Treatment of knee dysplasia in adolescents. Is knee dysplasia guaranteed to be cured?
Fibrous dysplasia is a disease characterized by systemic damage skeleton, in which healthy bone tissue is replaced by connective tissue. The main factor in the development of the disease is a gene mutation, but clinicians identify many other sources of the disease, which may differ depending on the form of its course.
The disease is characterized by pronounced clinical picture, in which, in addition to external deformations, pathological fractures also predominate.
Put correct diagnosis perhaps based on symptoms, but main role play instrumental examinations, in particular MRI. Treatment in all cases involves surgery.
Etiology
Today, the main causes and mechanism of the disease remain incompletely understood. However, clinicians believe that the source lies in gene mutations and anomalies of intrauterine development.
Clinicians believe that the following predisposing factors play an important role in the formation of the disease:
- hormonal imbalance;
- significant disturbances in the formation and development of cartilage and bones;
- pathologies of muscles and ligaments that articulate joints;
- genetic predisposition;
- poor nutrition expectant mother - this includes the lack of fresh vegetables and fruits, as well as other foods enriched with vitamins and nutrients;
- addiction to bad habits and unfavorable conditions environment, affecting female body during pregnancy;
- exacerbation of chronic ailments or previous severe infectious diseases during the period of bearing a child;
- uncontrolled use of certain medications during pregnancy;
- influence of toxic or chemicals on the body of a pregnant woman;
- the expectant mother has gynecological problems that are directly related to the uterus;
- heavy ;
- oligohydramnios.
It follows from this that the main risk group is children, but there are cases when a similar disease was first diagnosed in an elderly person. It is noteworthy that in female representatives this pathology is diagnosed several times more often than in the stronger half of humanity.
Classification
In children and adults, there are several main forms of fibrous dysplasia:
- monoosseous– characterized by damage to only one bone, and symptoms can appear at any age;
- polyostotic– differs in that the pathology involves several bones, for example, the hip or shoulder, but only on one side of the body.
Today, Zatsepin’s classification is widely used, which involves dividing the disease into:
- intraosseous dysplasia– can occur in both monoostotic and polyostotic forms. During microscopy, the presence of focal formations, but in some cases fibrous tissue can affect the entire body of the bone. However, in patients with this type of disease there is no expression of bone deformities;
- total damage– differs from the previous type in that all layers of the bone are affected, which causes the development of bone deformations, and this, in turn, leads to frequent fractures. Based on the name, it becomes clear that this type of disease occurs in a polyostotic form, and the tibia and femur are most often affected;
- tumor form– in all cases leads to growth fibrous tissue. This type of disease is extremely rare;
- Albright's syndrome– most common form, which is diagnosed among children. The pathology progresses rapidly and is rapid in nature;
- fibrocartilaginous type– differs from other types of disease in that in almost all cases it turns into a malignant form;
- calcifying form- this special shape The disease is diagnosed quite rarely.
The localization of the disease may also differ; most often the pathology involves:
- tibia and fibula;
- ribs and spine;
- bones of the jaw and skull;
- knee joint and humerus.
Fibrous dysplasia of the skull bones has its own classification and can be:
- sclerotic– characterized by the formation of areas of pronounced restructuring of bone tissue, which causes its compaction. Most often such changes are observed at the base of the skull, nasal bones, frontal and maxillary bones;
- cyst-like– often amazes mandibular bone. Cyst-like neoplasms can be multiple or single
- paget-like– deformation of the skull occurs when and is expressed in a significant increase in the volume of the cerebral region of the skull.
Symptoms
The clinical manifestations of the disease will differ somewhat depending on the location of the pathological process.
Fibrous dysplasia of the tibia has the following clinical manifestations:
- shortening of the femur;
- pathological fractures;
- tibial fractures;
- lameness while walking.
