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22Uzbek journal of case reports. 2022. Т.2, №1. Научная статья
УДК 616.727.4-073.43:616.72-002.772-052 https://doi.Org/10.55620/ujcr.2.1.2022.6
Influence of post-traumatic chondropathy on the functional state of the knee joints in athletes
Z.Z. UmarkuLov, B.M. MamasoLiev Samarkand state medical institute, Samarkand, Uzbekistan
Corresponding author: Bakhodir M. Mamasoliev, boxamed@mail.ru Abstract.
The article gives the assessment of the influence of post-traumatic hondropathy on the functional condition of knee joints in sportsmen with knee joints traumas in the past history. The negative influence of post-traumatic hondropathy on the subjective evaluation of the function of the traumatized knee joint according to the data of KOOS questionnaire and decrease of power parameters of periarticular muscles according to the data of the isokinetic test have been found out.
Keywords: post-traumatic chondropathy, joint knee, KOOS, ultrasonogrhaphy, isokinetic test
For citation: UmarkuLov ZZ., MamasoLiev BM. Influence of post-traumatic chondropathy on the functional state of the knee joints in athletes. Uzbek journal of case reports. 2022;2(1):31-35. https://doi.org/10.55620/ujcr.2.1.2022.6
Влияние посттравматической хондропатии на функциональное состояние коленных суставов у спортсменов З.З. Умаркулов, Б.М. Мамасолиев Самаркандский государственный медицинский институт, Самарканд, Узбекистан
Автор, ответственный за переписку: Баходир Мамаюсупович Мамасолиев, boxamed@mail.ru Аннотация.
В статье дана оценка влияния посттравматической хондропатии на функциональное состояние коленных суставов у спортсменов с травмами коленных суставов в анамнезе. Выявлено негативное влияние посттравматической хондропатии на субъективную оценку функции травмированного коленного сустава по данным опросника KOOS и снижение силовых показателей околосуставных мышц по данным изокинетического теста. Ключевые слова: посттравматическая хондропатия, коленный сустав, ультрасонография, изокинетическое тестирование
Для цитирования: З.З. Умаркулов, Б.М. Мамасолиев. Влияние посттравматической хондропатии на функциональное состояние коленных суставов у спортсменов. Uzbek journal of case reports. 2022;2(1):31-35. https://doi.Org/10.55620/ujcr.2.1.2022.6
INTRODUCTION
Knee injuries and their complications in athletes are an immediate problem in sports medicine. Particular attention should be paid to the timely diagnosis and treatment of posttraumatic degenerative-dystrophic changes in the internal structure of the knee joint, especially in the articular cartilage. It is also impossible to reduce chronic microtraumatization of the joint during sports. Physical load on the cartilage, which is more than physical, in the case of violation of the structure causes pathological changes in it, thinning and fibrillation, develops post-traumatic chondropathy. According to arthroscopy, the incidence of this pathology is 51 to 66% in people suffering from knee joint injuries.
The most common and severe complication of knee injuries is post-traumatic gonorrhea. Complications in the form of post-traumatic gonorrhea occur in 35.5-69.75% of cases and occur on average 3-5 years after injury. Damage to articular cartilage during post-traumatic gonadotropin development and stimulation trauma.
A feature of the clinical course of post-traumatic chondropathy is the absence of pain in the early stages of cartilage damage, since there is no change in articular cartilage. Pain sensitivity is accompanied by a decrease in cartilage thickness due to the ongoing regeneration process in subcutaneous tissue, the invasion of blood vessels in the affected areas, and the appearance of sensitive nerve fibers.
Tool analysis of articular cartilage damage reveals some difficulties. So far, the question of the rational use of instrumental methods to study articular cartilage damage has been controversial. The most common method of diagnosing radiation is radiography, however, soft tissue structures, ligaments, low sensitivity to articular cartilage, as well as radiation exposure for the patient, limit its use.
