Chondromalacia patella
Introduction
Introduction to patella softening Patellar softening (CP), also known as patella cartilage softening, osteochondritis, is a common disease of the knee joint, which occurs in young adults and is especially common among athletes and sports enthusiasts. The incidence of women is higher than that of men. The main pathological change is the degenerative change of cartilage, including cartilage swelling, fragmentation, and shedding. Finally, the same lesion occurs in the corresponding part of the femoral condyle, and the patellofemoral joint osteoarthritis develops. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific people Mode of infection: non-infectious Complications: Traumatic arthritis Meniscus injury
Cause
Causes of patella softening
Autoimmune (25%):
The surface of articular cartilage can prevent anti-collagen antibody from entering the deep tissue of cartilage and protect it. Anti-type II collagen antibody is found in the joint fluid of patients with articular cartilage injury. Immunofluorescence method is used to examine the lesion specimen of patients with patella softening disease. Immunoglobulin IgG, IgA, IgM and complement C3 are attached to the damaged area of the cartilage tissue and the remaining chondrocytes, and it is inferred that there is an autoimmune reaction involved in the cartilage injury process.
Cartilage dystrophy (20%):
Various injury factors (especially mechanical stimuli) cause abnormal changes in the secretion of joint fluids and their components (such as enzyme activity, various nutrient contents, osmotic pressure of joint fluids, etc.), affecting the normal nutrition of the cartilage and Physiological and biochemical processes promote cartilage degeneration. Because the viability of cartilage in the articular cartilage complex is highly dependent on the blood supply of cartilage, blood supply is also one of the causes of patella softening.
Cartilage dissolution (18%):
After the joint synovial membrane injury, the osmotic pressure changes, the enzyme in the plasma enters the synovial fluid, the activity is enhanced, and then the cartilage is dissolved. Chinese scholar Jian Jianhong found:
1 During the softening process of the tibial cartilage, chondrocytes synthesize a large amount of collagenase and release it into the cartilage matrix to cause serious damage;
2 Collagenase content was positively correlated with the severity of stress reduction in the medial cartilage degeneration of the tibia.
Therefore, collagenase plays an important role in the cartilage softening process of the medial aspect of the tibia with reduced contact stress. At present, most scholars tend to think that patella softening is the result of a combination of various factors, and various factors cause patellofemoral joint pressure change as an external cause. Autoimmune response, cartilage dystrophy is the internal cause of patella softening.
Prevention
Prevention of patella softening
The occurrence of patella softening has its internal and external factors for middle-aged and elderly people. The intrinsic factor is the degeneration of articular cartilage itself, which is related to age and other factors. The external factor is the chronic damage of mechanical cartilage to articular cartilage. To prevent the occurrence of patella softening, it is mainly to reduce the continuous pressure on the patellofemoral joint and improve the nutrition of the cartilage. The following measures can be taken:
1. Actively fully active joints should be carried out under no-load conditions, such as lying on the bed actively stretching, flexing the knee joints, insisting on each morning and evening, each time for 10 minutes, fully active joints can make all parts of the tibial articular surface Stimulated, the synovial nutrients can penetrate into the cartilage tissue evenly and enhance the lubrication of the joints.
2, to prevent continuous compression of the tibial articular surface, the pressure on the tibia of the knee flexion is large, easy to damage the articular surface, to avoid the pressure of the continuous sacral position on the tibial articular surface.
3, plaster fixed or lower limb traction treatment, to take the initiative to exercise quadriceps exercise, quadriceps muscle contraction can drive the humerus up and down movement, is conducive to the cartilage nutrient penetration and reduce the continuous compression of the patellofemoral joint surface.
Complication
Complications of patella softening Complications Traumatic arthritis meniscus injury
The symptoms of this disease are often not serious in the early stage. The rest or general painkillers can be relieved. The lesions continue to develop under the hidden state until the development of patellofemoral arthritis. In severe cases, the knee flexion and extension activities are limited and cannot stand on one leg. When the femoral arthritis has formed in the late stage, the cartilage and subchondral bone in the lesion area have been obviously damaged, and the cartilage has no ability to regenerate and repair. In addition, the disease is also prone to meniscal injury and traumatic arthritis.
Symptom
Symptoms of patella softening common symptoms sacral pain knee joint pain cartilage ossification sacral bone strain underarm pain sacral softening Q angle abnormal renal softening
Direct knee injury can cause fracture of the tibial cartilage or osteochondral, or multiple injuries, such as sports injuries, causing cartilage degeneration, cartilage surface roughness, loss of luster, severe cartilage loss, bone exposure, its relative femoral joint The surface is also damaged, and the injury site is mostly in the center of the humerus. This disease occurs mostly in young and middle-aged patients, and has a history of obvious trauma, or chronic accumulation of small injuries. The main symptoms are pain in the knee joint, severity, and flatness. The symptoms of walking are not obvious, and the pain is aggravated after standing up, going up and down the stairs, going up and down, or walking away.
Examine
Examination of patella softening
The auxiliary examination methods for this disease are mainly physical examination, X-ray examination and radionuclide examination:
1. Tibial pressure grinding test: During the examination, the tibia and its opposite femoral condyle joint surface are squeezed and rubbed together or slide up and down, and have a rough rubbing feeling, friction and pain and discomfort; or the examiner pushes the cheekbone to one hand. On the side, the thumb of the other hand can cause pain after pressing the edge of the humerus. When there is joint fluid, the floating sputum test can be positive.
2, single leg squat test: the patient's single leg weight, gradually squatting to 90 ° ~ 135 ° pain, soft, after a single leg can not stand up.
3, X-ray examination: according to the knee joint, lateral position and tibia tangential X-ray film, early no abnormalities, late can be due to the majority of cartilage wear, the tibia and femoral condyle gap narrowed, the humerus and femoral condyle edge There may be bone hyperplasia.
4. When radionuclide bone imaging is examined, the lateral position shows localized radioactive concentration of the humerus, which has early diagnostic significance.
Diagnosis
Diagnosis and differentiation of patella softening
diagnosis
1. Tibial pressure grinding test: During the examination, the tibia and its opposite femoral condyle joint surface are squeezed and rubbed or slided up and down, and have a rough rubbing feeling, friction and pain, or the examiner pushes the cheekbone to one hand. On the side, the thumb of the other hand presses behind the edge of the humerus to cause pain.
2. Single leg squat test: The patient has a single leg holding weight, and gradually squats to 90 ° ~ 135 ° when there is pain, soft, and can not stand up after a single leg.
3. X-ray examination: according to the knee joint, lateral position and tangential tangential X-ray film, early no abnormalities, late in the cartilage due to extensive wear, the tibia and femoral condyle gap narrowed, the humerus and femoral condyle edge There may be bone hyperplasia. The main basis for the diagnosis of patella softening is pain after the tibia. The tibia and the unilateral sacral test cause post-humeral pain. It should be checked for the presence of meniscus injury and traumatic arthritis.
Differential diagnosis
1. Congenital discoid meniscus hypertrophy;
2, congenital knee dislocation;
3. Intralateral and lateral meniscus injury;
4, meniscus calcification;
5, meniscus ossification;
6, exfoliative osteochondritis;
7. Synovial chondromatosis;
8, joint synovial fold syndrome;
9, semitendinosus, semimembranosus tendon slip;
10, femoral biceps tendon slip and so on.