Fibrous dysplasia of the knee joint is expressed in:
- pain, the intensity of which increases under the influence of heavy physical activity or with a sudden change weather conditions;
- characteristic crunching of joints during flexion and extension movements of the knee;
- changing the shape of not only the joint, but also the kneecap;
- partial or complete change in the shape of the lower extremities;
- increasing knee mobility.
Fibrous dysplasia of the jaws is characterized by:
- thickening of the lower or upper jaw;
- facial deformation;
- slow process of puberty.
Fibrous dysplasia of the skull bone leads to the following symptoms:
- malformations of teeth;
- reduction of the cranial cavity;
- overhang of the cerebral part of the skull over the facial part;
- change in the volume of the paranasal sinuses;
- deformation of the first vertebra.
Often this type leads to dysplasia hip joint and spine, which leads to various violations posture.
In cases of pathology localization in humerus, impaired mobility of the affected upper limb comes to the fore.
Albright syndrome has the most pronounced symptoms, including:
- dysfunction endocrine system;
- premature puberty in girls;
- violations of the proportions of the body;
- pigmentation skin focal nature;
- severe bone deformities.
In addition, this form similar disease very often accompanied malfunction internal organs and systems.
Diagnostics
An experienced doctor will be able to make the correct diagnosis based on the presence specific signs. Primary examination should include:
- a detailed survey of the patient necessary to determine the first time of onset and intensity of symptoms;
- studying the medical history and life history - to search for a predisposing etiological factor;
- a thorough physical examination of the affected area, palpation and percussion.
Diagnosis of fibrous bone dysplasia does not include laboratory tests blood, urine and feces, since they have no diagnostic value.
Among the instrumental diagnostic methods it is worth highlighting:
- radiography;
- densitometry;
- CT and MRI.
Treatment
Application conservative methods in most cases does not provide therapy positive results, why after establishing final diagnosis An operation is prescribed for an adult or child.
Treatment of fibrous dysplasia is carried out:
- osteotomy;
- resection of the affected area of the bone followed by replacement with a bone graft;
- lengthening of the bone - only in cases of shortening.
Polyostotic fibrous dysplasia may limit the possibility of surgical therapy. In such cases, treatment will include:
- wearing orthopedic shoes and other devices that reduce the load on bones and joints;
- passing the course therapeutic massage;
- physiotherapeutic procedures;
Prevention and prognosis
Since the mechanism of development of the pathology is unknown, in order to avoid the development of such a disease, it is necessary to follow the general rules:
- lead healthy image life during pregnancy and do not miss visits to the obstetrician-gynecologist;
- follow safety rules when working with hazardous substances;
- eat properly and balanced;
- maintain normal body weight;
- eliminate the influence of excessive physical activity on the most common locations of pathology;
- regularly undergo a complete medical examination.
The outcome of fibrous dysplasia is often favorable; only the polyostotic form can lead to severe crippling deformities. Complication in the form of formation benign neoplasm observed in 4% of all cases, and malignancy – in 0.2%.
Dysplasia of the knee joint is a violation of the normal structure of the connective, bone or muscle tissue resulting in malalignment of the kneecap or any other change in the configuration of the knee. In newborns, the pathology occurs with a frequency of 6:1000.
Congenital dysplasia most often occurs due to exposure to teratogenic factors in the so-called critical periods fetal development. Often the reason is premature birth, complications during pregnancy or genetic predisposition. In this case, the child is born with underdeveloped tissues of the knee joint. The pathology may appear immediately after birth or much later, in adolescence.
Teratogenic factors can be:
- Poor nutrition, abuse of alcohol and cigarettes;
- Inflammatory diseases or viral infections suffered during pregnancy;
- Taking medications that have a teratogenic effect (for example, tetracycline antibiotics);
- Exposure to the body of poisons, toxins, harmful environmental factors;
- Toxicoses of pregnant women or other factors.
In adults, dysplasia can develop after injuries, untimely treatment arthritis and arthrosis, adverse effects factors external environment. Sometimes the triggers are bad habits, lack of vitamins and minerals in the diet, occupational hazards. It should be noted that dysplasia is congenital disease, which can manifest itself both immediately after birth and during mature age under the influence of provoking factors. It is impossible for them to get sick.
