structure such as a
tendon)
or stabilize onto some structure such as the synovium. Most loose bodies
do not produce symptoms and are found incidentally on
X-ray. The diagnosis of loose bodies is essentially based on
X-ray findings because there is not one specific clinical finding.(1)
Loose bodies were one of the reasons
that “clean out”
arthroscopicies
became so popular. These arthroscopies were done to clean out all these
nasty loose bodies from a patient’s knee. There are many different types
of loose bodies, but some do represent chips of
cartilage
or meniscus.
Obviously if someone has lost a piece of their cartilage or meniscus, it
may be a good idea to get
Prolotherapy to the injured area.
(See A Retrospective Study
Shows Prolotherapy is Effective in the Treatment of
MRI-Documented Meniscal Tears)
Let’s review one
knee arthroscopy report
from January 2010.
Preoperative Diagnosis:
loose joint body, left knee.
Postoperative Diagnoses:
1. Multiple loose joint bodies, left knee.
2. Torn
medial
meniscus.
3. Grade 3 changes of the patellofemoral joint, left knee.
Procedure Performed:
Video arthroscopy, partial
medial meniscectomy, chondroplasty of the patellofemoral joint with
removal of multiple loose joint bodies, left knee.
Gross Findings:
A 51-year-old male who has
developed a floating loose joint body around his left knee. This has
been ongoing since the end of December, not associated with any
traumatic event. Occasional loose joint body will catch patellofemoral
joint and causes pain. He has had some swelling. X-ray showed a probable
loose joint body in the medial gutter. Due to his failure to improve
with conservative treatment, he elected to proceed with surgical
intervention. Procedure complication, postoperative convalescence were
explained in detail. He did elect to proceed.
Description of Procedure:
The patient was
taken to the operating room and general anesthetic was administered by
the department of anesthesia. He was given 1g of kefzol intravenous
piggyback prior to surgery. Left leg was elevated, exsanguinated, and a
pneumatic tourniquet was inflated to 300mmHg. Left leg was placed in a
leg holding device. The left knee was sterilely prepped and draped in
the usual fashion from the ankle to the leg holding device.
Surgery began with the insertion
of the artrhoscope through a lateral
infrapatellar puncture site. The
arthroscopic instruments were inserted through a medical infrapatellar
puncture site. The arthroscopic pump was inserted through a medial
suprapatellar puncture site. Examination of suprapatellar pouch revealed
copious synovial fluid. There was multiple cartilaginous loose joint
bodies floating around within the knee. There is grade 3 changes of the
patellofemoral joint including the trochlea. An oscillating
chondroplasty performed. The arthroscope was taken down through the
medial gutter. I did not see any bony loose joint bodies, although there
are a lot of cartilaginous loose joint bodies. Examination of the medial
compartment revealed some mild…
As you can see from this report, one
of the post-operative diagnoses was multiple loose bodies, as well as a
torn meniscus and
patellofemoral
joint grade 3
chondromalacia
changes. This person actually has many reasons to need
Prolotherapy after this
arthroscopy. Cartilage damage beneath the knee cap (grade 3 is not
quite bone on bone, but it is heading there) and a torn medial meniscus
are successfully treated with
Hackett-Hemwall Prolotherapy.
One of the reasons for writing this
article is just to educate folks on loose bodies. You can see in the
body of the report the orthopedic surgeon wrote, "I did not see any
bony loose joint bodies, although there are a lot of cartilaginous loose
bodies.”
What this means is the loose bodies were made of cartilage instead
of bone. How did this occur? Most likely the person experienced the
gradual deterioration of cartilage from poor tracking of the patella on
the femur, and eventually some of the cartilage particles became loose
and went into the joint. It is my opinion that Prolotherapy could have
stopped this process. Unfortunately, I saw this patient after
arthroscopy instead of before the arthroscopy!
I am sure you realize by now that
this patient came to see me at Caring Medical because he still has pain
post-surgery. This particular patient essentially received no pain
relief with the arthroscopy and very quickly came in for Prolotherapy.
He is improving steadily with Hackett-Hemwall Prolotherapy. Because
of the extensive damage to his knee, some of which was actually caused
by the arthroscopy, he will need a few more treatments. Just look at the
report. An oscillating chondroplasty was performed! What do you think
this means? The definition of chondroplasty is "reshaping the joint
surface" and refers to surgical techniques whereby damaged joint surface
is cut, scraped, lasered or burred away (or in this case oscillated
away) in the hope that the healthy joint surface will heal over the
defect. I am sure somewhere in the world a patient exists where
chondroplasty actually did heal the defect, but I have not found that
person in my practice. The patients I see tell me that the procedure
gave them temporary or no relief. They are subsequently left with less
knee cartilage than they had prior to the chondroplasty! I say there is
a better way, and that way is Prolotherapy!
Surgeons have been removing loose
bodies since orthopedic surgery was invented.2 Whether you
read Mayo Clinic’s information on loose bodies or Dr. Hauser’s
information, they will all tell you that it is a radiographic diagnosis
and you can never really tell which symptoms, if any, are coming from
the loose bodies. I can tell you this, if you found out you have loose
bodies on an X-ray, I can recommend you receive Prolotherapy before
arthroscopy because the loose bodies alone most likely represent
Degenerative
Joint Disease
. You have
Degenerative joint disease, whether the underlying bone has broken off (like a
bone spur)
or cartilage (like underneath the knee cap in
chondromalacia) or
meniscus tissue (remember, this is fibrocartilage which contains both
type I and II collagen and is both tough and flexible). Whatever the
damaged tissue, it needs regeneration. The medical procedure to
regenerate damaged tissue in joints is Prolotherapy. By stimulating
tissue repair, Prolotherapy will most likely eliminate the knee pain.
What about the loose bodies? What about it? Millions of people have them
and they cause no problems and the people do not even worry about them.
So why do you?
