13.08.2009 Рентгенография коленного сустава. Патология надколенника.


Разряжение какое-то в нижней

Разряжение какое-то в нижней части, ближе к суст. пов-ти. Раскручивать надо, у меня даже версии нет Без КТ/МРТ не обойтись, пункция-биопсия, как-то так.


У меня определённой версии

У меня определённой версии тоже нет ((( Одни домыслы. Рекомендовал МРТ, посмотрим, если придёт.



 остеохондромаляция надколенника 


Остеохондромаляция один из

Остеохондромаляция один из основных домыслов, поэтому и заказал МРТ (подчеркнул что нужен аксиал. и сагиттальные срезы на надколенник; посмотреть хрящ). 


Не могу себе представить

Не могу себе представить очаговую остеомаляцию в надколеннике

В отсутствии высоких технологий (КТ/МРТ), определенную помощь, детализацию, могли бы дать боковая и аксиальная рентгенограммы надколенника. Это так, заметки на полях


Хондромаляция надколенника

Хондромаляция надколенника хорошо определяется на МРТ, пример:

Если это на самом деле хондромаляция, мы это увидим; если другой вариант (например опухоль), МРТ также будет методом выбора.

Chondromalacia Patella:

Chondromalacia literally means "softening of the cartilage", and Patellae means "the knee-cap". So Chondromalacia patellae means "softening of the articular cartilage of the knee-cap." The articular cartilage is the cartilage lining under the knee-cap that articulates with the knee joint. Under normal circumstances, it is smooth and shiny, so that it glides smoothly along the articular groove of the femur as the knee bends. When it "softens", it may break down, causing irregularities along the undersurface of the patella.

Problems commonly develop when the patella suffers wear and tear. The underlying cartilage begins to degenerate, a condition most common in young athletes. Soccer players, snowboarders, cyclists, rowers, tennis players, ballet dancers, and runners are affected most often. But anyone whose knees are under great stress is at increased risk of developing chondromalacia patella.

Wear and tear can develop for several reasons. Acute injury to the patella or chronic friction between the patella and the femur can result in the start of patellofemoral pain syndrome. Degeneration leading to chondromalacia may also develop as part of the aging process, like putting a lot of miles on a car.

The main cause of knee pain associated with patellofemoral pain syndrome is a problem in the way the patella tracks within the femoral groove as the knee moves. Physical and biomechanical changes alter the stress and load on the patellofemoral joint.

The quadriceps muscle helps control the patella so it stays within this groove. If part of the quadriceps is weak for any reason, a muscle imbalance can occur. When this happens, the pull of the quadriceps muscle may cause the patella to pull more to one side than the other. This in turn causes more pressure on the articular cartilage on one side than the other. In time, this pressure can damage the articular cartilage leading to chondromalacia patella.

Weakness of the muscles around the hip can also indirectly affect the patella and can lead to patellofemoral joint pain. Weakness of the muscles that pull the hip out and away from the other leg, the hip abductor muscles, can lead to imbalances to the alignment of the entire leg - including the knee joint and the muscle balance of the muscles around the knee. This causes abnormal tracking of the patella within the femoral groove and eventually pain around the patella. Many patients are confused when their physical therapist begins exercises to strengthen and balance the hip muscles, but there is a very good reason that the therapist is focusing on this area.

A similar problem can happen when the timing of the quadriceps muscles is off. There are four muscles that form the quadriceps muscle group. As mentioned earlier, the vastus medialis obliquus (the muscle on the inside of the front of the thigh) and the vastus lateralis ( the muscle that runs down the outside part of the thigh) are two of these four muscles. People with patellofemoral problems sometimes have problems in the timing between the VMO and the VL. The VL contracts first, before the VMO. This tends to pull the patella toward the outside edge of the knee. The result is abnormal pressure on the articular surface of the patella.

Another type of imbalance may exist due to differences in how the bones of the knee are shaped. These differences, or anatomic variations, are something people are born with. Doctors refer to this the "Q angle". Some people are born with a greater than normal angle where the femur and the tibia (shinbone) come together at the knee joint. Women tend to have a greater angle here than men. The patella normally sits at the center of this angle within the femoral groove. When the quadriceps muscle contracts, the angle in the knee straightens, pushing the patella to the outside of the knee. In cases where this angle is increased, the patella tends to shift outward with greater pressure. This leads to a similar problem as that described above. As the patella slides through the groove, it shifts to the outside. This places more pressure on one side than the other, leading to damage to the underlying articular cartilage.

Finally, anatomic variations in the bones of the knee can occur such that one side of the femoral groove is smaller than normal. This creates a situation where the groove is too shallow, usually on the outside part of the knee. People who have a shallow groove sometimes have their patella slip sideways out of the groove, causing a patellar dislocation. This is not only painful when it occurs, but it can damage the articular cartilage underneath the patella. If this occurs repeatedly, degeneration of the patellofemoral joint occurs fairly rapidly.

Diagnosis begins with a complete history of your knee problem followed by an examination of the knee, including the patella. X-rays may be ordered on the initial visit to your doctor. An X-ray can help determine if the patella is properly aligned in the femoral groove. Several X-rays taken with the knee bent at several different angles can help determine if the patella seems to be moving through the femoral groove in the correct alignment. The X-ray may show arthritis between the patella and thighbone, especially when the problems have been there for awhile.

Diagnosing problems with the patella can be confusing. The symptoms can be easily confused with other knee problems, because the symptoms are often similar. In these cases, other tests, such as magnetic resonance imaging (MRI), may be suggested. The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. This machine creates pictures that look like slices of the knee. Usually, this test is done to look for injuries, such as tears in the menisci or ligaments of the knee. Recent advances in the quality of MRI scans have enabled doctors to see the articular cartilage on the scan and determine if it is damaged. This test does not require any needles or special dye and is painless.

In some cases, arthroscopy may be used to make the definitive diagnosis when there is still a question about what is causing your knee problem. Arthroscopy is an operation that involves placing a small fiber-optic TV camera into the knee joint, allowing the surgeon to look at the structures inside the joint directly. The arthroscope allows your doctor to see the condition of the articular cartilage on the back of your patella. The vast majority of patellofemoral problems are diagnosed without resorting to surgery, and arthroscopy is usually reserved to treat the problems identified by other means.

There is no clear link between the severity of symptoms and X-ray or arthroscopic findings. Most often, the doctor relies upon the history, symptoms, and results of the examination.


Насколько видно на

Насколько видно на представленных рентгенограммах соотношения в суставе, положение надколенника (нет девиации кнаружи), угол между бедром и голенью, не похожи на изменения (нарушение соотношений), показанные в представленной Марио статье.







В передних отделах суставной

В передних отделах суставной щели (коленного сустава) зона слабо неоднородно сниженной прозрачности. Это не может быть признаком болезни Гоффа? - воспаления и ущемления жирового тела?  


Не, не думаю. На рентгене

Не, не думаю. На рентгене болезнь Гоффа не увидишь.


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