Power methods for the development of knee contractures. What to use when developing a contracture of the knee joint at home

Contracture knee joint is a pathology of the lower limb, in which the knee is unbent and not fully flexed. It is considered a symptom past illness. Any kind of stiffness in the knee joint, whether it be congenital or resulting from mechanical damage, requires an appointment with a specialist. To avoid complete immobility of the joint, timely and thoughtful treatment is necessary. In the case of an inattentive attitude to one's health, such a pathology has very deplorable consequences.

A contracture is a temporary or permanent limitation of movement in a joint. Connections of both upper and lower extremities. A particularly unpleasant disease is the contracture of the knee joint, which is accompanied by strong and sharp pains. Treatment not taken on time usually leads to partial or complete disability. The term "contracture" contains Latin roots, which means "contraction". Such an interpretation can easily and intelligibly explain the essence of the disease. Pathology occurs when soft tissues change, the degeneration of which causes contraction and compression of the knee joint or, in other words, completely limits its mobility. The destructive process begins with his long inactivity. During this period, the muscle tissue is practically paralyzed, which causes a fixed position of the joint. This condition causes a change in the soft tissues, after which the ligaments and tendons become less elastic.

Reasons for the appearance

Most specialists do not consider contracture to be certain diseases and believe that it is a consequence of any disease or injury. And it's hard to disagree with them. As a rule, after any injury or damage, a scar remains on the tissues, which does not have elasticity. This feature leads to restriction of movements, to a decrease in the length of the ligament and further deformation of the knee joint.

The following reasons can cause contracture:

knee injuries and inflammation in it;
arthrosis, arthritis, causing gradual destruction of the elements of the knee joint and deformation of the bones;
decrease in elasticity and decrease in the length of muscle tissue and ligaments;
congenital pathology of the knee joint;
mechanical damage;
in CNS lesions.

The activity of the patient also has a huge impact on the occurrence of stiffness. The risk group includes professional athletes and people whose work requires increased physical exertion.

Types of pathology

The loss of the ability to move in the knee joint is classified by specialists depending on the cause of its occurrence:

arthrogenic. They are the result of degenerative processes in the joint, on its surface and in the ligament system;
dermatogenic. Such a violation is a consequence of serious skin defects, which result in extensive injuries (burns, inflammation, wounds) that capture the periarticular region;
desmogenic. This type of contracture is characterized by wrinkling of the periarticular tissues. Contracture develops after mechanical damage or inflammation in the fascia, ligaments and articular bag;
myogenic. It is formed after prolonged compression of muscle tissue, and are also the result of muscle ischemia and myositis of various forms;
tendogenic. Occur as a result of inflammatory or traumatic changes in the tendon ligaments;
neurogenic. Disturbance of mobility in the knee joint can appear after paralysis, cerebral hemorrhage and CNS disease.

Limitation of joint mobility can be in the following directions:

bending;
extension;
limitation of rotational movements;
inability to move the joint to the right or left side.

Temporary contracture

As a rule, temporary contracture is a consequence of insufficient development of the articular connection after injury or disease. In such a state, it is worth blaming not only the patient who allowed the stiffness of the knee, but also the doctor who was supposed to tell about possible consequences pathology and give recommendations on how to rehabilitate the joint.

Temporary contracture usually occurs during a reflex contraction of muscle tissue to hold the joint in a position that is the least painful on the this moment. After the pain syndrome decreases, blood circulation in the affected area is restored, and the scars gradually dissolve. If the disease requires maintaining the immobility of the joint for a long time, then the pathology takes on a combined form and is difficult to cure.

Persistent contracture

As the practice of treatment shows, a persistent creature can occur after 3 weeks of immobilization of the knee joint. At the same time, each week of forced position helps to reduce the strength of muscle tissue by 20%. And within 6 weeks elasticity joint bag decreases by 10 times.

Contractures of a resistant type also include congenital pathologies. Most often, they manifest themselves in violation of the natural position of individual elements of the lower limb and their forms. A prime example of this type is clubfoot in a child.

Therefore, the treatment of persistent creatures has always been particularly difficult, requiring the patient implementation of all the doctor's instructions. The inactivity of the patient and deviations from the prescribed course of rehabilitation of the joint only contribute to the deterioration of the condition. Forcing to straighten or bend the limb leads to the expansion of the affected area.

Failure to comply with the doctor's instructions or avoiding the prescribed therapy threatens with ankylosis (complete loss of knee mobility).

