Chondromalacia patellae (CP), also known as chondromalacia patellae and chondromalacia patellae, is a common disease of the knee joint that occurs in young adults and is particularly common in athletes and sports enthusiasts, with a higher incidence in women than in men. The main pathological changes are degenerative changes of the cartilage, including swelling, fragmentation and loss of cartilage, and finally the corresponding parts of the femoral condyles also undergo the same pathology, developing into osteoarthritis of the patellofemoral joint.
I. Clinical manifestations
Direct trauma to the knee can cause fracture of the patellar cartilage or osteochondral bone, or multiple injuries, such as sports injuries, cause degenerative changes to the cartilage, roughness of the cartilage surface, loss of luster, and in severe cases, the cartilage falls off, the bone is exposed, and its corresponding femoral articular surface is also damaged. The injury site is mostly in the center of the patella. The main symptom is post-patellar pain in the knee joint, which varies in severity.
Second, the examination auxiliary examination methods
Mainly physical examination, X-ray examination and radionuclide examination.
1, patella pressure grinding test examination so that the patella and its relative intercondylar joint surface of the femur squeeze and grind each other or slide up and down, there is a rough grinding sensation, grinding sound and pain discomfort; or the inspector force one hand to push the patella to one side, the other hand thumb pressure behind the patella edge can cause pain. The floating patella test may be positive when there is joint effusion.
2.Push patellar resistance test
3, single-leg squat test patient holding weight on one leg, gradually squatting to 90 ° ~ 135 ° when the pain, tenderness, squatting after one leg can not get up.
4, X-ray examination of the frontal and lateral knee joint and patellar tangential X-ray, early stage no abnormalities, late stage may be due to wear and tear of the cartilage, narrowing of the gap between the patella and femoral condyle, patella and femoral condyle edge may have osteophytes.
5. Magnetic resonance imaging (MRI): It also has early diagnostic significance. It can be observed the cartilage wear condition, and the presence of effusion.
6.Radionuclide examination shows limited radioactive concentration in the patella in the lateral position, which has early diagnostic significance.
7, arthroscopy arthroscopy is the most valuable method to confirm the diagnosis of chondromalacia patellae. It can clarify whether there is a lesion in the articular cartilage and the extent of involvement, and the degree of patellar chondrosis, and can better differentiate it from diseases characterized by anterior knee pain, especially in difficult patients.
Third, complications
Early symptoms are not serious, and can be relieved by rest or general pain medication; the lesion develops in a “hidden state” until it develops into patellofemoral arthritis, and in severe cases, the knee is limited in extension and flexion and cannot stand on one leg. In advanced stages of patellofemoral osteoarthritis, the cartilage and subchondral bone in the lesion area have been significantly damaged, and the cartilage has no regenerative repair ability. In addition, it is easy to combine meniscal damage and traumatic arthritis, etc.
IV. Treatment
The treatment of this disease includes non-surgical treatment and surgical treatment.
1, non-surgical treatment for mild symptoms, pay attention to avoid direct impact on the patella and reduce patellofemoral friction activities, such as up and down hills, up and down stairs, cycling and other activities, symptoms can be expected to reduce. When the swelling and pain suddenly increase, cold compresses should be applied, and after 48 hours, wet heat compresses and physical therapy should be used instead. Oral anti-inflammatory drugs, such as fotarine and meloxicam, can be taken for a short time during the attack period; joint cartilage nutrients, such as glucosamine sulfate, can be taken for a long time; as the nutrition of patellar cartilage mainly comes from the synovial fluid, various causes of abnormal synovial fluid composition, can make the patellar cartilage malnutrition, vulnerable to minor injuries and degenerative changes, so intra-articular injection of sodium vitreous acid (sodium hyaluronate). Intra-articular injection of sodium hyaluronate can regulate the viscosity and lubrication of joint fluid, protect joint cartilage, promote the healing and regeneration of joint cartilage, relieve pain and increase joint mobility. Usually each injection is 2ml, once a week, 4-5 times as a course of treatment. It has certain anti-inflammatory effect, relieves pain and increases joint mobility. Combined with serious symptoms of synovitis can be cautiously used in the intra-articular closure treatment of Depo-Provera.
2.Surgical treatment should be performed in a timely manner if the symptoms are severe, and the patella should be treated appropriately according to the lesion.
(1) Patellar cartilage cutting includes superficial cartilage cutting, cutting cartilage up to the bone and bone drilling.
(1) Superficial cartilage cutting A sharp knife is used to cut the degenerated cartilage up to the normal part of the cartilage. Although the cartilage repair ability is very weak after superficial cutting, the surface is smooth and covered with several layers of flattened cells after several months of shaping effect after removing the erosion cartilage, so that the operation can achieve more satisfactory results.
If the cartilage damage has reached the bone, the whole cartilage can be cut and the edges of the wound can be trimmed to make a beveled surface, and the exposed bone is not treated. The full-layer cartilage defect that does not reach the medullary cavity can be slowly regenerated endogenously, and the regenerated cartilage is transparent cartilage.
(iii) Cartilage cutting to the bone and drilling to remove the diseased full cartilage, the exposed bone is drilled with several holes with a kerf needle to cause bleeding in the bone bed, and the full defect of articular cartilage deep to the medullary cavity is repaired exogenously by mesenchymal tissue from the medullary cavity.
The above procedure can be done arthroscopically, with a planer cut, or under direct vision with an arthrotomy.
(2) After patellofemoral osteoplasty to cut away the diseased cartilage, the exposed bone can be covered by adjacent synovial membrane or by cutting a layer of fat pad and turning the suture to cover the exposed bone surface.
(3) Patellar resection can be considered in patients with older age, heavy symptoms, large exposed bone area (more than 3 cm) and greater wear of the relative femoral ankle cartilage, who cannot undergo patellofemoral osteoplasty.
V. Daily attention
1. Move the joints before exercise. Fully moving the joints before exercise can stimulate all parts of the patellofemoral articular surface, so that the synovial fluid nutrients can evenly penetrate into the cartilage tissue and enhance the lubrication of the joints.
2, avoid strenuous exercise to avoid continuous squatting and strenuous exercise, such as mountain climbing, stair climbing and other knee flexion position force exercise. Avoid sudden changes in the intensity of exercise, and increase the amount of strength and endurance activities gradually. Exercise with braces or knee pads
3. Maintain proper weight. Proper weight reduces the gravitational force on the knee joint, while obesity increases the risk of degenerative diseases of the knee joint, forming a vicious circle.
4, supplement cartilage nutrition more food containing vitamins, protein, such as fruit, vegetables, meat, seafood, etc..
5, pay attention to warmth and cold weather season, to keep the joints warm, to prevent wind and cold invasion.
6, timely treatment of knee discomfort or non-localized pain, take into account the possibility of early chondromalacia patella, rest and timely treatment to prevent aggravation of joint cartilage degeneration
7, pay attention to warmth and cold weather season, to keep the joints warm, to prevent wind and cold invasion.