Symptoms
X- and O-shaped leg deformities.
Dysplasia of the knee joint can manifest itself as a violation of the structure of any of its structural elements (bones, cartilage, ligaments, bursa, etc.). This leads to deformation and/or displacement of the patella, articular surfaces tibia and femur, narrowing of the joint space and even bone fusion. Clinically, dysplasia is manifested by a visible change in the configuration of the joints.
Typical symptoms of pathology:
Diagnostics
Quite often dysplasia knee joints in children it is confused with other diseases that cause deformation of the knee joint and/or displacement of the patella. Therefore, pathology must be distinguished from the following diseases:
- Subluxation of the knee joint is a partial displacement of the articular surfaces of the femur and tibia. Most often it occurs due to injury, much less often it is congenital. The causes of knee subluxation are most often excessively active sports, falls, cycling, road accidents, and genetically determined weakness of the ligamentous apparatus. Pathology is NOT characterized by changes in tissue structure.
- Patellar displacement is a movement of the kneecap from its normal position. Develops as a result of injuries, sprains, and certain diseases musculoskeletal system. The pathology is characterized by instability and increased mobility of the kneecap.
- Habitual luxation of the patella. Occurs in people who have previously experienced traumatic dislocation. The pathology is characterized by frequent displacement of the kneecap, which occurs with a slight bruise, fall, playing light sports, or a sudden movement while performing habitual housework.
For everyone traumatic injuries characteristic sharp pains, swelling and swelling in the knee joint. People also complain of redness of the skin and local increase temperature, severe difficulty walking, limitation of movements in the affected limb.
Treatment
In infants, dysplasia of the knee joints is treated conservatively, and in children over two years of age it is often recommended surgery. Timely restoration of the proper functioning of the joint allows the child to return the ability to move normally and live a full life.
What does a knee brace look like?
To prevent and correct joint deformation, special devices are used - clamps (these include orthoses, splints, splints, knee pads, hinges and bandages). All of them fix the limb in the desired position. In some cases, instead of orthoses, a plaster cast is used, which is worn for 3-4 weeks, after which it is removed or replaced with a new one.
Dysplasia is a pathology of tissue development or formation. In children, knee dysplasia can be detected immediately after birth or appear during adolescence. This disease is a violation of the position of the kneecap, which is accompanied by pain.
Knee dysplasia in adults is caused by wear and tear of the cartilage in the kneecap area.
Cause of structural abnormalities of the knee joint
In newborn children, the disease is caused not only by impaired development of the cartilage and bone structure, but also by pathology of the muscles and ligaments adjacent to the joint.
In infants congenital pathology This type of disorder occurs quite often - 6 cases per 1000 children. Treatment of knee dysplasia in children should be carried out in mandatory, otherwise there is a risk of disability at an early age.
Factors that provoke the occurrence of dysplasia may be the following:
- hereditary predisposition;
- genetic changes;
- poor nutrition, exposure to medications, toxic compounds, chronic and infectious diseases of women during pregnancy.
In adults, dysplasia can occur due to the following reasons:
- exposure to toxic compounds and aggressive reagents;
- occupational diseases;
- unfavorable environmental factors;
- abuse of bad habits.
Anatomical structure of the knee
It is impossible to understand what joint dysplasia is if you do not understand its anatomical structure.
The knee joint consists of the epiphyses of the tibia and femur. Outside it is covered with synovial membrane, inside - menisci and cruciate ligaments. Menisci are spacers cartilage tissue, acting as shock absorbers.
Stable functioning is ensured by articular ligaments. Together with the menisci, the lateral ligaments increase resistance to stress and prevent laxity in the horizontal direction.
The front surface of the knee joint is protected by a kneecap - the kneecap. It is connected to the quadriceps tendon. The kneecap is moderately mobile.