Contracture symptoms

In some cases, after the main course of treatment, an increasing limitation of movements in the knee joint becomes noticeable. The lower limb at the knee does not bend and unbend as before the injury, and its fixation becomes more and more noticeable, in one position.

If the development of temporary contractures is accompanied by sharp pains, then the persistent type of pathology is hardly noticeable: the patient may not be disturbed by pain at all. The resulting immobility of the articular connection on initial stage almost no worries. And only when the pathology has a significant impact on gait and the person begins to limp, the patient decides to consult a specialist.

Concerning bright symptoms, in most cases they are expressed by the following signs:

swelling in the affected area;
violation of the support;
pain in the joint;
limb shortening;
leg curvature;
feeling of uncomfortable position of the leg.

Other manifestations of contracture largely depend on the underlying disease. The presence of this pathology for a long time usually reveals the presence of arthrotic processes in the knee.

Diagnostics of the knee joint

A positive effect on the treatment is the definition of pathology at the initial stage, which will completely restore the knee joint. Any unnatural position of the leg, a change in the shape of the knee joint, as well as the impossibility of habitual movements in this area should be the reason for contacting a specialist.

To receive you need to correct diagnosis the specialist should examine the leg and take x-rays. You may also need MRI results and computed tomography(CT). In some cases, depending on the cause of the pathology, it may be necessary to obtain additional advice from a neurosurgeon, neurologist or psychiatrist.

Restoration of the knee joint

In many ways, the treatment and restoration of lost functions of the knee joint depends on the time spent and efforts on the part of the patient. Therapy can be either conservative or surgical.

Conservative treatment therapy

Treatment of this type is carried out in trauma centers. medical institution or at the patient's home. main goal conservative therapy is the restoration of the natural range of motion of the knee, the elimination pain, improving blood supply in the damaged area. Such a result can be achieved by carrying out the following activities:

appointment medications(analgesics, NSAIDs and hormones);
the introduction of intra-articular injections;
physiotherapy procedures;
massage and exercise therapy.

Surgical intervention

With cicatricial degeneration of periarticular tissues, it is necessary to use surgical treatment, which allows you to effectively restrain further education subcutaneous nodules. good result can be achieved by replacing the healed areas with healthy tissues. Other techniques such as tenotomy, capsulotomy, fibrotomy, and arthrolysis may also be used in surgery.

The prognosis for the treatment of pathology as a whole depends on the type of underlying disease, its duration and duration. general condition patient. But as practice shows, early diagnosis contractures and the applied efforts of the patient make it possible to achieve a complete restoration of the mobility of the knee joint.

- This is a persistent decrease in the range of motion in the joint. It is possible to limit both flexion and extension. The degree of contracture can vary considerably, from moderate restriction to almost complete immobility. Pathology is usually accompanied by external deformation and pain syndrome of varying severity. To clarify the diagnosis and identify the cause of the contracture, radiography, CT, MRI, arthroscopy and other studies may be prescribed. Treatment can be either conservative or surgical.

The reasons

The most common causes of the development of contractures of the knee joint are injuries and degenerative-dystrophic processes (gonarthrosis). With gonarthrosis, limitation of mobility occurs as a result of gradually aggravated changes in all structures of the joint, as well as a violation of the shape of the articular surfaces of the femur and tibia. In knee injuries, contracture can result from several mechanisms. Possible direct damage to the joint with a violation of its shape and the formation of scars in soft tissues(with intra-articular fractures), shortening of the quadriceps muscle due to a long stay of the limb in the extension position (with hip fractures and fractures of the lower leg, fixed with a plaster cast), as well as a change in the structure of the articular cartilage due to prolonged immobility.

It has been established that contracture of the knee joint can develop even after immobilization for 3 weeks. Each week of immobilization, muscle strength decreases by 20%. At the same time, in 6 weeks, the stiffness of the joint bag increases by about 10 times. That is, to perform a normal movement, the patient has to exert much more force despite the fact that his muscles are significantly weakened. Prevention of immobilization contractures is one of the critical tasks with fractures of the hip and leg. In order to avoid negative consequences long-term immobilization, is now increasingly used operational methods treatment (fixation with plates, rods and devices external fixation) and prescribe early exercise therapy.

