04 Nov Loose bodies on Arthroscopy: Another reason to get PRP and Prolotherapy!
Loose bodies on Arthroscopy:
Another reason to get PRP and Prolotherapy
There can be fragments of bone, cartilage, or collagen that are located in the joint cavities, these are called loose bodies. The knee is the most common location for loose bodies. Occasionally these loose bodies, truly are loose. They move freely and can be entrapped between the articular surfaces of say the knee bones (like the femur and tibia) within the joint. Symptoms such as intermittent joint locking, limitation of motion, pain and sometimes swelling can occur. Other types of loose bodies may exsist that are not so loose. A bursa (a fluid filled sac that prevents friction between bone and soft tissue structure such as a tendon) is where the fragments attach to or stabilize onto some structure such as the synovium. The majority of loose bodies are found incidentally on X-ray and do not produce symptoms. Because there is not one specific clinical finding, the diagnosis of loose bodies is essentially based only on x-ray findings.
One of the reasons that “clean out” arthroscopicies became so popular is loose bodies. Arthroscopies were done to clean out all these nasty loose bodies from a patient’s knee. Although there are many different types of loose bodies, some may represent chips of cartilage or meniscus. Prolotherapy to the injured joint, may be a good idea, if the paient has lost a piece of cartliage or meniscus.
Let’s review one knee arthroscopy report from January 2010.
Preoperative Diagnosis: loose joint body, left knee.
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 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 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 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?
Unfortunatly so many orthopedics gauge their diagnosis and treatment solely off MRI findings. I have personally been to a few for my own injuries years ago and had orthopedics who never even touched my injury. This is why it is important to have a physicain who is objective and does a good exam. Here we see excellent results with knee’s with PRP and Prolotherapy and I hope you will find either a Prolotherapy Doc. close to you or call our office to schedule to see us.