When using this method, the thickness of the articular cartilage is not directly determined by the width of the joint space, providing a closer look at its condition. For these reasons, the use of computed tomography is also limited. Magnetic resonance imaging (MRI) is a modern, highly informative way of looking at intraarticular structures. MRI has advantages such as non-invasiveness, absence of radiation exposure, ability to see articular cartilage and the degree of damage, changes in intra- and para-articular tissues. The disadvantages that limit the use of this method are high cost and low availability. Arthroscopy is a "gold standard" for diagnosing damage to the intra articular structure of the knee joint. Arthroscopy is a less informative method of direct visualization that allows for an objective evaluation of intra articular pathology. However, arthroscopy is an invasive diagnostic procedure, with many limitations and should be performed only after exhaustion of all available medical and instrumental examination methods.
Ultrasonography is the most advanced way to view the structure of the knee joint. The first ultrasound examinations in traumatological and orthopedic practice were conducted in 1985 (E.A. Gorbatenko, N.A. Eskin). Since then, ultrasonography has found wide application in the diagnosis of knee joint diseases and injuries. The literature presents data on the successful use of ultrasound for the diagnosis of male injuries, and identifies important indications for ultrasound diagnosis. The diagnosis of soft tissue structures, hyaline cartilage, and meniscus conditions is based on data from very high volume ultrasound (US) data, confirmed by a comparative study of US and MRI data. Therefore, according to the Russian authors, the sensitivity and specificity of the ultrasound method in estimating
articular cartilage damage are 83.2-87.7 and 76.5-82.4%, respectively. The undoubted advantages of ultrasound are the non-aggressiveness of the procedure and the absence of ionizing radiation, and therefore it can be used repeatedly without harm to the health of the patient (for example, the study of dynamics). Low cost and efficiency, availability and high throughput make the ultrasonography procedure indispensable in the clarification of screening and diagnosis, which is an essential requirement of modern medicine insurance. Disadvantages of Echography It is impossible to distinguish between bone structures, greater operator dependence, and reliance on ultrasound scanner selection.
Thus, each of the above research methods has its own advantages and disadvantages, and only their complex use, as well as comparing the anamnesis and clinical symptoms with data obtained during the instrumental evaluation. , significantly reduced knee joints. Improves the quality of diagnosis of pathological changes.
In clinical practice, the subjective assessment of their condition of the patient itself, as well as the effects of the disease on quality of life and professional activities, is insignificant, resulting in the use of various questionnaires. and questionnaire. WOMAC, ICRS, Goldberg, SF-36 scales are widely used for such surveys to assess the effects of pathology on the patient's condition. The most commonly used KOOS measure (result score for knee injury and osteoarthritis) in sports medicine practice to assess knee joint function is called E. Roos (Department of Orthopedics, Lund University Hospital, Sweden). The KOOS scale combines the features of WOMAC, SF-36 scales and allows you to assess the degree of pain syndrome, affected joint damage and the effects of pain on the patient's quality of life. A unique feature of the KOOS scale is the possibility of self -assessment of the effects of disease on sporting activities.
An objective study of the influence of ongoing pathological processes on the functional condition of the knee joints in athletes enables modern research methods such as biomechanical testing. The Biodex System 4 Pro System (USA) makes it possible to estimate the strength properties of parathyroid muscles, however, due to the high cost of equipment, the use of this method has not yet found wide application. In the modern literature, there is work on the use of electronic dynamometry after surgical treatment of knee joints, the degree of violation of the muscle strength properties of paracetamol during recovery, and the criteria for effectiveness after surgery. Rehabilitation of players is being prepared. However, we did not find data on the use of this method in chronic degenerative processes, in particular, posttraumatic chondropathy of the knee joints.
Purpose of the study: Demonstration of the effect of posttraumatic chondropathy on active knee joint function in team sports athletes.
