Title : Painful knee osteoarthritis & Iliotibial Band Syndrome (IBS), new approach
Abstract:
OA can be viewed as structural and functional failure of synovial joints, the pathophysiological response of a synovial joint to mechanical insult, and the attempt of the joint to repair the damage, therefore, thinking about OA is moving from biochemistry of the particular cartilage to the mechanobiology of the whole joint.
The hallmark symptom of knee OA is pain yet the etiology of pain in OA is not entirely clear.
It is clear that the severity of the joint damage on the radiograph bears little relation to the severity of the pain experienced.
According to multiple researches and articles the most prevalence and consistent signs from all the MRI findings in painful knee osteoarthritis are active effusion/synovitis and large bone marrow lesions BML (often associated with effusion and some degree of synovitis) suggesting these features may indicate the main aetiopathology of painful knee osteoarthritis compared with patients with no symptoms.
As well as the high incidence of iliotibial band friction syndrome ITBS and advanced medial compartment knee osteoarthritis with genu varum, this is due to cartilage loss associated with advanced degeneration of the medial meniscus led to reduced medial knee joint space created a varus knee deformation, and thus putting extra tension into the iliotibial band (Vasilevska s`group & Farell et al.), this alter bio mechanic may contribute to the development of painful fibro vascular tissue between ITB and lateral epicondyle.
Accordingly to presence or not of effusion/synovitivit we simply attribute the aetiopathology of pain in symptomatic knee OA into intra articular pathology with presence of effusion/synovititis or extra articular & periarticular pathology (iliotibial band syndrome) with no effusion/synovitis and different methods of treatment, after thorough history, clinical, radiological examination and always ultrasound with power Doppler scan we divide patients into two groups:
- (Wet KOA) Patients with signs of effusion/active synovitis and or MRI finding of large bone marrow lesion, BML (often associated with moderate effusion/synovitis) if visible, the ateiopathology is an intra-articular one and to be treated accordingly.
- (Dry KOA) Patients with no signs of effusion/active synovitis the aetiopathology is extra articular & periarticular one, (most probably iliotibial band friction syndrome) which is treatable.
Keywords: Osteoarthritis; Wet knee; Dry knee