In addition, limited mobility of the knee joint can occur due to purulent arthritis and extensive burns with the formation of scars that tighten the skin. Less often, scars after deep lacerated and lacerated wounds in the area of the knee joint, on the anterior and posterior surfaces of the thigh and on the posterior surface of the lower leg become the cause of limitation of movements. Among the congenital malformations of the knee joint, in which contractures can be observed, are congenital dislocation of the knee joint, hypoplasia and aplasia of the tibia.

Classification

Depending on the cause of occurrence, two large groups of joint contractures are distinguished: active (neurogenic) and passive (structural). Structural contractures occur when there is something that prevents movement in a joint. Neurogenic contractures are the result of a violation of innervation and develop with paralysis, paresis and some mental illnesses.

Depending on the localization of the obstacle, all structural contractures are divided into:

Arthrogenic - with joint deformities.
Myogenic - with shortening of the muscles.
Desmogenic - in the formation of connective tissue scars.
Dermatogenic - with the formation of scars on the skin.
Immobilization - with prolonged limitation of mobility.

Taking into account the cause of the occurrence, neurogenic contractures are divided into:

Central neurogenic - caused by injuries and diseases of the head and spinal cord.
Psychogenic - arising from hysteria.
Peripheral - developing with damage peripheral nerves. They can be painful, reflex, irritative-paretic, or are the result of disorders of autonomic innervation.

In addition, depending on the type of restriction of movements in traumatology and orthopedics, flexion (the joint is reduced in the flexion position) and extensor (the joint is reduced in the extension position) contractures are distinguished.

Contracture symptoms

The main symptom of knee contracture is limited flexion or extension. As a rule, there is a more or less pronounced deformity of the joint. There may be one or more of the following signs: edema, impaired support, pain in the joint, shortening and forced position of the limb. The rest of the clinical picture depends on the underlying disease. With prolonged existence of contracture, signs of arthrosis of the knee joint are usually detected. To assess the severity of contracture, measurements of the volume of active and passive movements are made.

Diagnostics

The diagnosis of contracture is made on the basis of an external examination. To clarify the cause of the pathology, the doctor finds out the history of the disease and prescribes an x-ray of the knee joint. If scarring of soft tissue structures is suspected, the patient may be referred for arthroscopy, CT or MRI of the knee joint. If a neurogenic contracture is suspected due to damage to peripheral nerves, the brain or spinal cord, a consultation with a neurologist or neurosurgeon is indicated. With hysterical contractures, a consultation with a psychiatrist or psychotherapist is necessary.

Treatment of knee contracture

Treatment can be both conservative and operative and carried out in a trauma center, trauma or orthopedic department. The main methods of conservative therapy are exercise therapy, physiotherapy (electrophoresis, shock wave therapy), massage, mechanotherapy and bloodless correction of the position of the limb using interchangeable plaster bandages and special fixing devices. With the ineffectiveness of conservative treatment, surgical operations are performed.

Surgery can be performed through open access or using arthroscopic equipment. The purpose of the operation is to restore the shape of the articular surfaces, remove scar tissue or lengthen the muscles. With a significant destruction of the articular surfaces and the preservation of the muscles of the thigh and lower leg, endoprosthesis replacement of the knee joint is performed. In some cases, the optimal solution is arthrodesis of the joint in a functionally advantageous position. AT postoperative period prescribe physical therapy. To increase muscle tone and improve blood circulation, massage and physiotherapy procedures are used.

The effectiveness of the treatment of neurogenic contractures in to a large extent depends on the success of the treatment of the underlying disease. With flexion contractures resulting from cerebral or spinal palsy, splints are applied to straighten the limb or devices with weights are used. With hysterical contractures, psychiatric treatment is carried out or various psychotherapeutic techniques are used.

Forecast and prevention

The prognosis largely depends on the underlying disease, the severity of pathological changes in the joint and surrounding tissues. Fresh immobilization contractures with adequate treatment and regular exercise physical therapy, as a rule, well give in to conservative correction. With chronic contractures of any genesis, the prognosis is less favorable, because over time, changes in the joint worsen, cicatricial degeneration of not only damaged, but also previously healthy tissues develops, and secondary arthrosis occurs.

Etiology and pathogenesis

Persistent dysfunction of the knee joint can be the result of three main clinical situations: 1) union of fractures femur; 2) defects of the femur and 3) treatment of patients with fractures complicated by purulent infection (Scheme 31.5.1). Patients of each of these groups have pathological features. The tactics of their treatment are also different.

Scheme 31.5.1. The main causes of the development of contractures of the knee joint in fractures of the femur.

