Recently, the weather in Beijing has turned cooler, and we met many white-collar workers in the clinic who complained of vague pain in the knees and weakness in the legs, especially difficulty in going up and down stairs. On the way to work, she fell down on her knees and couldn’t stand up for half a day, and was diagnosed with “chondromalacia patella” after examination and radiography.
The patella is often referred to as the kneecap. The cause of patellar chondromalacia is due to repeated flexion and extension and twisting of the knee joint, which causes the joint surfaces to constantly bump and rub against each other, causing abrasive damage over time. It is also believed that this disease is related to endocrine, arteriosclerosis in the elderly and insufficient local blood supply, which also causes this disease.
Autumn and winter are the seasons with a high incidence of chondromalacia patellae, athletes, mountaineers, dancers, factory sand turners, coal miners and other people with a high incidence of this disease, with an incidence of 36.2%. The incidence of chondromalacia patella is higher in women than in men.
When suffering from chondromalacia patella, knee pain or weakness is felt, most obviously when going up and down stairs, especially when going downstairs is the most difficult, and the symptoms disappear after rest and worsen with activity.
Due to the unevenness of the patella, when the disease occurs, a crisp sound will be emitted under the patella after a little activity and then it will be able to move again. If left untreated at this point, the lesion may spread to the entire knee joint, resulting in atrophy of the knee muscles, thinning of the thighs, and swelling of the knee joint with fluid accumulation.
Remind patellar chondromalacia patients: usually let the affected area rest and keep warm, because wind, cold and humidity can aggravate the symptoms; try to avoid strenuous exercise; in the acute stage, bed rest should be used; under the guidance of a doctor, local hot ironing can be used with Chinese medicine; some pain medications can be taken orally to reduce pain symptoms. Do self-massage frequently.
To prevent the disease, we must first avoid acute and chronic soft tissue injuries at the knee joint, especially when lifting heavy objects, and be more careful when working in a semi-squatting position or standing up with a lot of weight on your back, and pay attention not to work for too long.
Causes of chondromalacia patellae
1, mechanical joint injury: occupations with heavy joint loads, such as drivers, teachers, white-collar workers, etc., their joints remain in a rigid position for a long time or are subject to strong impact for a long time, resulting in bone and joint injury.
2, joint overuse: long-term repeated use of certain joints can cause an increase in the prevalence of these joints, such as miners’ knees and elbows; drillers’ elbows and metacarpals; baseball players’ shoulders and elbows; soccer players’ ankles, feet, knees, etc.
3, obesity: excess weight increases the burden on the joints, but also due to posture, gait changes on the biomechanics of the joints have an impact.
4, women before and after menopause, may be related to estrogen reduction.
The auxiliary examination methods for this disease are mainly physical examination, X-ray examination and radionuclide examination.
1, patellar compression and grinding test: during the examination, 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 painful discomfort; or the examiner forcefully pushes the patella to one side with one hand and presses the thumb of the other hand behind the edge of the patella can cause pain. The floating patella test can be positive when there is joint cavity effusion.
2, single-leg squat test: the patient holds the weight on one leg and gradually squats to 90° to 135° with pain, tenderness, and cannot stand up on one leg after squatting.
3.X-ray examination: frontal and lateral x-ray of the knee joint and tangential x-ray of the patella, no abnormalities in the early stage, but in the late stage, the gap between the patella and the femoral condyle may be narrowed due to wear of the cartilage, and there may be osteophytes at the edge of the patella and the femoral condyle.
4. Radionuclide bone imaging shows limited radioactive concentration of the patella in lateral position, which has early diagnostic significance.
The treatment of this disease includes non-surgical treatment and hand-like treatment of two kinds.
1, non-surgical treatment.
For those with mild symptoms, attention should be paid to avoid direct impact on the patella and reduce patellar friction activities, such as walking up and down hills, going up and down stairs, cycling and other activities, and symptoms can be expected to be reduced. Local heat physiotherapy can be used to strengthen the quadriceps exercise, oral pain medication.
2.Surgical therapy.
Those with more severe symptoms should be operated in a timely manner, and appropriate treatment should be made according to the lesion of the patella.
Patellar cartilage cutting: including 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. After superficial cutting, although the cartilage repair ability is very weak, but after cutting away the erosion cartilage, after several months of shaping, the surface becomes smooth and covered with several layers of flat cells, so that the operation can achieve more satisfactory results.
(2) Cartilage cutting to bone.
If the cartilage damage has reached the bone, the whole cartilage can be cut, and the edge of the wound can be trimmed to make a beveled surface, and the exposed bone will not be 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.
(3) Cartilage cutting to bone and drilling.
The full cartilage of the lesion is cut away, and the exposed bone is drilled with several holes with a keratome needle, causing bleeding in the bone bed, and the full defect of articular cartilage deep to the medullary cavity can be 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.
Patellofemoral osteoplasty: After cutting away the diseased cartilage, the exposed bone can be covered with adjacent synovial membrane or by cutting a layer of fat pad and turning the suture to cover the exposed bone surface (2 to 3 cm).
Patellar osteotomy: If the patient is older, has heavy symptoms, has a large exposed bone area (more than 3 cm), and the relative femoral ankle cartilage is worn out, and patellar osteotomy cannot be performed, patellar osteotomy can be considered.