The most common presentation of osteoarthritis of the knee joint (UAC) is the involvement of the tibiofemoral joint, the space between the femur and the calf.
These are the two surface areas that contain the most hyaline cartilage inside the knee.
As mentioned earlier, hyaline cartilage is the “harder” of the two types of cartilage in the knee. Hyaline cartilage covers the ends of the long bones inside the joint, and the fibromatic, softer, more flexible cartilage is represented by the medial and lateral meniscus of the knee. It is a semicircular piece of cartilage that provides additional protection for hyaline cartilage when it comes to absorption, sliding and rotation.
UAC symptoms usually consist of stiffness, swelling, build-up of joint fluid and tenderness along the line of joint. Over time, the ability to bend and straighten the knee will also be compromised. While one compartment, the medial (inside) or the lateral (outer) compartment of the knee may be affected more than the other, both compartments are often damaged. This causes diffuse pain.
The diagnosis can be suspected clinically in history and physical examination. This can be confirmed by the positive changes observed with radiographs of the permanent knee. Magnetic resonance imaging (MRI) is much more sensitive to changes in the KLA, which will consist of cartilage defects, bone edema (edema) and fluid.
A typical treatment regimen aims to relieve pain and maintain function.
If the patient is overweight, weight loss is mandatory. Regular low-impact aerobic exercise, resistance and stretching exercises are components of a common sense program for a patient with KLA.
You can also use the addition of nonsteroidal anti-inflammatory drugs, taken orally or as a local remedy.
Removal of excess fluid in the joint with subsequent injections of glucocorticoids (“cortisone”) is useful for symptomatic relief. Glucocorticoids have a detrimental effect on articular cartilage and should be used sparingly, no more than three times a year in a given joint.
The patient may also use viscosupplement injections. These are substances consisting of hyaluronic acid, which mimic the characteristics of normal fluid in the joints. These injections can also help relieve symptoms.
All injections must be administered using an ultrasound guide to ensure accuracy.
Surgery is defined as cartilage or cartilage sacrifice. Sparing cartilage procedures include an osteotomy — removing a bone wedge to level the knee joint. It is used in young active adults to buy time. Cartilage sacrifice procedures are related to joint replacement. Recently, there has been a tendency for patients to receive these operations at a younger age. The disadvantage is that these operations are associated with a small but real risk of serious complications, including infection, blood clots and death.
A variation that turns out to be an alternative is the use of autologous stem cells, the patient’s own stem cells, which help maintain and possibly restore cartilage in the knee of osteoarthritis.
(Wei N, et al. Leading mesenchymal stem cell therapy for the treatment of osteoarthritis of the knee joint J Applied Res., 2011, 11: 44-48)