The main reasons for the development of contractures of the knee joint in patients with fractures of the femur are:
- degenerative-dystrophic and cicatricial changes in the capsule of the knee joint with prolonged immobilization of the limb;
- cicatricial adhesive processes in the area of torsion of the knee joint (especially the upper one), developing with periarticular injuries;
- fibrous degeneration of the heads of the quadriceps femoris muscle with the appearance of an additional fixation point;
- loss of normal extensibility of the quadriceps femoris muscle with prolonged immobilization of the limb.

Due to the fact that almost always the lower limb is immobilized in the position of extension in the knee joint, the combined contractures of the knee joint are predominantly extensor in nature.

Degenerative dystrophic changes joint capsules during prolonged immobilization. Due to the long periods of fusion of femoral fragments (A-6 months or more, depending on the nature of the fracture), the best results in the treatment of patients are achieved with the use of internal stable osteosynthesis of bone fragments, the most important advantage of which is the possibility of early onset of functioning of the knee joint.

Otherwise, prolonged immobilization of the knee joint is inevitably accompanied by the development of degenerative-dystrophic changes in the capsule of the knee joint with loss of its elasticity.

Cicatricial tissue changes in the area of the upper inversion of the knee joint. When the fracture is located in the lower third of the femur, scar tissue changes can spread to the area of the upper torsion of the knee joint. And even with fractures in middle third segment, an extensive hematoma may descend distally to this level. In addition, concomitant injuries of the knee joint with damage to the ligamentous apparatus and menisci, as well as fractures of the condyles of the femur and patella, are generally not uncommon in fractures of the femur. All this leads to direct scarring of the damaged elements of the knee joint, which, combined with prolonged immobilization, can lead to the development of arthrogenic contracture.

Cicatricial changes in the muscles in the fracture area and their fixation by scars to the femur. As you know, the quadriceps muscle of the thigh has a significant amplitude of movement, which, when the limb is bent at the knee joint to an angle of 90 °, is 7-10 cm. The inevitable development of extensive scars in the fracture zone quickly leads to a strong fixation of the muscle to the femur. This is especially true of the broad intermediate muscle, which starts from the anterior surface of the femur throughout its middle and upper thirds.

Cicatricial processes are aggravated by direct traumatization of the thigh muscles by the ends of bone fragments, as well as by the direct impact of a traumatic force on the fracture area. Finally, internal osteosynthesis of bone fragments is accompanied by additional tissue trauma, and even when using external fixation devices, the wires passed through the muscles block their movement.

All together, this is manifested by the loss of the ability of the muscle to move in relation to the femur.

The processes described above are significantly enhanced with the development of suppuration of the wound (with open and especially gunshot fractures) with the development of osteomyelitis. Therefore, in patients of this group, combined contracture of the knee joint occurs in almost 100% of cases.

Loss of normal extensibility of the quadriceps femoris. With prolonged immobilization of the limb in the position of extension of the head of the quadriceps muscle, the ability to increase its length when flexed at the knee joint gradually decreases. This is especially true for the rectus femoris, which starts from pelvic bones and has the greatest length, and consequently, contractility.

Treatment of patients with persistent contractures of the knee joint

Treatment of patients with severe contractures of the knee joint can vary significantly depending on different groups patients:
1) with the consequences of diaphyseal fractures of the femur;
2) with diaphyseal fractures and concomitant fractures of the condyles of the femur or patella;
3) with the consequences of a fracture of the femur, complicated by osteomyelitis.

Contractures of the knee joint after diaphyseal fractures of the femur. The main task in the treatment of patients in this group is to restore the ability for free movement of the quadriceps femoris and the normal extensibility of its heads, which provides a full range of flexion and extension in the knee joint.

Operation technique. The operation is started from a linear longitudinal approach along the anterior surface of the thigh just above the patella.

After mobilization and shifting of the skin-fascial flaps to the sides, the anterior surface of the quadriceps muscle is exposed. Due to the fact that the superficially located rectus femoris muscle has the greatest length, the surgeon mobilizes it, separating it from it ( sharp way) tendon stretching of the medial and lateral broad muscles(Fig. 31.5.1, a).

Rice. 31.5.1. Stages of mobilization of the quadriceps femoris muscle.
a - isolation of the tendon of the rectus muscle; b - suture of the tendon of the rectus muscle with the tendons of the lateral and medial wide muscles.
If necessary, the muscle is isolated more proximally. Then, moving the tendon of this muscle aside, the surgeon separates the cicatricial adhesions that connect the medial and lateral broad muscles to the surface of the femur.