Flexion of the knee is ensured by soft tissue elements: the muscles of the thigh and lower leg, the joint capsule and tendon ligamentous apparatus:
- the quadriceps muscle is attached to the tibia;
- sartorius muscle - connects the tibial tuberosity to the patellar ligament.
The remaining muscles of the articulation on the side of the thigh:
- adductus magnus;
- quadriceps;
- medial;
- lateral.
From the side of the lower leg: calf and popliteal.
Symptoms of knee dysplasia
Asymmetry of the knee joints. Visually, the legs seem to be longer than the other, the kneecaps in a vertical position are located on different heights, if the legs are straightened on a horizontal surface, then one cup also appears higher than the other.
You may suspect knee joint dysplasia if visible signs no, but the child begins to walk late and stands on his toes. In addition, a pathology in the structure of the knee may be indicated by inverted toes—outward or inward.
Dysplasia can appear in adolescents or adults. First complaints - severe pain, which occur while driving with increasing load, are associated with weather changes. During flexion and extension, a crunching sound is heard in the knee joint.
The clinical picture - a change in the configuration of the joint, incorrect location of the patella, deformations of the lower extremities - O or X-shaped - are visible visually.
Lameness appears, the volume of the thighs and lower legs changes. Now they differ in circumference - right from left - by several centimeters. Depending on how pronounced the deformation is, the degree of dysplasia is diagnosed.
With changes in the connective tissue and dysplasia of the knee joint, excessive mobility and laxity are revealed in it, and the range of motion increases.
Separately, it is necessary to highlight fibrous dysplasia of the knee joint. It is close in structure to an oncological neoplasm, although it is not one. Fibrous dysplasia is a disease of bone tissue in which bone tissue is replaced by fibrous tissue, resulting in periodic fractures and slower bone growth in length.
It is impossible to develop dysplasia of the bone and connective tissue of the knee joint. This is a congenital pathology, which - if it is expressed to a minor extent - may not manifest itself for a long time, but then it will definitely come to light.
Treatment methods for dysplasia
The earlier the disease is detected, the greater the guarantee that the deformity can be corrected. Treatment starts from the very beginning early age and, depending on the severity of the disease, includes many therapeutic measures.
At home, orthopedic devices are selected for the baby - orthoses: turgors, splints, special bandages. They fix the joint in the desired position.
Sometimes, to correct the curvature, plaster casts are applied, which are constantly changed as the child grows - usually this needs to be done once every 3 weeks, babies grow quickly.
Massage procedures and therapeutic exercises are required.
In adults, exercise therapy not only corrects deformities, but also strengthens the leg muscles that hold the joint in the desired position.
Physiotherapy is of great importance. Medicines penetrate deeper into the joint during the procedure of electrophoresis and phonophoresis. Thermal applications and mud wraps are used, ultrasound and magnetic laser therapy are used.
If dysplasia develops gradually in adults, drug therapy may be required.
To improve the tissue structure, the following drugs are injected into the joint:
- calcium preparations;
- chondroprotectors;
- vitamins;
- hyaluronic acid.
In case of pain, painkillers are used, such as local application, and in the form of injections and tablet forms. Sanitary resort treatment accelerates the recovery process - resorts with balneological procedures are recommended.
IN acute form disease, the damaged joint must be completely unloaded; it is advisable to use a cane or crutches when walking.
The disease, dysplasia of the knee joint, is congenital and is associated with impaired or abnormal development of bone tissue. Therefore, it is more often diagnosed in infants, but sometimes it manifests itself in older children, and even in adults. It is the age and degree of changes that affect the choice of treatment methods.
General characteristics and causes of the disease
Disturbances in the formation of the skeleton can occur at any stage of human development. Pathologies that arise in the prenatal stage are considered especially dangerous.
Pawned skeletal system in the embryo at 6–8 weeks. And that's it negative influences may affect the formation bone structures. Failure occurs not only at the beginning of formation, but also during the development of the fetus. Against the background of knee joint dysplasia, problems with the formation of cartilage, connective and muscle tissues may occur.
