Diseases of Knee (In General)

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Many diseases of knee joint may be encountered from birth to death. We will just explain the most prevalent diseases and treatments in this section.

Congenital knee diseases

The most prevalent diseases are the shortnesses in quadriceps tendon and patella dislocations. Quadriceps tendon is short in both conditions. Therefore, patella will always be in dislocation position. Patella is in fixed position on the lateral side of knee in flexion and extansion movement of the knee. Early period exercise rarely provides better outcomes. Generally, the surgical lengthening of the quadriceps tendon is required. Knee joint must be treated seperately because knee dislocations are also present due to the absence of anterior cruciate ligament in fibular hemimelia, tibial hemimelia and PFFD.

Septic arthritis and osteomyelitis

The joint and bone infections generally settle on the knee joint and in the neighborings during the neonatal and childhood period. They develop with the settlement of bacteria through blood circulation. The primary symptoms are pain, fever and inability to move the knee. Then, the heat and swelling on joint region increases. The laboratory findings are particularly higher (leukocyte, CRP and sedimentation). The diagnosis is made by identification of the bacteria in the puncture. Surgery is performed in treatment to drainage the intraarticular purulent discharge.

Cartilage losses

One of the knee diseases which develop in adults. The disease emerges after sudden and serious trauma or repeated forced movements. The degree of cartilage loss may range from simple to severe. The most severe form is the total seperation of cartilage out of bone bedding; this is defined as osteochondritis dissecans (joint mice) .Hyaluronic acid injections may be used for treatment of simple damage to strengthen the cartilage and increase the lubricity on knee joint. However, the remedial period of injections may vary from person to person,but it is not over than 1 year. Different treatment methods may be used in more severe losses such as cartilage surface drilling(microfracture), cartilage transplant(mosaicplasty) and cartilage cell culture transplant(autologous chondrocyte implementation). The risk of damage to the patients is relatively low because those methods are performed using arthroscopy. Patients can maintain the daily activities in a short period.

Sports injuries

Sports injuries are more prevalent today due to the increase in number of people who like exercising and sports activities. The most frequent sports injuries are the meniscus ruptures and anterior cruciate ligament ruptures. Stitching back and repairing of meniscus is preferred for patients who are young and willing to continue their sports activites. Anterior cruciate ligament reconstruction, which is the process of generating a new ligament using patellar tendon or hamstring or autografts of the patient, is performed if there is an accompanying anterior cruciate ligament rupture. Both meniscus repair and anterior cruciate ligament reconstructions have fairly satisfying outcomes.

Fractures

The increase of urbanisation have increased the traffic accidents. The accidents may cause deaths and to the bone fractures which may lead to disabilities. The most frequent fractures are hip and knee fractures. The knee region includes the intraarticular and cartilage structures therefore, treatment of knee fractures may be difficult and problematic. A complete anatomic repairment must be obtained by opening the joint surface in knee fractures accompanying with cartilage injury. Then, the fracture region must be fixated tightly and early knee movements must be initiated. Otherwise, serious problems may develop in reunion of fracture and in the movement of knee joint.

Gonarthrosis

Gonarthrosis is the osteoartritis of the knee. The prevalence is higher than hip arthrosis both in Turkey and in the world. The knee joint is more prone to damage as being exposed to biomechanic loading compared to hip joint. Obesity(overweight) and inactive lifestyle(reluctance for exercising and sports) increase the damage on the knee joint. In addition, rheumatic diseases(rheumatoid arthritis), metabolic diseases(Gauncher), hematologic diseases(hemophilia) and post-traumatic defects of joint surface may cause gonarthrosis. The most common symptoms are pain, movement restriction and immobility. The degree of damage on the joint has vital importance for the treatment.

Total knee arthroplasty must be performed in case of complete damage on the joint. The damaged cartilage surfaces are replaced with metal implants and the patients can maintain the daily life activities with comfort because the pain is relieved. Unichondylar prosthesis may be preferred when one-half of joint is damaged and the other-half is unaffected. Because the aim is to relieve the pain and maintain the daily life activites of patient, the healthy cartilage structure will be preserved. Treatment may be possible without any need of prosthesis in patients younger than 60 years by providing rearrangement in the bone after cutting the bone. This method called high tibial osteotomy is preferred particularly in middle aged patients who like sports and have dynamic life style.