Cartilage Deterioration in the Knee Joint

The term refers to a pathology that occurs in the rib region and is characterized by gradual flattening, degeneration, and softening of the cartilaginous tissue. Over time, cracks and defects form in it. The onset of changes usually involves the deep layers within the matrix and collagen fibers. However, the aforementioned progressive changes also begin to appear on increasingly superficial structures of the knee joint. The effect of their prolonged presence is a marked decrease in the resistance to loading, which gradually reduces the destruction of the structure of the joint and its fibrillation, i.e., the absence of a breakdown of the bone. Source: hyalutidin. Rib chondromolacia most commonly occurs in young people between the ages of 17 and 30. This pathology is less common in men than in women. The disease has four stages of development, which according to the Outerbridge classification are as follows: - Stage I - flattening and softening (edema); - Stage II - cracks and fragmentation of incomplete depth (cracks < 1.25 mm); - Stage III - cracks of full depth (cracks > 1.25 mm) reaching the subchondral bone without exposing the bone surface; - Stage IV - defects exposing the subchondral bone.

There are numerous factors that contribute to the development of this disease, hence it is much more effective to classify them to present them in a more comprehensible manner. In this review, Jackson's classification is used, which pertains to the etiology of this disease.

A) acute: – direct injuries (fall or impact on the knee); – knee bone fractures; – knee joint dislocations; B) chronic: – cartilage-thigh conflict; – excessive lateral compression of the knee joint; – recurring subluxations or dislocations of the knee joint; – reflex sympathetic dystrophy; – high positioning of the knee; – disturbances in the meniscus area, resulting in impaired mobility and stability of the knee joint; – disturbances in the tension of the broad inner muscle; – disturbances as a result of a thigh bone fracture; – increase in the value of angle Q (encompassed between the anterior superior iliac spine, the center of the knee joint, and the tibial tuberosity.. The norm is approximately 15 degrees); C) other: – bowleggedness; – excessive body weight; – excessive activity of the thigh bone, which causes additional pressure on the knee; – flatfoot; – tall stature.

alkaptonuria; excessively prolonged immobility; recurring intracranial hemorrhages; primary degenerative alterations; repeated steroid reabsorption injections; rheumatoid arthritis; septic arthritis and ankylosis; inflammation of the synovial membrane.

The symptoms of chondromalation of the patellar cartilage provide a source of information for specialists who will eventually deal with the damaged knee joint. To diagnose degeneration of the patellar cartilage, the patient must feel pain in the anterior part of the knee. This pain will manifest during movement (e.g. long walking, walking up stairs) and during rest (e.g. prolonged sitting). The pain will spread diffusely and contribute to the disruption of the stability of the entire knee joint. Other symptoms of the disease include stiffness in the knee, cracking sounds in the knee joint during movement, and an inflammatory reaction leading to joint swelling. Over time, these symptoms can lead to weakening of the quadriceps muscles, limited range of motion, balance problems, and contractures.

The therapeutic methods for treating hip chondromalacia can be divided into two main strategies for dealing with this pathology. The first strategy is conservative therapy, which is most commonly used in the early stages of the disease. In this approach, pharmaceuticals such as non-steroidal anti-inflammatory drugs, metabolism stimulants, steroids, and agents that regulate and improve joint metabolism are mainly used, as well as physiotherapy, which is based on exercise and physical procedures. In addition, orthopedic methods such as splints and other devices for rapid joint reloading are also applied. The second treatment strategy is surgical therapy, which is only applied when the extent of the structural changes in the joint cartilage, as well as the disturbances in joint function and the character of the accompanying discomfort, are very significant and lead to impaired daily functioning of the patient or the previous conservative treatment has not achieved the desired result. The most commonly used surgical method is arthroscopic chondrektomy in the hip joint, which involves the complete removal of the diseased joint cartilage fragments and the leveling of any deviations in its structure.

Similar to other diseases of the motor system, physical therapy also plays a significant role in the pathology of the knee joint. The goal of physical therapy is not only prevention and treatment of milder forms of this disease, but also restoration of full mobility after possible surgical procedures. The methods used in physical therapy have various functions during the treatment of chondromalacia. The use of a magnetic field accelerates the process of bone growth and reduces pain, while the application of light and electrical impulses can further enhance the pain relieving effect. Cryotherapy can also be a good preparation for walking training after surgery, due to its detonizing properties and strong pain relieving effect. Kinesiotherapy, understood as therapy with movement, aims to restore normal mobility of the knee joint, lower limb, and the whole body.