Degeneration of the knee joints (gonarthrosis) affects every fifth European. Experts estimate that only about 40 percent of knee joint degeneration is caused by the aging of the body. In the remaining 60 percent of cases, knee degeneration is the result of overstrain, contusions and injuries. This is the price we pay for our lifestyle. How is knee degeneration treated?

Degeneration of the knee jointsis one of the leading causes of disability in the world.Degeneration of the kneethis colloquial name of the disease, referred to by doctors asgonarthrosis , i.e.degenerative disease (arthrosis) of the knee joint .

Gonarthrosis usually occurs on both sides. It affects more often obese women aged 40-60.

Treatment of degenerative joint changes depends on the degree of their destruction, the patient's expectations and the causes that led to the development of the disease. If it was any other medical condition it should be treated; when the cause is overweight, you need to lose weight.

Causes of knee degeneration. What can damage the knee joint?

There is no age limit at which degenerative changes in the knees begin. We do know, however, what can speed up this process.

  • Too heavy loads . Hard physical work, obesity and competitive sports lead to faster wear of the joints.
  • Injuries . The ligaments in the knee are responsible for its stabilization, and the menisci, or elastic cartilages, resemble shock absorbers. If these structures are damaged, the entire joint malfunctions and its surfaces wear down faster.
  • Diseases . Damage to the articular cartilage can be caused by inflammatory changes in the synovial membrane caused by diseases such as Lyme disease, chlamydial infection or other bacteria or viruses. Degeneration in the knee joints often occurs as a result of thyroid diseases and rheumatic diseases.
  • Weakening of the muscles surrounding the joint . They stabilize the knee and ensure that its movement is correct and smooth. They need to be constantly strengthened.
  • Congenital disordersbuilding bones and joints . Valgus or varus of the knees or hip dysplasia can cause overload and accelerated wear of the joints.

Degeneration of the knee joint: symptoms

Due to the fact that the articular cartilage is not innervated or supplied with blood, usually in the initial stage of the disease, no pain is felt in the joint. However, when the knee begins to ache, swell, stiffen, crackle, it is usually a signal that the joint damage is already well advanced - it includes the cartilaginous layer closest to the bone.

Only a doctor can assess (based on the history and test results: X-ray in the standing position, blood or joint fluid analysis) whether the cause of the pain is actually degenerative changes and not other diseases, e.g. from the group of rheumatic diseases, crystallopathy (e.g. gout), or post-infectious or psoriatic arthritis.

On the basis of the X-ray image, it is possible to diagnose joint space narrowing, limb alignment disorders, the presence of a free body in the joint or bone superstructure, called osteophytes. These are common problems related to degeneration. Experts estimate that about 40 percent of such changes are due to the aging of the body. The remaining 60 percent are the result of injuries, infections, and overload. While walking, each knee is affected by a force equal to eight times our weight.

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How to relieve degenerated knee joints and reduce knee pain?

1. Do compresses

Cold compresses will be better for two reasons. First, when articular cartilage is significantly damaged, it becomes thinned and bone is damaged, and exposed and rubbing articular surfaces will cause pain, swelling and an increase in temperature of the knee joint. Cooling it down will be a relief. The second argument for putting ice on the sore knee, not with a hot water bottle, is that there is a risk of inflammation in the knee. The heat may make it worse.2. Get pain medication

Every fifth inhabitant of Europe suffers from knee joint pain, and every thirteenth person uses painkillers every day for this reason. When the pain is the result of being overburdened, it is enough to conserve the joint. Occasionally, you can use a painkiller tablet (preferably from the group of anti-inflammatory drugs such as ibuprofen, naproxen, diclofenac, ketoprofen). If the symptoms persist for more than a week, the pain is severe, or there is morning stiffness, see your doctor.3. Do not quit your activity

The pain that occurs during movement spares the sick limb, limiting physical activity, whichit leads to a reduction in mobility in a given joint, and even contractures (mainly in the flexion position). Meanwhile, numerous studies have shown that exercise is one of the most effective treatments for arthrosis. Controlled activity (the type and intensity of exercise is best discussed with an orthopedist or physiotherapist) improves mood, but also reduces pain, increases joint flexibility, and improves blood circulation. This is the cheapest method of treatment.

People with osteoarthritis should exercise in highly cushioned shoes. For walks, forest paths, grassy areas or a running track are better than hard asph alt. Disciplines that do not overload the joints, such as swimming, cycling, cross-country skiing will be safe.

Sports in which the pond carries heavy loads, such as long-distance running, football, weightlifting, are not recommended. It is also worth doing simple strengthening exercises every day, e.g. sitting on a chair, squeezing a pillow between your knees or sitting straight, put a rolled-up towel under one leg (back of the knee) and press it in series of five seconds.

