Clinical diagnosis, treatment and prevention of chondromalacia patellae Questions and Answers
1. What are the possible manifestations of chondromalacia patellae? How is the diagnosis confirmed?
The early manifestation is pain in the anterior side of the knee joint, which is aggravated when going downstairs, and in severe cases, it is often necessary to go downstairs sideways and sideways, and when going downstairs or walking, there is often sudden weakness and fall, commonly known as “limp leg”, and the knee joint is afraid of cold, and the knee joint can be repeatedly swollen with fluid, which is often misdiagnosed as “rheumatism”. This is often misdiagnosed as “rheumatism”. When the disease worsens, it becomes difficult to squat and painful at night, which affects sleep and normal life. In advanced stages, due to severe wear and tear, free bodies may appear in the joint cavity, causing intra-articular strangulation and sudden jamming of the joint.
A typical examination reveals a patellar grinding test (+); a sassafras sound. Clinical X-ray examination often has varying degrees of osteophytes, and X-ray
Axial examination shows lateral tilting or subluxation of the patella, narrowing of the lateral patellofemoral joint gap, and excessive long-term wear of the lateral patellofemoral joint, resulting in subchondral osteosclerosis of the corresponding joint, and “moon bud-like” osteosclerosis can be seen on lateral patellar x-ray.
Normal patellar image
Biologically normal patellar images during patellofemoral joint activity, mechanical analysis of patellar subluxation or tilt images in chondromalacia patellae, analysis of the pathology of surgical specimens and years of clinical experience have confirmed that chondromalacia patellae occurs due to different degrees of patellar subluxation or tilt, and that the patella slides on an abnormal trajectory, resulting in adverse wear and tear of the lateral patellofemoral joint space.
When the following phenomena occur, patellar chondromalacia should be highly suspected: pain on the front side of the knee joint, increased pain when sitting and standing up or going downstairs and downhill, often with “playing soft legs, joints afraid of cold, or repeated swelling and fluid accumulation in the knee joint.
Bin bone chondromalacia photo method, x-ray film placed under the knee of the finger
2. chondromalacia patella
Non-surgical treatment.
* anti-inflammatory and painkilling drugs. Early cases, can inhibit the biochemical changes of arthritis, but can not last, pain relief does not cure the disease, the reason is the patellofemoral joint abnormal wear the root cause has not been resolved.
* Support to squeeze and push the patella into the intercondylar groove method, or like athletes, fixed patella with rubber plaster wrapping, but this is only a temporary benefit, these methods will produce some unfavorable pressure and friction on the patella, which will aggravate the injury, and will eventually lead to quadriceps atrophy. ,.
*The 30-degree knee flexion and extension exercise for quadriceps recommended by Kummeld and Steiner has some effect, and we have modified it into a knee extension tensing exercise as shown in the figure, but it cannot strengthen the medial head of the quadriceps alone, and is only used as an adjunct to treatment.
Specific practice practice: 6 pounds of sandbags on the knee, bend the knee 30 degrees, and then downward force downward tense for 5 seconds, relax for 10 seconds, and then repeat, 10-15 times per minute, 2 or 3 times a day, each time half an hour.
*Electrical stimulation therapy. In order to strengthen the medial head of the quadriceps alone, the treatment instrument developed by Professor Ye Qibin and others has an obvious effect of selectively strengthening the medial head of the quadriceps, so the efficacy is satisfactory and provides an effective treatment method for early chondromalacia patellae.
How to treat chondromalacia patellae with the treatment instrument?
Patients with chondromalacia patella have different degrees of weakness and atrophy of the quadriceps muscle, and the axial phase of the knee joint shows that the patella is mostly laterally A or semi-dislocated, resulting in long-term transitional wear of the lateral patellofemoral joint and causing the above-mentioned series of symptoms, and this root cause has not been solved for a long time, which is the reason why the problem of chondromalacia patella cannot be solved satisfactorily for a long time. Patients in this category have a history of long-term pain and have tried a variety of treatments with no significant results.