By the time of birth, the baby's skeleton is fully formed, but growth continues. Therefore, pathology may appear later. If the underlying growth cells are already abnormal, the risk of developing knee dysplasia continues into adolescence.
There is also a possibility of developing secondary or acquired diseases, which is more often diagnosed with dysplasia of the knee joints in adults.
Primary or congenital dysplasia of the knee joint is most often associated with:
- with a genetic predisposition;
- with related marriages.
Both on the development of the skeleton in the prenatal period, and on growth, degeneration bone elements may also affect
External factors in the form:
- working conditions in hazardous conditions;
- poor environmental conditions in the place of residence;
- single or prolonged exposure to poisons, heavy metals and other toxins, radiation;
- food culture and eating habits.
Secondary pathologies are much less common. Therefore, you can hear the opinion that knee dysplasia is exclusively a congenital disease.
How does knee dysplasia manifest?
The presence of dysplasia in a newborn is indicated by different lengths of the legs. This is visually noticeable even in a horizontal position of the baby, when the patella on one leg is located slightly higher. To detect a developmental defect, the child is recommended to be examined by an orthopedist as early as two months, who, after conducting certain tests, will be able to detect congenital anomalies development. 
However, there may be no visible signs, and the disease is discovered much later. The way you move will tell you about improper knee development. The child does not begin to walk for a long time compared to his peers, but takes his first steps by stepping on his toes. By the way, the fingers themselves can be twisted, the knee joint can be hyperextended in an unnatural direction, that is, forward.
Pathology of knee development also appears in adolescents. They begin to complain of knee pain. More often painful sensations appear after exercise or may be associated with changes in weather conditions. Clicking or crunching sounds are heard in the joint itself when flexing and extending.
Clinically there is a change appearance knee The kneecap is positioned unnaturally, and the limbs themselves are deformed.
May be observed different shape location of deformed legs:
- Varus deformity resembles an O-shaped deformity. By bringing the child’s feet together, you can see their divergent different sides knees.
- Hallux valgus is similar to an X-shape. In this case, even with the knees closed, it is impossible to place the feet together, since the bones diverge in different directions in the knees.
If the pathology involves connective tissues, the patella itself is unstable, dislocations and displacements can be observed, which without treatment can develop into habitual dislocations of the patella. The gait becomes unsteady, and lameness may appear.
Fibrous dysplasia stands out separately, which, due to its structure, is often confused with oncological pathology. This form of the disease affects specifically bone tissue, which is replaced by fibrous. With such a disease, pathological causeless fractures may occur at the site of developmental anomalies. The bone itself may stop growing, which will manifest itself as a shortening of the limb in length.
With dysplasia there may be a long latent period, when the defect is expressed slightly. But in adulthood, against the background of dystrophic or inflammatory diseases knee pathology will still manifest itself.
Video
Video - Gymnastics for a child with knee dysplasia
How is knee dysplasia treated?
Selects therapeutic and diagnostic measures pediatric orthopedist. Less commonly, therapy is performed by a surgeon. For dysplasia of the knee joint, surgery is suggested when all conservative treatment resources have been exhausted and have not yielded results.
Therapy begins with restriction physical activity on your knees. To do this, it is recommended to immobilize the joint. The patient is recommended to wear a knee brace or a special orthosis.
For infants, special orthoses are selected that fix the knees in a certain position. Infants are often given a cast, which has to be changed as the child grows. Since babies grow quite quickly, the cast is replaced every 2 or 3 weeks.
Exercise therapy must be prescribed in rehabilitation period. Therapeutic exercise necessary for general development child, as well as for local exposure. It is thanks to specially selected exercises that you can improve the trophism and functionality of the ligamentous apparatus of the knee and muscle strength. The complex is selected individually by a physical therapy instructor. Mechanotherapy can also be carried out, in which the effect is directed specifically at the osteoarticular joint.
