LOOSE BODIES IN KNEE

Dr.Harsha Surath

• Loose bodies are fragments of bone or cartilage that are freely float in joint space.

• Single or in groups

• They effect only one joint

• They classified as stable or unstable.

• Stable loose bodies are in fixed position are generally well tolerated.

• Unstable loose bodies are free to move about the joint and cause symptoms.

• Individuals with a degenerative joint disease (e.g., arthritis or osteochondritis dissecans) are more likely to develop loose bodies in the knee

Classification

Individuals who participate in sports are at risk of developing loose bodies in the knee.

Loose bodies are common and affect men and women equally

1.Fibrinous

2.Cartilagenous

3.Osteo cartilaginous

Fibrinous

• Due to bleeding with in joint

• from the death of the tissue lining of joints (synovial membrane) associated with tuberculosis, osteoarthritis, and rheumatoid arthritis

• . Cartilaginous loose bodies are fragments of cartilage and are caused by injury (trauma) to the joint and osteoarthritis

• Osteocartilaginous loose bodies are fragments of cartilage and bone caused by fractures, bone and cartilage inflammation (osteochondritis dissecans), osteoarthritis, and benign tumors of the synovial membrane (synovial chondromatosis).

Clinical features

• knee pain and swelling, with intermittent locking or catching of the joint.

• The locking disappears spontaneously,

• Hearing a grating sound (crepitus) with joint movement.

• The joint intermittently "gives way" or "goes out" causing them to fall

• joint may be locked (unable to fully extend).

• There may be evidence of effusion in the joint.

• Loose bodies are rarely felt by touch (palpation)

DIAGNOSIS

• Larger loose bodies are typically calcified and thus easily visible on a plain film x-ray of the affected joint

• small or no bone may not be visible with an x-ray and are typically diagnosed using either CT or arthrography or MRI .

• . Ultrasound scans may be performed to determine the presence and location of loose bodies

Treatment • For small loose bodies, treatment may be directed

at relief of symptoms by NSAIDS

• Large loose bodies may require removal by use of an arthroscope (arthroscopy

• Very large loose bodies and those located in the back of the knee need to be removed by open surgery (arthrotomy

• . In some cases, such as synovial chondromatosis, part of the synovium may be removed (partial synovectomy

REHABILITATION

The focus of rehabilitation for loose bodies in the knee is to control pain and restore function

The first goal is gait training with an assistive device

Prolonged immobilization should be avoided for non-surgical cases .

REFERANCES

• CAMPBELL’S OPERATIVE ORTHOPAEDDICS 12TH EDITION

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