Materials and methods. The study included 98 players from team sports (football, handball, volleyball) with a history of knee joint injuries of various athletic abilities (from the first adult category to MSMK). The average age of the players was 25.8 x 7.2 years. Sports experience — 12 ± 4 years.
A comprehensive evaluation of all athletes was conducted: a survey with a KOOS questionnaire, a medical examination, an ultrasound examination of the knee joint, and a two-way isokinetic examination of the flexible/extensor muscle of the joint. of the knee.
The condition of the hyaline cartilage of the knee joints was assessed by ultrasonography. The study was carried out on a Toshiba, Samsung SonoScape R3 device using a high-frequency linear sensor with a frequency of 7.510.0 MHz. The structure and thickness of the hyaline cartilage of the femoral condyles of the injured knee joint were assessed with the calculation of the index of degenerative
cartilage thinning (hereinafter referred to as IDI). The main areas for assessing the thickness and structure of the femoral cartilage were the loading surface in the longitudinal infrapatellar projection in the position of flexion at the knee joint at an angle of 90° and the posterior surface of the femoral condyles in the longitudinal (medial and lateral) popliteal projection. IDI was calculated by the ratio of the thickness of the hyaline cartilage of the loaded surface to the thickness of the cartilage of the posterior surface of the femoral condyle. Structural changes in hyaline cartilage were assessed according to a classification close to the ICRS (International Cartilage Repair Society), based on the classification of Outerbridg (1961), supplemented and modified for ultrasound diagnostics. Ultrasound criteria for the diagnosis of post-traumatic chondropathy of the knee joint were a diffuse increase in echogenicity, an uneven, fuzzy contour, and thinning in the loaded sections of the femoral condyles.
We used magnetic resonance imaging as a reference method. MRI study was performed on a Siemens 1.5 Tc Magnetom Symphony device (Germany) using the pd + T2 TSE, pd TSE fs, T1 TSE, T2 me2d programs in the axial, coronal and sagittal planes with a slice thickness of 3 mm. The results of MRI examination of the knee joints were carried out in 10 athletes and compared with the data obtained during the ultrasound examination. Comparison of data from ultrasound and magnetic resonance imaging showed the comparability of methods in identifying changes in articular cartilage.
To analyze the relative diagnosis of an injured knee joint condition, athletes themselves used a scale to estimate the consequences of knee joint injuries and pain.
KOOS consists of five sub-sections: "Pain", "Symptoms", "Difficulty Performing Daily Activities at Home", "Sports, Recreational Activities", "Quality of Life". According to the digital value from 0 (favorable condition, absence of score) to 4 (worst case, maximum intensity of score), taking into account the maximum value for each of them, the indicators are calculated and normalized.
To assess the functional condition of knee joints in athletes with post-traumatic chondropathy, isokinetic dynamics of the leg flexor/extensor muscle were used using the Biodex System 4 Pro System (USA). The study was conducted according to the following protocol: isokinetic mode of operation, bilateral testing at angular speeds of 60°, 180°, 300, the number of repetitions was 5, 10 and 15, respectively. For an overall analysis, the peak torque body weight (PVM / BT) ratio was used. Prior to the start of the trial, athletes were trained to work with the Biodex System 4 Pro system, warm-ups, individual patient stability analyzes in the chair, and system calibration procedures. Examination began on the affected knee joint. The results obtained from the dynamometry were compared with similar indications of intact feet. Diagnosis criteria: 10% loss - minor, no correction required. 25% — moderate deviation, rehabilitation is recommended to improve muscle balance,> 25% — significant functional impairment, requires active treatment.
The reliability of the difference between the data processing and the results obtained was assessed according to the student's CT test.
Results of the study and their discussion. Ultrasound data revealed a disproportionate increase in echogenicity in 61.2% of cases (60 people), an uneven contour of hyaline cartilage on the main surface of the femoral condyles of the injured knee joint. In 16.3% of cases (16 people), these structural changes were not accompanied by thinning (from 0.85 to 1 IDI), in 44.9% (44 people), in addition to structural changes, thinning of the cartilage in its more severe part. The condyles showed the femur (IDI ranging from 0.55 to 0.75).
