A modern approach to the treatment of chondromalacia of the knee joint

Chondromalacia of the knee joint is a common disease of the musculoskeletal system. It accounts for 10-19% of cases of all degenerative-dystrophic diseases of the knee joint. Pathology is more common in young people.

Chondromalacia usually affects the patellofemoral joint. At first, the cartilage covering the posterior surface of the patella is destroyed in the patient. Subsequently, the pathological process extends to other parts of the knee joint, leading to the development of osteoarthrosis.

Chondromalacia is a pathological change in the articular cartilage lining the surface of the patella. It is characterized by thinning, softening and gradual destruction of cartilage tissue. When other parts of the knee joint are involved in the destructive process, the term “chondromalacia” is not used. In this case, they are already talking about deforming osteoarthrosis (gonarthrosis).

How effective is conservative therapy

The disease most often develops in athletes and people performing hard work. Therefore, when chondromalacia need to adjust the training regimen and limit physical activity. But this does not always help to defeat the disease.

The main factor provoking the development of chondromalacia is the instability of the patella. It leads to its hypermobility and trauma to articular cartilage. It is logical that fixing the patella in the right position slows down the destruction of cartilage, helping to avoid the development of arthrosis.

Activities to help stabilize the patella:

  • regular exercise to strengthen the quadriceps and medial broad muscles of the thigh;
  • tight elastic bandaging of the knee joint;
  • fixation of the patella using a brace or orthopedic apparatus.

The listed measures are sufficient to relieve knee pain that occurs during chondromalacia. However, they do not help inhibit the degenerative processes that occur in the cartilage, and the disease gradually progresses.

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Table 1. Drugs for the treatment of chondromalacia of the knee joint.

GroupRepresentativesAction and application features
NSAIDs
  • Diclofenac;
  • Ketolorak;
  • Ibuprofen;
  • Meloxicam;
  • Indomethacin
Non-steroidal anti-inflammatory drugs, have analgesic and anti-inflammatory effects. With chondromalacia they are often used in the form of ointments and gels. Tablets and injections are prescribed for intense pain
Chondroprotectors
  • Structum;
  • Alflutop;
  • Don;
  • Arthra
  • Teraflex
Drugs in this group stimulate the regeneration of articular cartilage. They slow down degenerative processes and prevent their spread to other parts of the knee joint. Doctors recommend the use of tablet or injectable forms of chondroprotectors. The effectiveness of ointments causes serious doubts among health workers
Hyaluronic acid preparations
  • Fermatron;
  • Gialgan;
  • Sinocrom
Restore the composition and structure of the synovial fluid, stimulate the regeneration of cartilage. Hyaluronic acid is injected directly into the joint cavity. This is often done after arthroscopy.

Surgical methods of treatment

Surgery is usually required for people with chondromalacia of the knee joint 2-3 degrees. Its main goal is stabilization of the patella with fixation in a biomechanically correct position.

Types of operations that are performed during chondromalacia:

  • diagnostic arthroscopy. Allows you to see degenerative changes in cartilage and establish the stage of the disease. During the manipulation, doctors can remove fragments of destroyed cartilage tissue and rinse the joint cavity. If necessary, surgeons mobilize the outer edge of the patella, thereby restoring its mobility and the function of the patellofemoral joint;
  • mobilization of the patella by myofasciotomy and arthrolysis. During the operation, doctors open the joint cavity and remove the fibrous adhesions there. Along with this, surgeons dissect a part of the muscles and tendons that interfere with the physiological movements of the patella. All this helps to restore the normal biomechanics of the knee joint;
  • corrective osteotomy. Used for chondromalacia of the 2nd to 3rd degree and arthrosis of the knee joint, which are accompanied by a violation of the axis of the lower limb. The essence of osteotomy is the excision of small fragments of the femur or tibia. This allows you to remove contractures and restore mobility of the knee. An osteotomy can be done open or closed (arthroscopic);
  • partial arthroplasty. Perform if massive osteoarthritis of the patellofemoral joint has developed. During the operation, doctors replace the destroyed part of the joint with an artificial prosthesis. Such surgery is more radical, but effective.

Arthroscopic treatment is increasingly combined with intraarticular administration of hyaluronic acid preparations. Such tactics neutralize the negative effect of leaching fluid on the condition of cartilage. Hyaluronic acid restores the normal composition and structure of the synovial fluid, preventing the degeneration of cartilage.

The appropriateness of rinsing the joint cavity during arthroscopy still causes controversy among doctors. But the diagnostic value of arthroscopic examination is beyond doubt. Today, manipulation is part of the preparation for surgery.

Cartilage Recovery Options

Since articular cartilage suffers during chondromalacia in a person, their restoration is a promising method of treating the disease. For this purpose, cell engineering techniques are used in medicine. Their essence lies in the cultivation of human chondrocytes with their further implantation under the periosteum. Such treatment is indicated for young patients with small (2-4 cm 2) defects in the cartilage lining of the joint.

Scientists are working on the creation of artificial cartilage that could be implanted into patients by arthroscopy. But the currently existing methods are imperfect, because of which they are not yet being introduced into clinical practice.

To restore cartilage, drugs from the group of chondroprotectors are used. These drugs act slowly and do not always meet the expectations of patients.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Shishkevich Vladimir

Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews. It specializes in the treatment of diseases in orthopedic, traumatological, vertebrological profiles

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