Patella Cartilage Softening Of Etiology, Pathology, And The Research Progress Of Diagnosis And Treatment Of Disease

Patella osteomalacia cartilage was first reported by Budinger1906years, first cited as softening patella cartilage (hereinafter referred to the Chondromalacia patellae as CP)by Alemen1928, this disease ’used to represent a simple degenerative change of the patellofemoral joint.The disease is a kind of degenerative joint disease, pathologic features of which the surface became softening, disintegrate, fall off, degeneration, and are the common relatively causes of knee pain.But the early lesion is different from the traumatic osteoarthritis [1], the early changes for cartilage lesions begin with deep homogeneous material and collagen fiber, only to later development involving cartilage surface, so the joint surface is complete smooth, later involvement load area, the cartilage structure ruptured appearly, intire of the cartilage was assaulted, the surface cilia formation. Then subchondral bone of nerve endings are stimulated and causeed the feeling of the pain; And traumatic arthritis of cartilage changed from the surface and gradually destroyed the collagen fiber, thus the cartilage surface cilia change was happen.It is a chronic knee disease, common the knee has a traumatic history of old people.The Clinical manifestations of the knee at first are sore or discomfort blunt painful, gradually progress of the knee joint pain, especially at the timeof down stairs, climbing the campaign such that the pain aggravating, when stop walking the pain may be significant relief, afraid of the cold, noise in the joints, and the relevant symptoms of giving way.On examination, there are pressing pain on and around the patella, torsional resistance pain when extension of the knee joint,the positive of Single foot and a half CunWei test, the person when weigh that appear patellar rubs and limp, and knee flex activities is limited, floating patellar, positive of extrusion grinding test.The causes of this disease, currently there are several doctrines:Trauma theory, patellar disorder doctrine, the patellar bone pressure, increased bone pressure or drop, cartilage dissolution doctrine, cartilage theory of nutrition disorders, autoimmune theory,the pressure of the patellofemoral joint doctrine. Trauma doctrine is recognized as the most important risk factors and sports injuries makes this disease tend to be younger, patellar disorders is more common risk factors. The main pathological mechanisms of this disease are as follows: Structural damage to cartilage, cartilage fragmentation, shedding; subchondral bone exposed, vascular proliferation of fibrous tissue in the bone, new bone hyperplasia; synovitis response, synovial proliferation, hypertrophy, loss of elasticity.Chondromalacia patella syndrome pain in the pathogenesis of pathophysiological mechanisms to explain three:Secondary synovitis, increased intraosseous pressure caused pain and tissue pain threshold lower. In addition, anatomical terms, the rich innervation of subchondral bone, the periosteum as well as intra-articular synovial surrounding ligaments and joint capsule and other parts of chondromalacia patella is the source of pain in patients with sexual stimulation.Chondromalacia patella disease more treatment, but no certainty of specific treatment. Traditional Chinese medicine therapies such as massage therapy, acupuncture, Chinese Herbs, washing therapy, small needle-knife therapy to play a crucial role in the symptomatic treatment to improve symptoms. Surgical therapy, such as sartorius forward in the treatment of patellar sagittal osteotomy, rotate, and enhance the tibial tuberosity treatment for patellar joint disorders, to improve the environment of the patellofemoral joint stress; improve the regeneration of cartilage for autologous periosteumdrilling in the treatment of transplantation in the treatment of cartilage, arthroscopy surgery by removing foreign matter and clean up of intra-articular cartilage, meniscus, etc. through the joint surface replacement, completely solve the patient’s pain and motor dysfunction.In recent years, tissue engineering, cytokines, gene therapy and other aspects of the treatment of chondromalacia patellae provide new ideas and methods, and preliminary studies have shown that treatment of cartilage lesions with validity and reliability. Cytokines, gene therapy is still in clinical trials, with further research, they will become an important treatment.