A child or adult is recommended to undergo several courses of knee massage, involving the thighs and lower legs. This method not only helps improve blood flow in the knee area and muscle endurance, but also reduces pain and removes contractures.
The course of therapy may be supplemented by:
- Physiotherapeutic procedures such as magnetic or laser exposure , EHF, USV. Mud, paraffin, ozokerite applications. To reduce pain, EPH can be performed with painkillers.
- Medication prescriptions. The doctor may prescribe painkillers, vascular agents to improve blood flow. Sometimes prescribed vitamin complexes and chondroprotectors.
- Treatment in a specialized sanatorium, where the joint is affected according to proven schemes, including physiotherapy, massage, exercise therapy, hydromassage, spa treatments, balneotherapy.
It is advisable to begin correction immediately when developmental deviations are detected. This allows you to increase the likelihood of a successful outcome significantly. If available methods Conservative therapy does not help restore normal functionality of the joint, resorting to osteotomy. During such an operation, the deformity is eliminated and the limb is lengthened.
When it is impossible to correct the developmental defect, the patient is offered endoprosthetics. Such cases are rare, but they still exist. For such patients, joint replacement is the only way to avoid disability.
What is joint dysplasia? This is not a disease, but a condition of bone and cartilage tissue that develops in a person as a result of various pathologies. Most often, this condition is congenital, but there are cases where dysplasia developed after birth.
Dysplasia is a pathology of tissue development. If it occurs after birth, then in some cases it is considered a precancerous condition.
Joint dysplasia is irregular structure or development Underdeveloped tissue makes joints excessively mobile.
The most common is dysplasia or dysplasia. Some experts believe that the pathology of the hip joint in most cases is congenital, and the pathology of the knee joint is acquired. However, not all experts agree with this opinion.
What is knee dysplasia? This is an extremely painful, very unpleasant condition that occurs in people as a result of the fact that the kneecap no longer matches the shape of the grooves into which it should fit. This discrepancy causes severe pain, the bones wear out and take on an irregular shape, which makes it difficult for the knee to move in the joint.
Dysplasia of the knee joint can affect different areas: the growth zone of the bone, the ligamentous apparatus, joint capsule or intra-articular cartilage. Depending on which area is affected, certain deformities develop. It is known that varus (arched) or valgus (change in length) deviation (pathology) can cause curvature of the legs in the shape of the letter “X” or “O”.
Dysplasia of the knee joint. Causes of pathology
Today it has been established that the pathology can be caused by:
- hereditary predisposition;
- postpartum or birth injuries, malpresentation fetus;
- hormonal imbalances in women;
- injuries;
- overweight.
Usually any dysplasia causes severe pain. When diagnosed with knee dysplasia, changes in the joint can be seen during a routine examination.
Although patients are usually sent to surgeons, treatment is carried out by orthopedic doctors.
Treatment of dysplasia, like every disease or disorder, begins with research. The doctor should prescribe an ultrasound of the joint and x-ray images of it.
Treatment methods depend on the form and degree of development of the disease. Usually prescribed:
- massages. The course must only be taught in medical institutions and repeated many times;
- physical therapy. Certain exercises can strengthen your joints. Important: professional sports with dysplasia are prohibited:
- physiotherapy;
- drug treatment;
- surgical intervention. Held in extreme cases. Sometimes doctors can completely replace a joint by installing an artificial one in place of the damaged one.
As mentioned, dysplasia can be congenital or acquired. Regardless of this, lack of treatment leads to the same complications. The most unpleasant and dangerous of them:
- severe pain in a deformed joint;
- gait disturbance;
- pathological changes in the spine.
Prevention of dysplasia
When swaddling a newborn, it should be remembered that tight wrapping leads to and, as a result, an increased risk of dysplasia.
Adults should monitor their weight and carefully control hormonal background(especially women). It is very important to exercise and be regularly examined by medical specialists.