Due to the fact that the main cicatricial tissue changes occur in the intermediate wide muscle and that it is impossible to restore its normal contractility, the cicatricial tissues are excised or cross the muscle near the place of its transition to the tendon. In this case, the plane of dissection of the muscle passes in the oblique direction (Fig. 31.5.2).

Rice. 31.5.2. The level of intersection of the vastus intermedius muscle of the thigh (arrow) according to V.I. Karptsov (1988) (explanation in the text).
Rice. 31.5.3. Moving the tendon stretch of the lateral wide muscle of the thigh (M) to a more proximal level (according to V.I. Karptsov, 1988).

The second element of this operation is the separation of adhesions between the lateral and medial heads of the muscle on one side and the femur on the other.

At normal condition sliding elements of the knee joint, this allows you to restore the mobility of the entire quadriceps muscle.

The effectiveness of the performed operation is assessed by the degree of restoration of the volume of passive movements in the knee joint.

In some cases, due to the secondary shortening of the lateral and medial wide muscles of the thigh, full flexion in the knee joint is restored only when their tendons are sutured to the tendon of the rectus muscle at a more proximal level (Fig. 31.5.3).

With pronounced cicatricial changes in the tissues in the area of the upper constipation of the knee joint, the tissues in this area are additionally excised.

We emphasize that the complete intersection of the tendon of the quadriceps femoris and its suturing with lengthening give poor results due to the fact that full active extension in the knee joint is not restored.

According to the indications (pronounced cicatricial changes in tissues), the operation can be completed by applying an external fixation device with a hinge located at the level of the knee joint. This allows slow and therefore less painful flexion of the joint in the postoperative period.

postoperative treatment. Movements in the knee joint begin on the 6th-7th day after the operation, and isometric contractions of the quadriceps muscle - from the 3rd-4th day. The apparatus is removed after reaching a significant volume of active movements with the rods of the apparatus removed.

After removal last treatment supplement with a complex of physiotherapeutic procedures. Contractures of the knee joint with a combination of a diaphyseal fracture with intra-articular fractures of the condyles of the femur and patella. Due to the fact that near- and intra-articular scarring plays a significant role in patients of this group, the surgical techniques described above are combined with intra-articular intervention. Depending on the predominant location of scar tissue changes, internal or external parapatellar access is used. Scar adhesions between articular surfaces separate, mobilizing (or excising) torsion of the joint. The effectiveness of the operation is assessed by the degree of restoration of movements in the knee joint.

In these patients, in contrast to the patients of the previous group, the prognosis for the restoration of function is much less favorable, and the development of deforming gonarthrosis is almost inevitable.

Contractures of the knee joint in combination of hip fractures with osteomyelitis. The significant distribution and complex topography of cicatricial tissue changes in patients with femoral osteomyelitis determine the particular complexity of their treatment. In this situation, the operation to mobilize the elements of the quadriceps femoris muscle should be supplemented by an intervention aimed at eliminating the suppurative process. This includes not only the radical excision of the affected tissues, but also the filling of the resulting cavity with well-perfused tissues.

With widespread cicatricial tissue changes in the lower third of the thigh, and in particular in the area of tendon stretching of the quadriceps muscle, tendon mobilization often does not lead to restoration of muscle gliding due to rapid re-scarring. This was the basis for the use by surgeons of an insulating siloxane film temporarily implanted under a tendon sprain, the edges of which protrude into the wound.

The film is removed on the 7-10th day after the operation, and immediately begin to move in the knee joint. This approach has serious drawbacks, which primarily include the risk of suppuration associated with the introduction of foreign material into the wound that is in contact with external environment. On the other hand, the effect of using the film can hardly be noticeable due to the fact that the fibroplastic period of scar formation (from the 2nd week after the operation until the end of the 3rd month) passes under unfavorable conditions after its removal.

An alternative to this may be transplantation of a well-perfused fat flap into the region of the superior torsion of the knee joint, which can become a permanent and reliable biological seal between the quadriceps tendon and the surface of the femur. As a complex of tissues, fat flaps with outer surface hips based on the 3rd or 4th perforating arteries located in the lateral intermuscular septum. The points of exit of these vessels can be determined using a Doppler flowmeter, and they are the points of rotation of the flaps, the long axes of which are directed proximally. Once the tissue complex has been isolated, it can be moved under tendon stretching of the quadriceps femoris.

