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Koenig's disease (loose bodies of the knee joint)

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Koenig's disease (dissecting osteochondritis) - the separation of a small area of cartilage from the adjacent bone with its displacement into the joint cavity. The disease is more common in men, twice as common as in women.

In principle, there are juvenile (child and adolescent) and adult forms of the disease. The juvenile form is well treated and gives excellent results, while the adult form is more difficult to treat and gives worse results. Juvenile occurs in children older than five years, more often at the age of 11-18 years. The adult form can occur up to 50 years of age (later-extremely rare).

What are the symptoms of Koenig's disease?

The manifestation of the disease depends on its stage and location.
There are four stages of the disease.

At the first, initial stage of the disease, the cartilage at the site of the disease becomes softer, but it does not have clear boundaries. The second stage is characterized by the appearance of distinct boundaries of cartilage damage, but the cartilage remains stationary.
In the third stage of the disease, the fragment of cartilage already moves a few millimeters relative to the underlying bone, but remains connected to it, and in the fourth stage of the disease, the fragment of cartilage and subchondral bone completely peels off and begins to move freely in the joint cavity.

At different stages of the disease, there is a dull, aching pain that can increase with exertion, movements. There is an effusion in the joint, i.e. a large amount of synovial fluid. This condition is called synovitis. In the early stages of Koenig's disease, it is very difficult to determine the cause of the pain. If there is a separation of the cartilage, then the free intra-articular body can serve as a mechanical obstacle to movement – there may be blocks in the joint, restriction in movement, sharply increasing pain in a certain position. Since there will be a bare bone in the place of the separated section of cartilage, the joint will continue to be inflamed, which is manifested by edema (synovitis).

Diagnostics

Only an orthopedic surgeon can diagnose Koenig's disease. In the early stages of the disease, there are no specific signs of the disease, so additional instrumental research methods are needed. At the fourth stage, you can determine the intra-articular body, but this is not the fact that it will indicate Koenig's disease.

To accurately determine the diagnosis, it is necessary to perform X-ray diagnostics and magnetic resonance imaging (MRI). It should be noted that only an MRI examination will help to identify areas of necrosis in the early stages . Ultrasound and other methods are uninformative in this pathology.

Treatment

When the diagnosis is confirmed, the treatment depends on the age and state of health of the patient. In young patients with unclosed growth zones (usually younger than 20 years), conservative treatment is quite often successful. Its principle is to give rest to the joint, which will lead to the regression of the disease.

The main method of treatment in patients over 20 years of age continues to be surgery. Koenig's disease is best treated by arthroscopy. The advantage of arthroscopy is that the joint does not open completely during the operation.

What if Koenig's disease (dissecting osteochondritis) is not treated?

The probability of developing osteoarthritis is very high, despite adequate and timely treatment. Depending on the location and size of the free bodies, arthrosis develops in 5-40% of cases.

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