According to the results of a comprehensive analysis, all athletes were divided into two groups: group 1 (n=60)
— athletes diagnosed with post-traumatic chondropathy of the knee, group 2 (n=38) — athletes diagnosed with post-traumatic chondropathy. There are no painful changes in the knee joints. Both groups of athletes were asked to complete the Knee Injury and Disease Questionnaire (KOOS). After calculating and normalizing the indicator, we obtained the following data: the value of the «pain» subscale in the main group was 72.3±15.3, in the comparison group 79.5±10.2% «Symptoms» -54.8±8.4 and 74.7±7.6. , respectively. "Difficulties in doing daily household chores" -81.9 ± 12.2 and 85.8 ± 5.6 "Sport. Health-improving activity»
- 57.8 ± 8.7 and 69.6 ± 7.9 «Standard of life» - 62.3 16.6 and 71.7 ± 5.8 «Final index» - 65.8 ± 11 and 76 .3 ± 5.9.
The importance of statistical treatment and variance was assessed using Student's t-test. The results of statistical processing are shown in table 1.
As can be seen from the table. 1, differences in sub-level values such as "illness", "symptoms", "sports". Active recreation», «quality of life» and final scores on the KOOS scale between the groups analysis is significant in statistical terms (t> trp_= 1.96). The effect of posttraumatic chondropathy on the sub-scale value of "difficulty in performing daily tasks at home" was not statistically significant (Mgr. = 1.96). The data obtained indicate a negative impact of post-traumatic chondropathy on the functional condition of the knee joints in athletes, as evidence of significant differences in sub-scale values of "pain", "symptoms", "sports", "Final score on Active Laser", "Quality of Life" and KOOS scale.
Using isokinetic dynamometry as a test result on the muscle strength capabilities of the leg flexors / extensors in athletes with post-traumatic chondropathy of the knee joint, we obtained the following data: Average PVT / VT values (% Extensors of damaged / the intact legs at speed 60 were 179.8 ± 42.6 and 220.6 ± 53.2, respectively, at speed 180 ° — 123.5 ± 40.5 and 141.9 ± 46.7, at speed 18 ± 3 - 6. 93.4 35.5 The average AVT / VT values (%) of injured / intact leg flexors at speed 60 were 94.8 ± 20.3 and 108.8 ± 24.2, respectively, 180 ° - 59.3 ± 17.7 and 64 8, 64 8. ° - At speeds of 38.5 ±
14.3 and 40.6 ± 15.2.
At 60 speed, the average value of the deficit in leg extension strength is 18%, at 180 speed it is 13%, at 300 speed it is 7%. Flexible - 12%, 8%and 5%, respectively.
The results of digital indicators of power characteristics and processing of statistical data are presented in the table. 2.
Thus, we have revealed lower power capabilities of the flexor-extensor muscles of the injured knee joint compared to the intact limb in athletes with post-traumatic chondropathy at all tested speeds. Statistical processing of the data obtained showed significant differences in the power characteristics of the knee extensor muscles at the angular speeds of 60° and 180° and the flexor muscles at the angular speed of 60° (tcr>tgr=1.96). Differences in strength indicators of extensor muscles at an angular velocity of 300° and flexors at an angular
velocity of 180° and 300° are not significant (tcr>tgr=1.96).
Conclusions. Data obtained from ultrasonic examination of hyaline cartilage in these athletes who have suffered knee joint injuries indicate a slow degenerative process of post-traumatic chondropathy in the injured knee joint. The incidence of post-traumatic knee joint chondropathy was 61.2% of the total number of athletes we reviewed who suffered knee joint injuries.
