Degenerative Osteoarthritis – Knee

MEDICAL HISTORY:

The patient is a 66-year-old bus driver who presented with severe pain in the right knee. He has had many sports injuries in his formative years and had a tibial osteotomy performed on the right knee in 1998. At the time of presentation, the pain was so severe that he found it difficult to walk even short distances. Symptoms have been progressive over several years and he is unable to work or be comfortable even at rest. Knee replacement surgery had been recommended.

PHYSICAL EXAMINATION:

The right knee demonstrates a significant degree of hypertrophy and multiple scars that are healed. An 18o lack of extension exists and flexion is to 90o only. Marked tricompartmental tenderness is noted to be present; there was no evidence of instability. The patient walked with a perceptible limp.

DIAGNOSIS:

Degenerative Osteoarthritis of the Knee

DISCUSSION:

Between October 2nd and 13th the patient had 6 Laser Therapy treatments to the right knee. At the time of his most recent examination, his gait was normal, hypertrophy of the knee had diminished, flexion of the knee was normal and the lack of extension was only 8o. No significant tenderness was noted. He related that he was able to perform his work duties without pain. The patient was so impressed with the result that he immediately initiated treatment to the left knee where symptoms and clinical findings were only moderate in degree.

RECOMMENDATION FOR FUTURE THERAPY:

This patient was encouraged to continue treatments on a weekly basis for 2 months and then every 2 weeks in order to continue the regeneration of cartilage. This case demonstrates the rapid improvement that can occur and the need for continuing therapy as indicated.

CONCLUSION:

Degenerative Osteoarthritis of the Knee is a condition that not only produces significant pain but also results in a debilitating limitation of routine weight bearing activities. Laser Therapy addresses the chronic inflammatory process involved in osteoarthritis and promotes cartilaginous regeneration in order to achieve a resolution of this condition.

PATHOPHYSIOLOGY OF DEGENERATIVE OSTEOARTHRITIS:

Osteoarthritis (OA) is the most common joint disorder and often becomes symptomatic in the 40s and 50s. It is almost universal (although not necessarily symptomatic) by age 75. Only 50% of patients with pathologic changes are symptomatic. Prior to age 40 years, most cases of osteoarthritis are the result of trauma. Women predominate from ages 40 to 70, after which men and women are equally affected.

All articular and periarticular tissues become involved in the osteoarthritic process encompassing the knee. Subchondral bone loses elasticity, then undergoes infarction resulting in the development of subchondral cysts. Natural efforts to stimulate bone repair result in subchondral sclerosis and the formation of osteophytes at the joint margins. The osteocytic malformations that develop appear to be nature’s attempt to stabilize the joint, thereby reducing pain. As part of the process, the synovial lining of the joint becomes inflamed and thickened, producing synovial fluid that is less viscous and reduced in volume. Periarticular tendons and ligaments are stressed, resulting in tendonitis and contractures. As the joint becomes less mobile, surrounding soft tissues, including the muscles, atrophy and provide less support. Meniscal fissuring and fragmentation are part of this pathology. This disease process may be acute or chronic.

a) Normal knee structure, illustrating the bones and cartilage of the knee joint.

b) Osteoarthritis leads to erosion of bone and cartilage and the formation of bone spurs. The soft tissues surrounding the joints also deteriorate and become inflamed.