In some cases, it is also possible to use complex free polycomplexes of tissues, with the help of which, on the one hand, osteomyelitic cavities of complex shape can be replaced, and on the other hand, a favorable environment for sliding segment structures.

IN AND. Arkhangelsky, V.F. Kirillov

What causes contracture of the knee joint and how to get rid of it? In the treatment of leg fractures, temporary immobilization is performed using plaster casts, traction or. Immobilization is necessary for proper fusion of bone fragments. However, it contributes to the emergence of various. The most common among them is flexion contracture of the knee joint. It is the immobilization of the legs that is considered its main cause. Knee dysfunction can be observed after arthroplasty, as well as arthroscopy. The treatment plan for injuries of the lower extremities should include measures aimed at preventing the formation of contractures.

Causal factors

The reasons why this pathological condition occurs can be different. Functional and organic disorders in the joint appear with a long course of the inflammatory process, injuries, arthritis or arthrosis, a decrease in the elasticity of the ligaments, and shortening of the muscles. Arthrogenic contracture is formed when a bone is dislocated or fractured, bruised and sprained. This problem is faced by people suffering from joint diseases. However, it can also occur in a perfectly healthy person.

contract does not count full disease, it is referred to post-traumatic and postoperative complications. Less common congenital forms pathology.

Almost any complex fracture contributes to the disruption of the functions of nearby joints. Affected tissues begin to scar and lose their elasticity. This interferes with the movements of one or another department of the musculoskeletal system. The post-traumatic type of contracture appears with injuries of any severity. The destruction of cartilaginous tissues can also contribute to its occurrence.

Other reasons include damage nerve endings. However, most often the contracture has mechanical origin. Recovery from any injury requires reducing stress on the knee. The longer it stays immobilized, the higher the risk of complications.

Signs of contractures

The joint can be fixed in an extended or flexed state, with rotation and abduction. The main types of disorders are flexion and extensor contractures knee joint. Her combined view characterized by complete immobility of the affected area. This is the most severe complication practically not amenable to conservative therapy.

By origin, violations can be:

Desmogenic. Their appearance is facilitated by scarring of tissues against the background of injuries and inflammatory processes.
Tendogenic. Appear when the ligaments are damaged.
Myogenic. The cause of the development of such contractures is considered to be acute and chronic myositis, ischemia or tissue compression.
Arthrogenic. They develop against the background of a long course of destructive processes in the joint.
Neurogenic. Paresis and paralysis of the limbs contribute to their occurrence. Rarely occur in pathologies of the spinal cord.
Dermatogenic. Their appearance is associated with thermal and chemical burns, as well as injuries of the skin and underlying tissues.
Conditionally reflex. This type of contractures is formed under the influence of adaptive reactions.

Key symptoms of data pathological conditions- Decreased joint mobility and deformity. Additionally there are:

Other manifestations depend on the cause of the disease. In people with arthrogenic forms of contractures, signs of destruction of cartilage tissues are almost always found. To determine the type of pathology, the volume of movements is measured.

Ways to treat pathology

In order to improve the condition of the joint after arthroscopy or injury, it is necessary to relieve inflammation and pain, restore mobility. Modern therapeutic techniques allow you to get rid of contractures without surgery. Recovery time largely depends on the type and severity of the violation, the amount of time that has passed since the injury. The sooner treatment begins, the higher the chances of a full recovery.

For the development of the joint are used:

physiotherapy;
massage;
physiotherapy procedures (electrophoresis, thermal exposure, SWT).

Treatment at home involves the use of non-steroidal anti-inflammatory drugs and analgesics. In a hospital, hormonal agents are injected into the knee joint. They eliminate pain syndrome, increase muscle tone, slow down the processes of tissue destruction.

Massage of the knee joint should be performed according to a specific pattern. An active effect is exerted on weakened muscles and a cautious one on those that are in increased tone. First, soft movements are performed, then active ones. Only after a while, elements of resistance are introduced.

Exists exercise therapy complex aimed at improving the condition of the joint in the presence of contractures. The legs are pulled to the stomach and begin to alternately bend them at the knees. The bent limb is lowered to the floor, after which it is straightened. The bicycle exercise is performed first for one leg, then for the second. It is useful to hold the bent leg on weight for a long time. The straightened limb is placed on the gymnastic ball and pressed on it. After that, rotational movements of the lower leg are performed.