If the pain makes it difficult to move, you can use assistive equipment - an orthosis or crutches. However, it has been proven that these aids should not be used continuously as this could lead to increased stiffness and a weakening of the muscle structures that support the joint.

4. Rehabilitate

In the case of degenerative changes, the improvement of their condition can be achieved with rehabilitation.

  • Kinesiotherapy - proper selection of exercises will help to strengthen weakened muscle groups and reduce the tension of overloaded ones. The physiotherapist will correct movement patterns and, if the patient's condition allows it, will introduce elements of functional training. Muscle stretching (stretching) is also important, as it will increase the elasticity of tense tissues.
  • Soft tissue therapy - the use of deep tissue massage and myofascial relaxation techniques (usually on the muscles of the hip and lower limb) increases their flexibility and prevents the formation of contractures and adhesions.
  • Physical therapy - cryotherapy, magnetotherapy, laser therapy, shock wave and ultrasound are often used.
  • Kinesiotaping - applying patches corrects the fascia, which is able to reduce and even relieve pain. However, with degeneration of the knee joint, it has a short-term effect.

5. Ask your doctor for injections

Your doctor may recommend viscosupplementation, a therapy aimed at improving the quality of the synovial fluid.Then, preparations with hyaluronic acid are administered to the joint, which inhibits the progress of degenerative changes. The use of such a treatment, which lasts at least three weeks (depending on the dose of the drug), allows for a significant improvement in he alth, usually for a year. The preparation has an anti-inflammatory and moisturizing effect on the cartilage, which makes the joint more efficient and less painful. The number of injections and their price depend on the concentration of the preparation (PLN 400-900).

For the regeneration of the joint, you can also use platelet-rich plasma (PLN 1100-2500) or stem cells obtained from your own adipose tissue. Collection and transplantation are performed during one procedure (PLN 5,000-6,000).

In some cases it is necessary to apply a blockade - a steroid drug is injected into the joint. However, when it comes to steroid drugs, the indications for use in gonarthrosis are very limited.

6. Change diet

Losing 10-20 kg of excess weight reduces the risk of developing osteoarthritis of the knees by 30-40 percent. Diet can speed up or slow down the development of arthrosis. Ponds are damaged by saturated fats (butter, fatty meat and cheese) and vitamin D deficiency. Omega-3 fatty acids (fatty sea fish) and antioxidants (found in vegetables and fruits) have a beneficial effect. The right amount of protein is also important, because the strength of the muscles stabilizing the joints depends on it. When it comes to supplementation, glucosamine sulfate and chondroitin sulfate are usually recommended.

Advanced knee degeneration

When the degenerative disease is in its advanced stage, pain occurs not only during activities that put maximum stress on the knee joint. Walking, standing for a long time, getting up from a chair, and going downstairs also become a problem for the patient. Depending on which tissue fragments are damaged, gonarthrosis may be more prevalent in the lateral, medial or patellofemoral compartments of the knee.

Degeneration of the knee joints - damaged ligaments

Stability of the knees is ensured by a system of several ligaments (the most important of them is the anterior and posterior cruciate ligaments, and the tibial and fibular collateral ligaments). They can be compared to a not very flexible band connecting bone to bone. It is because of this low flexibility that the ligaments are often damaged - a sharp twist of the torso with slightly bent knees or a not too strong blow is enough to cause a serious injury.

The cruciate ligament is the most vulnerable to damage. Without surgery, it cannot be repaired. The procedure involves inserting a graft in place of the damaged ligament from a tendon taken from the patient. The operation iscomplicated and precise, because the cruciate ligament is only 2-3 cm long. Its reconstruction is very important for restoring the proper functioning of the joint. It is also about stabilizing the knee, but also about the flow of information between the knee joint and the brain, because this ligament is something like an eye that tells the brain about the position of the joint.

This complicated operation is performed using an arthroscope - a device that allows you to look inside the joint through small incisions in the skin, insert micro-tools and replace the ligament. The femur and tibia are drilled, and then the tendon is inserted into the holes. Once it is in place, it is secured to the femur and, with sufficient tension, to the tibia. The screws used during the procedure decompose in the body after 3 years, without causing any harm to it. After the procedure, intensive rehabilitation lasts about 2 months, but the complete regeneration of the knee can be discussed only after six months. However, the effort pays off, because you can even return to competitive sports.

  • Arthroscopy in the diagnosis and treatment of the knee joint
Important

You can try to rebuild the articular cartilage

The destruction of articular cartilage occurs as a result of degenerative processes, but also during injuries. Cartilage injuries usually occur along with other injuries to the knee. The cause of post-traumatic destruction of articular cartilage are injuries, during which the knee joint was subjected to enormous force.

