Knee osteoarthritis.

Causes of osteoarthritis

Exactly how osteoarthritis forms is not entirely clear. What we do know is that osteoarthritis increases with age. We distinguish between different forms of osteoarthritis. Osteoarthritis can develop as a result of natural aging. We call this degenerative osteoarthritis. Osteoarthritis can also develop as a result of an accident. We call this post-traumatic osteoarthritis. The joint is then damaged, for example, by a fall. Osteoarthritis can also form as a result of rheumatoid arthritis (RA). In degenerative osteoarthritis and osteoarthritis due to RA, there is often osteoarthritis in several joints. Normally, cartilage is a smooth structure. During aging or damage, the quality of the connective tissue decreases. As we age, cartilage cannot properly repair itself like, say, a muscle can. This is because cartilage has poor blood flow. The degree of osteoarthritis does not always determine the degree of symptoms. It may be that people experience relatively few complaints with a substantial osteoarthritis of the knee. There may also be a lot of symptoms and pain with little osteoarthritis in the knee. The degree of pain depends on many different factors such as, for example; strength of the muscles around the knee, degree of physical activity, physically demanding work. Cartilage itself has little to no pain sensors. Thus, cartilage itself cannot hurt. Because of osteoarthritis, there is an inflammatory process leading to irritation of the capsule, synovial fluid (synovium) and muscles and tendons around the knee.

Anatomy and function of cartilage in the knee

A joint is a place in the body where two pieces of bone come together. In the knee, this is the femur (upper leg) and the tibia (lower leg). Between these bone parts is cartilage which has a very smooth surface so it can move smoothly. To properly control the knee joint, there are different types of ligaments in and around the knee. On the inside and outside are the collateral ligaments. Between the femur and tibia is the inner and outer meniscus which acts as a shock absorber between these two parts of the bone. In the knee there is the anterior and posterior cruciate ligament. We distinguish between different types of cartilage: hyaline, elastic and fibrous cartilage. Hyaline cartilage is the most common in our body and is also found on the end of our bones. In particular, the function of cartilage is to keep the joint moving smoothly and acts as a shock absorber along with the meniscus in the knee. Osteoarthritis in the knee is also called gonarthrosis in the medical world.

Symptoms in knee osteoarthritis

Osteoarthritis in the knee can cause a variety of symptoms:

• Start-up complaints especially in the morning are a common symptom of knee osteoarthritis. Even after sitting for longer periods and starting up again, the knee can give symptoms.
• Climbing stairs and long walks often produces a reaction in the knee.
• A limitation in mobility. Especially toward stretching. Bending is usually a little easier.
• Osteoarthritis in knee has a variable course. Symptoms can spontaneously worsen and also calm down.
• Swelling in the knee, especially after physical strain. We call this synovitis.

Physical tests in knee osteoarthritis

The following physical tests can be performed for osteoarthritis-related complaints

Pain on palpation of joint gap
The examiner palpates the entire joint gap. The test is positive when pain is felt when pressure is applied to the joint crevice. Often a thickening of the bony structures of the knee is also felt.

Motion function examination of the knee
During this examination, the mobility in the knee is tested. The maximum extension and maximum flexion of the knee joint are tested. We often see a decrease in the mobility of the joint in people with osteoarthritis. Also, crepitations can often be felt or heard.

The different degrees of knee osteoarthritis

There are four grades of knee wear and tear, increasing in severity:

Grade I: The cartilage has softened and its springiness is reduced. Sometimes a single osteophyte (bone protrusion) is visible at the edges of the knee joint. This grade I damage is often not detectable on an x-ray.

Grade II: There are cracks and irregularities in the surface of the cartilage. However, this damage is often superficial and does not yet extend to the bone. Also, the cartilage layer has not yet become thinner due to the wear and tear damage. Sometimes clear osteophytes are visible on X-rays. Grade II damage is also not always detectable on an X-ray.

Grade III: The aforementioned cracks have left deep grooves or holes in the cartilage. This damage extends deeper toward the bone, but the bone is often not yet exposed. However, a narrowed joint gap can sometimes be seen on the X-ray. Also, the edges of the bone ends are often affected.

Grade IV: In a grade IV lesion, the cartilage is (almost) completely gone and the underlying bone is exposed. The joint gap has narrowed and sometimes almost completely disappeared. Also, large bone protrusions have often formed and the ends of the bone parts are deformed.

Rehabilitation at Physio Fitaal

Complaints of osteoarthritis in the knee can be very annoying. Of course we cannot take away osteoarthritis. But we can teach you to deal with your complaints in a responsible way. The therapists at Fysio Fitaal are specialized in treating and rehabilitating osteoarthritis related complaints. Our specialists will guide and motivate you in the best possible way. By combining our extensive expertise in the field of orthopedic rehabilitation with an extensive facility, Fysio Fitaal is the right place for you!

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