Squats are done with the ball between the legs. The same object is placed under the knees and they begin to put pressure on it with the heels. Lying on its side, the leg is bent and lifted up. In the same position, the limb should be held on weight. Lying on your stomach, bend both legs. In the same position, the straightened limb is raised. All actions are performed at least 10 times. Classes should be held regularly, at least 1 time in 2 days. The constant supervision of an experienced instructor is required.

For the treatment of neurogenic and post-traumatic forms of contracture, warm baths are used, over time they are supplemented paraffin applications and mud treatment. The development of contracture allows you to restore mobility and function of the joint. In this case, the disease does not lead to complications, discomfort disappear, the muscles are strengthened, the nutrition of cartilaginous tissues is restored.

During the recovery period, it is shown, which includes therapeutic and supportive exercises, exercises on simulators.

When is surgery required?

Operations are applied when drug treatment contracture of the knee joint is ineffective. Surgical intervention means:

dissection of scars;
restoration of the volume of muscles and tendons;
decompression.

With significant tissue damage, artificial or natural implants. Surgery to correct bones may be prescribed.

Prolonged development of contracture of the knee joint can lead to its immobilization. Advanced forms of diseases are treated exclusively surgically. Therefore, when the first signs of dysfunction of the joint are found, you should contact an orthopedist. Mixed contracture does not allow you to use the leg as a support, walk and run normally. In severe cases, a deformity of the joint is revealed, which makes a person unable to work and significantly worsens the quality of his life.

Alternative ways to eliminate pathology

Treatment with folk remedies is effective only in the early stages of the development of degenerative phenomena. For this, rubbing and infusions based on medicinal plants. They improve efficiency drug therapy, allow to reduce dosages of drugs.

Relieve muscle tension with warm compresses or baths. Add to water essential oils coniferous plants. Baths with Dead Sea salts have a healing effect, restore blood supply to tissues. They can be used to treat post-traumatic or post-operative contractures.

All folk remedies must be used with the permission of the attending physician. This will help to get the best result and avoid the development of allergic reactions.

Contracture of the knee joint in most cases has a favorable prognosis. With the timely start of therapy, the mobility of the affected area is completely restored.

Joint contracture is a condition characterized by limitation of movement in the area of articulation of the bones. With the development of the disease, it is impossible to fully bend or straighten the limb in the joint. The cause of disorders in the work of the musculoskeletal system lies in the scarring of the tendons, the pathological development of muscle and connective tissue, injuries, prolonged immobilization, etc.

Contracture of the knee joint is a disease of the lower limb caused by a limitation in the amplitude of flexion and extension movements. Most often, changes in the articular joints are associated with dystrophic processes in cartilaginous tissues, malformations, stretching, permanent microtraumas, inflammation, etc.

The severity of the disease can vary from partial limitation of mobility to complete immobilization of the joints. The contracture has a bright clinical picture thereby facilitating the process of diagnosis. The main manifestations of the disease are deformities articular cartilage and moderate to severe pain.

The disease has wide use and is most often diagnosed in people engaged in heavy physical labor.

In the international classification of diseases, contractures are assigned an individual code in the category of violations musculoskeletal system– M24.5. Inflammatory processes in cartilaginous tissues are one of the causes of premature decline in performance and disability. Therapy of diseases of the lower extremities is carried out by specialists in the field of traumatology and orthopedics.

The reasons

The primary cause of limiting the range of motion of the articular joints are degenerative processes (gonarthrosis) and injury to the joints. Among the factors provoking dystrophic changes in cartilage tissue, relate:

intra-articular fractures;
prolonged immobilization;
long stay of muscles in an extensor position;
purulent arthritis;
damage to periarticular structures;
extensive burns;
cicatricial contraction of tendons;
leg fractures;
bone inflammation;
excessive physical activity;
purulent arthritis;
connective tissue hypoplasia.

Read also: Why do pelvic bones hurt during pregnancy?

According to the clinicians, the contracture of the left and right knee joint develops even in the case of immobilization for 20 days. Every week, muscle tone and strength decrease by an average of 18-20%, and the degree of stiffness of the articular capsule increases by 1.5-2 times. Immobilization contractures are difficult to treat, therefore, in orthopedic practice, operations are increasingly being resorted to, and patients are also prescribed a course of exercise therapy.

Very rarely contracture occurs against the background neurological disorders or organic damage to CNS structures. In 83% of cases, the disease is mechanical in nature and therefore more often develops in athletes and people engaged in physical labor.