  • If a small area of ​​cartilage is damaged, an effective method of repairing it is a procedure that involves drilling tiny holes in the bone beneath the damaged articular cartilage. The blood that leaks out of them forms a scar that replaces damaged cartilage. The scar develops painlessly 6-12 months.
  • If this method is unsuccessful or the damage is very extensive,chondrocyte transplantcan be used. A piece of articular cartilage the size of two match heads is collected from the patient. Then, under special laboratory conditions, they are multiplied. When the appropriate number of cells is obtained, they are transferred to a collagen biomaterial. The cartilage prepared in this way is implanted into the knee. Here the cells continue to multiply and completely fill the cartilage defect. This is an unusual method of treatment, its effectiveness is estimated at over 90%. It takes a long time to rebuild the cartilage. This is because articular cartilage cells prepared for laboratory multiplication must, in a sense, regressdevelopment - they become cellular newborns. The implanted cartilage has the consistency of a gel, i.e. it is in the form found in the joints of newborns. It takes about a year for the cartilage to mature and harden. This, of course, does not condemn people undergoing this method to stand still, but you can return to full activity after a year. Cartilage transplantation procedures are not reimbursed by the National He alth Fund, fortunately others are not reimbursed.

Degeneration of the knee joints - damage to the meniscus

There are two menisci in the knee. They are flexible cartilages that resemble a horseshoe. They play a very important role because they are like shock absorbers - they absorb the energy that acts on the joint. And it is quite a lot. When walking on the knee, a force equal to eight times our weight is created. Meniscus absorb 30-40 percent. the load that arises when standing, and when we go up the stairs - as much as 75 percent. Injury to the meniscus is the most common knee injury. It is manifested by severe pain or - in the case of detachment and displacement of a piece of cartilage - blocking the ability to move the joint. Damage occurs after a sharp twist of the knee, and less often after a quick extension or bend of the leg. If the meniscus is damaged, then the force in the knee acts directly on the bones that make up the joint. This results in faster destruction of the articular cartilage, and a meniscus can rupture or tear as a result of a knee injury. Then the best way to repair it is arthroscopic stitching of the fragments. If, on the other hand, the trauma is untreated for a long time or the meniscus is completely destroyed, a fragment of it or the entire meniscus can be replaced with a biomaterial implant. An implant is a type of foam structure (somewhat reminiscent of a sponge) into which the cells penetrate. Over time, the implant becomes overgrown with tissue. When it finally dissolves, a new meniscus of its own is in its place. The implant is inserted into the joint through the arthroscope. The doctor cuts a fragment of the size of the defect and fixes it with special stitches. For several hours after the surgery, blood leaks into the implant, and with it the so-called polypotent cells that change into cells that make up the joint meniscus. After such an operation, the patient quickly begins rehabilitation. The treatment can be combined with other techniques. When the implant is inserted, the pain subsides. However, the greater benefit is that the development of degeneration and possibly the implantation of a knee prosthesis is avoided.

  • Treatment of a damaged meniscus

Treatment of degenerative changes in the knee joints

With minor changes in the knee joints, the improvement of their condition can be achieved through rehabilitation, i.e. muscle exercises, physical therapy treatments thatthey increase the range of motion in the joint, reduce inflammation, and improve the blood supply to the tissues. It is also beneficial to take preparations that can stop the progression of degeneration. Means containing glucosamine sulfate and chondroitin are recommended. It is worth remembering that these preparations do not regenerate the articular cartilage, but only delay the progression of the disease. Your doctor may also recommend viscosupplementation, a therapy aimed at improving the quality of the synovial fluid. Then the preparation with hyaluronic acid is administered directly to the joint. The treatment usually lasts about 3 weeks and its effect lasts for a year. The preparation (available on prescription) causes increased secretion of synovial fluid, as a result of which the friction of the joint surfaces is reduced and the cushioning properties of the synovial fluid improve. This makes the joint more efficient and less painful, and there is no way to stop the changes in the joints. When rehabilitation and medications do not help, knee surgery is the only option. If the knee damage is minor, arthroscopic operations are performed to clean the joint of damaged fragments. Sometimes it is enough to surgically change the angle of the bones that make up the joint so that the pain disappears and its degradation does not continue. After such surgery, the sick knee is forgotten for several years. The most radical repair of the knee joint is the surgical cutting of the bone fragments that make up the joint and replacing them with metal implants. For people with severe degenerative changes in the knee or after difficult-to-treat injuries, the only solution is often the insertion of a complete knee prosthesis. The procedure is usually performed on patients whose joint mobility has been significantly restricted and who suffer from severe pain that cannot be relieved by medication, rehabilitation or physical therapy.

Gonarthrosis and knee replacement

It happens that in the case of advanced degenerative changes in the knees, the only solution is arthroplasty, i.e. the implantation of an artificial joint. The surgical procedure consists in a cost-effective, complete resection of the articular surfaces of a diseased joint and replacing them with an artificial joint made of beep-absorbable materials - says Dr. n. med. Juliusz Dec from Sport-Clinic Żory.

Source: Sport-Klinika Żory / youtube

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