to heavy physical loads.
However, often the disease occurs in people not belonging to these categories. Some vascular diseases such as thrombosis, thrombosis, thrombophlebitis, occlusive disease can contribute to dissecting osteochondrosis.
So, risk factors for the development of the disease are:
- emboli of various origins;
- trauma to the joint;
- thrombosis or sudden spasms of blood vessels;
- genetic predisposition;
- disorders of the endocrine system;
- synovial chondromatosis;
The stage of the disease
Pathology occurs in 4 stages:
- The first stage is characterized by the protrusion of cartilage in the joint cavity and its further softening.
- The second stage is characterized by increased softening and bulging of the cartilage, as well as the accession of the inflammatory process with edema.
- The third stage is characterized by aseptic melting, the dissociation of the cartilage and a partial separation of the necrotised area of bone.
- The fourth stage is characterized by complete separation of the osteochondral fragment.
The symptoms of the disease
Dissecting Legg has specific symptoms: pain, localized at the front or prednimustine surface of the joint.
At the initial stage of pain are constant, aching character. When pressed on the inner part of the knee joint is increased pain.
When complete separation nekrotizirovannah plot inside the joint pain be different. The pain covers the entire knee joint. There is a feeling of foreign body sensation inside the joint.
If the infringement of intra-articular bodies there is a sharp pain that is localized at the location of the bone of the body. When movement in the joint there is a crunch, occasionally edema.
There is a decrease in range of motion in the knee joint, as the person loses the ability to fully bend and straighten the joint.
In the initial stages of the disease decrease in the amplitude of movements is associated with increased tone of the muscles that stabilize the joint. In severe cases there is a violation of the anatomical structures of the knee joint, which leads to movement disorders.
Sometimes there is a complete blockade of the knee joint for disadvantaged bone of the body. In this case, the mobility of the knee joint is lost completely.
To diagnose the diseases need to use x-ray examination.
X-ray diffraction allows not only accurate diagnosis, but also to determine the stage of the disease, which is very important for selecting appropriate treatment.
In the early stages of disease development, before the form visible on the radiograph defects, using magnetic resonance imaging with contrast.
Introduced intra-articular or intravenous contrast to show patients areas of the bones in the study.
You can use intra-articular endoscopy.
With the introduction of the endoscope into the joint cavity, the doctor can clearly see all structures of the joint and their changes.
Depending on the stage will be seen the following changes:
- By endoscopy in the first stage of the disease Koenig changes of the articular cartilage is not, there may be uncharacteristic of cartilage springy mobility in the place of necrosis of the bone.
- In the second stage will be visible deep crack extending in a circle of the center of ossification of the bone.
- In the third stage in the joint cavity will be detected osteochondral body and deepening of the cartilaginous surface at the place of separation. Depending on the duration of existence of the joint intra-articular bodies may have a different shape and form. The body, newly formed, consists of clearly defined bone and cartilage parts. Existing long-body look «run-in», curved.
The treatment of the disease
The disease Koenig in children can be cured without surgery disease, as they have continued strong growth of the skeleton.
The patient restrict all activity, giving the load on the knee joint, ranging from one to six months. Sometimes resorted to immobilize the knee.
Assigned to physiotherapy: diathermy, ultrasound, elektroforez with procaine, a vasodilator, hydrocortisone.
Indications for surgical treatment:
- appearance or the continuation of the rolling bone and cartilage of the body;
- the ineffectiveness of conservative treatment;
- the deterioration of articular tissue on radiographs or on MRI;
- closure of the epiphyseal growth zones.
Thus, the operation when it is necessary to conduct regardless of the stage of the disease. Conservative treatment very rarely may be used alone to cure, because the disease will develop, and sooner or later there will be separation of a fragment of the cartilage to the underlying bone.
In the initial stages of the disease when surgical treatment is the removal of dead skin tissues, that allows to recover a normal bone structure by means of substitution of new bone tissue.
In the later stages of the disease is destruction of bone and cartilage fragments and mapping of the articular surfaces of the knee joint relative to each other. At small dimensions of intra-articular bodies, they are removed during endoskopicheskoe study of the joint cavity.
Already the day after the operation is assigned physiotherapy.
Usually this exercise is associated with rhythmic contractions of the muscles of the femur and tibia, finger movements of the foot, are carried out active and passive movements in the knee joint.
A week after the operation the patient is prescribed physiotherapy and hydrotherapy.
Two weeks after the operation permitted metered load on the joint. After one to two months after surgery, the patient can carry out the complete load on the joint.
Complications of disease
The main complication of dissecting degenerative disc disease is arthritis of the knee joint.
The likelihood of osteoarthritis due to the localization, the size of the osteochondral fragment, the success, timeliness and adequacy of treatment. This complication occurs in 5-40% of cases.
To prevent the occurrence of the disease Koenig is necessary to diagnose and treat pathologies of the locomotor apparatus.
Prevent injury to the knee joint, rational, balanced, rich in vitamins and minerals eating, maintaining normal weight, regular adequate exercise on knee joints — all this will allow you to avoid the development of this disease.