Clinical pictures
Gonarthrosis is the wear and tear of the cartilaginous parts of the knee joint and is also known as ‘knee joint arthrosis‘. The most common cause is the limited ‘durability’ of joint cartilage: with age, the elasticity of the cartilage decreases and the joint surfaces shrink. Over time, bone changes may occur, so that the original joint structure is no longer present.
It is estimated that about 6% of all pensioners are affected! In addition, axial malpositions of the legs (bow legs), previous joint damage, e.g. as part of meniscus or cruciate ligament injuries, or massive overweight can be among the reasons for gonarthrosis at a younger age. Initially, patients complain of movement-related pain in the knee joint, which gets worse in the course of the day.
Furthermore, there is a so-called starting pain in the morning or after long breaks from sitting. In the course of the disease, the symptoms increase gradually, so that in advanced cases knee pain occurs at rest. Very often a clear knee swelling can be recognized.
Affected persons also report a ‘cracking’ or crunching in the joint, especially during certain movements (e.g. when squatting). The cause and severity of the problem determine the individual therapy of gonarthrosis. There are many possibilities: physiotherapy can be used to maintain or improve mobility.
Helping to relieve the strain, as well as pain and inflammation reducing medication or ointments provide additional relief. In severe cases a joint prosthesis (‘artificial knee joint‘) may be indicated.This topic might also be of interest to you: Chronic Knee PainChronic polyarthritis belongs to the rheumatic joint diseases. Due to various causes (e.g. genetic predisposition, bacteria, viruses) the joint mucosa (synovialitis) becomes inflamed and swells.
In addition, there are repeated joint effusions, i.e. fluid collects inside the joint. At this stage, the knee joint is painfully swollen and overheated. The presence of a ‘dancing kneecap‘ speaks in favor of an articular effusion: When the kneecap (patella) is pressed from the front, a kind of ‘springing back’, also called rebound, is clearly felt.
Characteristic is the intermittent occurrence of symptoms, including morning stiffness. In the course of advanced polyarthritis, the joint cartilage is destroyed. Finally, the joint capsule and ligaments are also affected.
Considerable pain can limit the mobility of the knee joint to the point of total inability to walk! There are numerous therapy options, depending on the pathogen and stage of chronic polyarthritis. These include medication against the underlying rheumatic disease, physiotherapy (e.g. mud packs, thermal baths), protection, cooling and bandages.
If the painful swelling does not subside despite the above-mentioned measures, the inflammatory joint mucosa can be removed in one operation (synovialectomy). In case of advanced cartilage damage, there is the possibility of a knee joint endoprosthesis. A Baker’s cyst is a bulging, fluid-filled tumor in the area of the hollow of the knee, often accompanied by a chronic joint effusion (e.g. in chronic polyarthritis or activated knee arthrosis).
Affected patients complain of pain and a feeling of pressure in the popliteal fossa, especially when the knee is bent. When the cyst has reached a certain size, there is also a risk that vessels and nerves are pinched off. It can become dangerous as soon as a vein comes under pressure: In the worst case, a blood clot (thrombosis) may form!
After an ultrasound, the diagnosis can usually be made with certainty. Mild discomfort can be removed with a pressure bandage, whereas large cysts must be removed by surgery. Osteochondrosis dissecans involves the rejection of parts of the joint surfaces.
This results in small fragments, also known as joint mice or dissecants. What remains is a joint defect, also called joint bed. It is suspected that circulatory disorders or numerous small cartilage damages lead to the death of the bone (aseptic necrosis).
In addition, there seems to be a connection between continuous stress on the knee joint, e.g. in the context of competitive sports. In its early stages, the disease often proceeds largely without symptoms. Only in the course of the disease does pain occur that is dependent on movement and pressure.
If a fragment comes loose, the joint can become blocked and a ‘joint lock’ occurs. Treatment depends on age, exact location and progression of osteochondrosis. In affected children, immobilisation of the knee in a flexed position using a splint (‘brace’) may be sufficient, provided that no fragment has come loose.
In adult patients, on the other hand, surgery is usually required to ensure permanent freedom from pain. Sinding-Larsen’s disease and Osgood-Schlattter’s disease are also found increasingly in children. Bacterial gonitis or inflammation of the knee joint can lead to complete destruction of the knee joint without treatment.
The germs are often introduced by non-sterile work during knee joint punctures! Especially affected are patients whose immune system is weakened, e.g. during chemotherapy. In addition to swelling and pain in the knee, the inflammation leads to a general feeling of illness with fever, fatigue and an increase in white blood cells.
Therapeutically, it is recommended to clean the inflamed knee with subsequent removal of the joint mucosa. Once the pathogen has been identified, antiobiotic treatment should also be started. Torn meniscus is a frequent consequence of sports accidents.
