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Illness of Keniga (The dissecting osteochondrosis of joint surfaces)
The illness of Keniga, or the dissecting osteochondrosis of coxofemoral and knee joints – one of types of an osteochondropathy, a disease is characterized by subcartilaginous necrosis of a site of a joint surface of a bone with its further separation from a cartilage. In the course of department the osteoarticular fragment gets into a joint cavity, forming a so-called "joint mouse", her sizes can fluctuate from a prosyany kernel to the haricot sizes.
For the first time this disease of a knee joint was described by the German surgeon Franz Kenig, according to his assumption the injury is an origin of pathology. After carrying out a number of researches the hypothesis claiming about genetic predisposition to this disease was made. The exact reasons of development of the dissecting osteochondrosis are not known yet, but allegedly the disease arises owing to hereditary features in a structure of joints, endocrine frustration, the small repeating injuries, a deep vein thrombosis. These factors lead to disturbance of blood supply of a bone tissue in a joint, and under a cartilage there is a center of a noninfectious necrosis. Necrosis of a site of osteoarticular fabric leads to formation of blood clots in vessels that worsens blood supply even stronger and promotes rejection of part of a bone tissue.
The dissecting osteochondrosis most often affects area of a knee joint. Less often coxofemoral, beam, talocrural and elbow joints suffer. The disease aged from 15 till 35 flyings develops, but it can be observed both at children, and at people of old age. More often men, than women are ill that is connected with more active and traumatic way of life.
Diagnosis and symptoms of an illness of Keniga
The disease proceeds is rather long without explicit clinical manifestations. In many cases of a course of a disease owing to an injury its symptoms perceive as traumatic damages. In rare instances there can be an acute beginning of a disease directly right after an injury, more often symptoms accrue gradually after a while after damage.
On increase of symptoms the illness of Keniga has four stages of development. The disease by means of X-ray inspections is diagnosed. If necessary for specification of a stage of an illness carry out a computer and magnetic and resonant tomography, ultrasonic research. In difficult cases the arthroscopy at which by means of an artroskop through small cuts the internal surface of a joint is investigated is applied.
The first stage of a disease is shown by weak clinical symptoms. Most often symptoms of an illness of Keniga consist in feeling of discomfort and easy morbidity in a joint at load of it. At diagnosis on the roentgenogram the center of a necrosis of a wedge-shaped or oval form is observed.
At the second stage at load of a joint of pain are shown stronger, puffiness appears. Pains amplify when bending a knee joint, walking, at palpation. On the roentgenogram the necrosis site is accurately visible.
At the third stage rejection of a devitalized site begins to happen. The osteoarticular fragment leads not completely separated to a joint contracture. When diagnosing it is possible to see a shadow of not separated site.
The dissecting osteochondrosis of the fourth stage is characterized by strengthening of pains and inflammations. In this phase of a disease the nekrotizirovany site is completely torn away in a joint cavity. Migration of a joint mouse also leads to strengthening of symptoms. At diagnosis the intra joint body is well visible. Muscular and joint dysfunction is often observed, the joint ceases to move, and muscles will gradually atrophy.
Treatment of an illness of Keniga
At early stages of a disease conservative treatment of an illness of Keniga is applied. Medicines the improving blood supplies of joints, exchange processes in a bone tissue regenerating a bone tissue and others are appointed. Completely unload on the injured joint, walking on crutches within two months then if there are no such symptoms of an illness of Keniga as pain and puffiness apply massage, remedial gymnastics, electromagnetic stimulation is for this purpose appointed. Conservative treatment lasts about 1-1,5 years.
At later stages or at high loadings, for example at athletes, carry out surgical treatment of an illness of Keniga. During operation the nekrotizirovany site and the separated fragment is removed, stimulation of recovery of a cartilaginous covering of a joint is carried out.
Operations with use of arthroscopic equipment the least traumatic. After removal of a joint mouse the cavity of a joint is filled with special structure which promotes an angenesis.
Section: Orthopedics and traumatology