Types of contractures

Depending on the etiological factors contractures are usually divided into two categories:

Neurogenic (active) - pathologies arising from impaired innervation that accompanies the development mental disorders, paresis and paralysis.
Structural (passive) - local damage caused by mechanical barriers that can form both in the joint itself and in adjacent muscle-ligamentous structures (fascia, tendons).

Most often, passive contractures are diagnosed, which are divided into several groups depending on the provoking factors and the localization of mechanical obstacles:

myogenic - are formed due to compression of muscle fibers, myositis and muscle ischemia can provoke the development of contractures;
arthrogenic - the result of degenerative changes in the articular cartilage itself or the ligament system;
desmogenic - caused by inflammation of the knee, in which deformation of the periarticular tissues is observed, can cause the formation of extensive connective tissue scars;
tendogenic - degenerative changes in the tendons, provoked by injuries and inflammatory diseases;
dermatogenic - occur during the formation of extensive skin defects caused by deep wounds and burns;
neurogenic - a consequence of mental disorders or damage to the nervous system.

Extension and flexion types of pathology

According to the type of limitation of the range of motion in the articular joints, there are three types of contractures:

extensor - pathological change the process of extension, in which it is impossible to unbend the leg bent at the knee;
flexion - violation of the flexion process, i.e. a condition in which it is difficult to fully bend the leg at the knee;
combined - the most severe form of the disease, characterized by the absence of limb movement in both directions.

The extensor contracture of the knee joint appears due to damage to the ligaments and the formation of connective tissue scars in them. Sometimes the pathology manifests itself against the background of cartilage ossification and the formation of osteophytes on their surface.

Temporary contracture

In this case, stiffness of the articular joints is caused by insufficient development of muscles and ligaments after immobilization and injury. Contracture occurs as a result of reflex muscle contraction, in which the leg is held in the least painful position.

As discomfort in the limb decreases, blood circulation in the tissues normalizes, fibrous adhesions dissolve, thereby restoring joint mobility.

Persistent contracture

According to practical observations, persistent stiffness of the articular joints is a consequence of prolonged immobilization and congenital pathologies. Contracture develops due to deformity functional elements limbs in violation of their natural position. An example of this type of disease is clubfoot.

Symptoms

Limited flexion and extension joint mobility is one of the key manifestations of contracture. The severity of symptoms is determined by the degree of damage to the articular cartilage and ligaments, the cause of organic damage and the phase of the disease. The classic manifestations of joint contracture are:

soreness during movement;
forced position of the leg;
swelling of soft tissues;
protrusion of the lower leg outward;
visual shortening of the limb;
violation of the support;
deformations in the place of articular joints of bones.

Read also: Arthroscopy of the ankle joint: indications for carrying out, technique of execution

It is not excluded the appearance of inflammatory processes in the damaged joint when tissues are injured. For this reason, abscesses can occur in cartilaginous and soft tissues and, as a result, osteomyelitis.

Diagnostics

To determine the type of contracture and the degree of joint damage, a comprehensive hardware examination of the patient's limbs is used. Prior to the appointment of certain diagnostic procedures orthopedist needs:

study the medical history;
examine the place of damage;
clarify the patient's complaints;
visually assess the degree of mobility of the limb.

Depending on the results primary examination the patient is prescribed:

MRI of the affected joint;
radiography of the legs;
arthroscopy.

With extensor and flexion contracture of the knee joint, additional consultation with a neurosurgeon, psychiatrist, traumatologist or neurologist may be required.

Treatment and development of the knee

Treatment methods are determined by the severity of the disease and related complications. Treatment of contracture of the knee joint can be both non-operative and surgical. The use of medications, exercise therapy and other physiotherapy is resorted to with temporary stiffness of the articular joints. Surgery is indicated for persistent contractures which can be caused by scarring.

Conservative treatment

Inoperable therapy is shown on initial stages development of pathology. It consists in manual forcible correction of deformities, the use of orthoses and fixing plaster bandages. Also, conservative treatment is prescribed for patients who have contraindications to surgery.

Restoring the mobility of the limbs allows manual redressing of the knee joint, which is carried out in several stages:

Under local anesthesia, the affected leg is placed on a splint and fixed by placing a soft roller under the heel or popliteal fossa.
The orthopedic assistant presses on the iliac bones so that the patient's pelvis is pressed against the operating table.
Meanwhile, the specialist “swings” the joint, holding the shin with his left hand, and the knee with his right hand.
The procedure takes no more than 7-10 minutes in the presence of spring movements.