Due to shear forces (rotation in the knee joint, with fixed lower leg) the meniscus is overstretched and torn. Especially affected are e.g. skiers, as their foot is rigidly fixed by the ski boot. In most cases, the inner one tears from the two menisci, since it is firmly attached to the inner ligament and therefore has no possibility to avoid the meniscus when turning.
Typical for a torn meniscus are direct shooting pains at the affected joint space. Furthermore, the ability to bear weight is greatly reduced, so that sporting activities have to be discontinued. Patients report a kind of ‘snap’ over the joint, in the worst case the mobility can be blocked.X-rays are inconspicuous in the case of fresh injuries, but an MRI in the case of a meniscus rupture or a knee reflection can provide clarity.
In addition, the physician carries out specific examinations to provoke pain by the meniscus tear in the knee. These meniscus tests are also called the Böhler test, Payr test or Steinmann I and II test. Depending on the severity of the injury, a surgical procedure is performed.
If feasible, the two ends are sutured together again by a meniscus suture. The standard therapy, however, is a partial removal of the injured meniscus. Only in the case of a large-area injury does the entire meniscus have to be removed.
However, this total meniscectomy must be viewed critically, as it can cause osteoarthritis of the knee joint at a young age. After about seven days of immobilization, physiotherapy can already be started. Depending on the severity of the injury, a surgical procedure is performed.
If feasible, the two ends are sutured together again by meniscus suturing. However, the standard therapy is a partial removal of the injured meniscus. Only in the case of a large-area injury does the entire meniscus have to be removed.
However, this total meniscectomy must be viewed critically, as it can cause osteoarthritis of the knee joint at a young age. After about seven days of immobilization, physiotherapy can already be started. Similar to a torn meniscus, an injury to the anterior cruciate ligament is often preceded by a sports accident: The cruciate ligament tears due to a violent rotational movement of the lower leg when the foot is fixed.
Shortly after the accident, affected persons experience varying degrees of pain in the knee. The ability to move is not immediately reduced, injured soccer players may remain on the field for some time! Due to the good blood circulation, however, a considerable swelling quickly develops and the resilience decreases considerably.
Sometimes an injury of the anterior cruciate ligament is not immediately recognized and treated. In such cases, instability (frequent bending) in the knee joint can be clearly observed after a few weeks. When examining the damaged knee, the doctor finds typical signs of an anterior cruciate ligament rupture.
These include, for example, the anterior drawer phenomenon and a positive anterior Lachmann sign. An experienced examiner can thus detect various injuries of the cruciate ligaments. In addition, there is the possibility of displaying the defect by means of a magnetic resonance imaging (MRI) or knee endoscopy.
In general, the higher the instability and the higher the demand on the functionality of the knee, the more likely it is that the anterior cruciate ligament will be restored. In such reconstructions, the destroyed cruciate ligament is replaced by the body’s own tendon using various techniques. The middle third of the patellar tendon, the tendon of the gracilis muscle or the semitendinosus muscle serve as a replacement.
The posterior cruciate ligament ruptures rather rarely and usually in combination with other structures of the knee joint. Direct application of force, e.g. in a traffic accident, is one of the most common causes. The symptoms are similar to a tear in the anterior cruciate ligament.
However, the examination reveals a posterior drawer phenomenon and signs of laughter. Posterior cruciate ligament reconstructions are rarely used. Instead, knee stability can be restored through targeted strength training of the thigh muscles (especially quadriceps femoris muscle).
Surgery should only be considered if the symptoms persist. Distortion of the inner ligament is one of the most common knee injuries and occurs when stress causes the knee joint to bend sideways (valgus trauma). Typically, pain in the knee occurs immediately after the accident, while the ability to bear weight is not limited.
As a rule, a distortion heals without complications. Cold packs and relief for the knee joint support the healing process. If the inner ligament is completely torn, patients often describe a sharp, stabbing pain.
Therapeutically, immobilization with a splint may be sufficient; in severe cases, surgery may be necessary. If there is varus trauma, i.e. if the knee joint is bent inwards by excessive force, the outer ligament can tear. Unhappy Triad refers to a severe injury to the knee joint.
The inner meniscus, inner ligament and anterior cruciate ligament are affected simultaneously. Due to the considerable loss of stability, the knee can no longer be loaded. A distinct, painful swelling is visible.
In most cases, the therapy consists of a surgical restoration of the knee defects. A patella fracture is a bony injury to the kneecap. Mostly it is caused by direct force, e.g.B.
during a violent fall to the knees. Characteristic features are a strong pain in movement and pressure in the area of the kneecap, as well as swelling and hematomas. Due to the massive pain, many patients are no longer able to walk independently.
After x-rays have been taken, the patella fracture can be divided into different forms (e.g. longitudinal fracture, type A). If the fragments have not shifted (undislocated), a plaster cast is sufficient for 4-6 weeks. More complicated fractures, on the other hand, must be operated on and then fixed, e.g. with wire systems.