The role of the patellar chondromalacia treatment instrument is to selectively exercise the medial head of the quadriceps muscle that pulls the patella inward, increasing its muscle strength to pull the patella inward, resetting the semi-dislocated or outwardly inclined patella, reducing the long-term excessive wear of the lateral patellofemoral joint, and achieving the fundamental treatment purpose. Early diagnosis and early use of the instrument can reduce the pain of chondromalacia patellae developing into osteoarthritis of the patellofemoral joint, which requires surgical treatment.
How to use the chondromalacia patella treatment instrument correctly?
(1) Find the exact stimulation point. In the use of chondromalacia patella treatment instrument treatment, should be used sitting or flat position, lower limb muscle relaxation, knee completely straight, so that the patient tense lower limb muscles, can be found in the medial thigh pike quadriceps medial head, (male patients can be accurately touched by forceful knee extension) in the head and tail of this muscle, each put a skin patch, female patients and longer duration of the disease, due to muscle atrophy is not easy to find, can be in the upper edge of the patella line and Female patients and those with long duration of disease, because of muscle atrophy is not easy to find, can put a skin patch inside the intersection of the patella’s upper edge line and inner edge line (or use the finger cross method to position the skin patch), and at this point slightly oblique to the inner upper 10cm, each put a skin patch (Note! (The upper skin patch do not cross the midline of the thigh) (illustration)
(2) open the instrument treatment. Turn on the power, the apparatus began to work, slowly adjust the intensity of stimulation until appropriate, at this time, the inner muscles of the knee every interruption of 6 seconds that the contraction of the bulge, and then diastole, at this time, can touch the patella was moved inward to draw displacement, two times a day treatment, each time 30 minutes. After a month or so, most of the symptoms were relieved. This can be done once a day instead. When the symptoms are completely relieved, you still need to do it 2-3 times a week to consolidate, because the principle of this instrument treatment is actually selective exercise to strengthen a muscle, if you do not continue to exercise, the muscle exercise effect will degrade back over time.
13, chondromalacia patella treatment instrument efficacy indications
Generally, some patients feel a sense of lightness in the knee joint after stimulating treatment, and most patients experience rapid relief of symptoms in about 10 days of treatment, with significant improvement in going up and down stairs, cycling, and squatting difficulties.
Another objective indication is to measure the circumference of the knee joint at the three horizontal fingers (patient’s own fingers) of the upper edge of the patella before doing the instrumentation treatment and keep records, and review every week.
Attachment: results of electrical stimulation treatment for chondromalacia patellae (211 cases with one-year follow-up report of treatment)
After one year of treatment.
The results of electrostimulation treatment for chondromalacia patellae were: excellent rate of 93.7%.
General outpatients are not advocated to go for x-ray comparison because in general outpatients, the projection angle of each x-ray is not likely to be consistent and the films taken are not comparable. To perform the study work, it is necessary to have the X-ray done by a dedicated person and to pay attention to the consistency of the projection angle of each X-ray in order to get the same standard X-ray for the comparative study.
After a longer period of combined electrical stimulation and functional knee exercise treatment, these cases can also recover quadriceps contraction for therapeutic purposes. Patients with a combined X-leg are also later to take effect , requiring a longer treatment period.
Note! Patients with significant osteoarthritis of the large joint (tibiofemoral joint) or with stage III patellofemoral chondromalacia have a poor outcome and require total knee surface replacement. Do not delay surgery by further treatment with electrical stimulation.
Attention! Investigation of very few patients “treatment ineffective” reason analysis: in addition to the above 14) special patients need longer treatment, a few patients poor patience, anxious, only a few times, each time is not enough time, only a few days, then give up treatment, of course, can not get the treatment effect, because we need to wait for the electrical stimulation of muscle strength, the effect can The effect can be seen only after the electrical stimulation muscle is strong. This kind of patient is best in the hospital to guide the treatment 7 ~ 10 days, after the initial effect, and then buy the instrument home treatment. Some people also use the electrode plate is not placed correctly, the doctor is responsible to find out the reason, to give a solution.