Changes in the knee joints are most often caused by rheumatic, endocrine (eg thyroid diseases), metabolic and infectious diseases. Inflammatory changes in the synovial membrane caused by infection with chlamydia, Lyme disease or other bacteria or viruses usually damage the articular cartilage and, consequently, degenerate the joints. Degenerative changes are the most common causes of knee pain in the elderly, and in young people, knee pain is caused by injuries. In both of these cases, medicine can work wonders.
With minor degenerative changes, well-chosen muscle exercises and physical therapy treatments that increase the range of motion in the joint, reduceinflammationand improve the blood supply to tissues will help. It is also beneficial to regularly take preparations that stop the degenerative process , e.g. containing glucosamine and chondroitin sulphate. But beware: these preparations do not regenerate the articular cartilage, but only delay the progress of the changes. Your doctor may recommend viscosupplementation, a therapy aimed at improving the quality of the synovial fluid. Then preparations with hyaluronic acid are administered - it has an anti-inflammatory and moisturizing effect on the articular cartilage, reduces friction in the joint, thus inhibiting the degenerative process. The preparation is given as an injection into theknee joint . The effects are usually visible after 4-12 weeks, and the improvement in the efficiency of the joint lasts for a year.
The knee joint is protected by he althy articular cartilage
The best protection for your joints is he althy articular cartilage, which protects your bones. When it is damaged during an injury, wears off due to high pressure (in overweight people), or simply wears out, the bones of the joint will feel it. You can try to repair minor cartilage damage. The procedure involves drilling tiny holes in the bone beneath the damaged cartilage. During the healing process, a scar is formed, which successfully replaces the damaged cartilage. A scar takes 6-12 months to develop.
If the drilling method fails or the cartilage damage is extensive, chondrocyte transplantation can be used. Then a piece of articular cartilage is taken from the patient, the size of two match heads. Then, in special laboratory conditions, they aremultiplied. When the appropriate number of cells is obtained, they are transferred to the collagen biomaterial. The cartilage prepared in this way is implanted into the knee. Here the cells continue to multiply and over time completely fill the cartilage defect. The effectiveness of this method is estimated at over 90%. But it takes a long time to rebuild mature cartilage. This is because the articular cartilage cells prepared for laboratory multiplication must regress in development, become like 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 around 12 months for the cartilage to mature and harden. This does not condemn patients to immobility, but you can return to full activity after a year. Cartilage transplant procedures are not reimbursed. Recently, it is also possible (at the Sports Medicine Center in Warsaw) to perform the collection, isolation and transplantation of chondrocytes during one operation.
Knee joint - dangerous meniscus injuries
There are two menisci in each knee - flexible, horseshoe-shaped cartilage. They act as shock absorbers. They absorb the force that acts on the joint. And it is no small: walking on the knee produces a pressure equal to eight times our weight. The importance of menisci is evidenced by the fact that they absorb 40 percent. the load that arises in the knee when standing, and as much as 75% when we go up the stairs. If the meniscus is damaged, the pressure force acts directly on the bones and leads to faster destruction of the articular cartilage. A meniscus injury is the most common knee injury. Usually it is manifested by severe pain or - in the case of detachment and displacement of a piece of cartilage - joint blockage. The damage usually occurs after a sharp twist of the knee, less often after a sudden extension or bend of the leg.
Knee joint treated with stem cells
In a knee injury, the meniscus may tear or tear. Then the best way to repair it is arthroscopic stitching of individual fragments. Innovative operations consist of sewing a collagen patch around the ruptured meniscus. Collagen is saturated with stem cells collected from the patient during the procedure. The procedure is short and is performed with the use of an endoscope, thanks to which the patients quickly recover. Carrying out such operations is an expression of understanding of the role of the meniscus in the knee joint. In the 1980s, it was considered a redundant component of the knee and could be removed if broken. It turned out, however, that the lack of or damage to the meniscus quickly leads to joint degeneration, even if it isonly 10 percent were removed its masses. If the injury has not been treated 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 kind of foam structure that cells penetrate into. Over time, this structure grows through the patient's tissue, and the implant itself dissolves after a few years. Then a new, own meniscus already exists in its place. The implant is inserted into the joint through the arthroscope - a device that allows you to look inside the joint through small incisions in the skin and insert micro-tools there. The implanted fragment must be adjusted to the size of the defect in the natural meniscus and fixed with special stitches to keep it in the right place. Within a dozen or so hours from the operation, blood leaks from the knee joint to the implant, and with it the poly-potential cells that can change into cells that make up the articular meniscus. After surgery, the patient can start rehabilitation quickly. The newest types of implants can be combined
with other surgical techniques, such as re-alignment of the knee axis or ligament reconstruction. After inserting the implant, the pain disappears. But a much greater benefit is that the progression of the degenerative disease is inhibited. The procedure is performed on young and middle-aged patients. In young people, it can be considered the gold standard. The procedure protects against the insertion of a knee joint endoprosthesis. For 4-8 weeks after the surgery, you should use crutches to relieve the joint, but you need to exercise to ensure proper rehabilitation of the joint.
Knee joint - when the tendon is torn
Stability of the knees is ensured by a system of a dozen or so tendons, i.e. ligaments (the most important of them are the anterior and posterior cruciate ligaments, tibial and fibular collateral). They can be compared to the inflexible band that connects bone to bone. However, the role of the ligaments is not only to mechanically stabilize the knee. Increasingly, the problem of joint instability is considered a neurological disease. The ligaments play a key role in proper proprioception, i.e. the internal feeling of the joint. They tell the central nervous system how the knee is positioned, what surface we walk on and how fast we are moving. The flow of this information takes place without our awareness, thanks to which we can admire the views while riding a bicycle, instead of focusing on tensing some muscles and relaxing others. The ligamentless knee loses communication with the brain and starts to "run away" instead of making coordinated movements. The low flexibility of the ligaments means that they are often damaged. A sharp twist of the torso with slightly bent knees, a not too strong blow, is enough for it to occurserious injury. The cruciate ligament is the most vulnerable to injuries. Its reconstruction is extremely important for the proper functioning of the joint and the precision of the movements performed. It is about regaining stability of the knee and restoring the flow of information between the knee joint and the brain, as the ligament is the "eye" that tells the brain about the position of the joint. Without surgery, a torn ligament cannot be repaired.
Knee joint - ligament reconstruction
The procedure involves inserting a fragment of the tendon taken from the patient in place of the damaged ligament (in some clinics synthetic ligaments are inserted, but they are not perfect yet and not every patient can use them). The operation is complicated and requires great precision as the cruciate ligament is only 2-3 cm long. The procedure is performed using an arthroscope. During the operation, the femur and tibia are drilled, and then the tendon is inserted into the holes. When it is in place, it is attached first to the femur and, when properly tensioned, to the tibia. The screws used during the procedure decompose in the body after approx. 3 years, without damaging it. Rehabilitation takes about 2 months, but the complete regeneration of the knee takes six months. This effort pays off, because then you can even return to competitive sports.
ImportantImplants and endoprostheses
Minor damage will be repaired by the procedure of cleaning the joint from damaged fragments of articular cartilage. Sometimes it is enough to change the angle of the joint bones surgically so that the pain disappears and its degradation does not progress. The most radical knee repair procedure is surgical cutting of the bone fragments that make up the joint and replacing them with metal implants. For people with major degenerative changes or complicated injuries, the only solution is to insert an endoprosthesis. The procedure is performed when the mobility of the joint has been significantly restricted and the patient suffers from pain that cannot be alleviated with medications and rehabilitation.