During the study, we revealed the negative impact of posttraumatic chondropathy of the knee joint on the relative assessment of the active condition of the knee joints of the athletes themselves, which was confirmed by the results of the questionnaire and the result obtained. Significant differences in the values of «pain», «symptoms», «sports». Final assessment on "Active Fun", "Quality of Life" and KOOS scale.
Examination of the strength characteristics of the flexible / extensor muscles of the knee joints in athletes with posttraumatic chondropathy showed significant differences in high-angle test speeds, confirming deficiencies in strength at 60% to 18% test speed. Occurs from And considered moderate.
Thus, the identified chronic processes of deterioration in injured knee joints in athletes negatively affect their functional status and require an initial complexity of treatment rehabilitation measures.
Name/number 1 group (М±а) 2 group (М±а) t- statistics (Р=0,95, V-1,96)
1. Pain 72,3±15,3 79,5±10,2 2,6
2. Symptoms 54,8±8,4 74,7±7,6 9,4
3. Difficulty performing daily activities 81,9±12,2 85,8±5,6 1,05
4. Sport. Leisure activities 57,8±8,7 69,6±7,9 4,07
5. The quality of life 62,3±16,6 71,7±5,8 3,76
6. Final index 65,8±11 76,3±5,9 3,16
Table 1
Values of indicators of KOOS subscales of the studied groups
REFERENCES
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Tested muscle group / tested angular velocity Extensors PVM/VT(%) tkr=1,96 р=0,95 Flexors FDA/VT(%) tkr =1,96 р=0,95
defeat (X±a) intact (X±a) defeat (X±a) intact (X±a)
60° 179,8±42,6 220,6±53,2 6,4 94,8±20,3 108,8±24,2 3,4
180° 123,5±40,5 141,9±46,7 2,7 59,3±17,7 64,8±20,3 1,6
300° 86,4±33,1 93,4±35,5 1,1 38,5±14,3 40,6±15,2 0,8
Table 2
Strength characteristics of leg flexor/extensor muscles in athletes with post-traumatic chondropathy of the knee
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ЛИТЕРАТУРА
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2. Khamidov OA, Urozov UB, Shodieva NE, Akhmedov YA. Ultrasound diagnosis of urolithiasis. Central Asian journal of medical end natural sciences. 2021;2(2):18-24.
3. Khamidov OA, Yakubov DZh, Ametova AS, Bazarova SA, Mamatova ShT. Application of the ultrasound research method in otorhinolaryngology and diseases of the head and neck organs. International journal of development and public policy. 2021;1(3):33-37.
4. Khamidov OA, Yakubov DZh, Ametova AS, Turdumatov ZhA, Mamatov RM. Magnetic resonance tomography in diagnostics and differential diagnostics of focal liver lesions. Central Asian journal of medical end natural sciences. 2021;2(4):115-120.
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Статья поступила в редакцию 01.02.2021; одобрена после рецензирования 11.02.2022; принята к публикации 15.03.2021. The article was submitted 01.02.2021; approved after reviewing 11.02.2022; accepted for publication 15.03.2021.
Информация об авторах:
Умаркулов Забур Зафаржонович — ассистент кафедры медицинской радиологии ФПДО Самаркандского государственного медицинского института, Самарканд, Узбекистан. E-mail: radiologyuz@gmail.com
Мамасолиев Баходир Мамаюсупович — Травматолог-ортопед хирургического отделения узловой железнодорожной больницы на станции Самарканд, Самарканд, Узбекистан. E-mail: boxamed@mail.ru
Information about the authors:
Umarkulov Zabur Zafarjonovich — Assistant at the department of medical radiology FPE, Samarkand state medical institute, Samarkand, Uzbekistan. E-mail: radiologyuz@gmail.com
Mamasoliev Bakhodir Mamayusupovich — Traumatologist-orthopedist of the surgical department of the nodal railway hospital at Samarkand station, Samarkand, Uzbekistan. E-mail: boxamed@mail.ru Источники финансирования: Работа не имела специального финансирования.
Конфликт интересов: Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи.
