Ahlbäck's disease

Synonyms

Ahlbaeck’s disease

definition

The term Ahlbäck M.

General

The reasons for the occurrence of M. Ahlbäck are based in most cases on one inferior blood circulation the lower part of the thigh. They are mainly affected by this disease Older people. So far, hardly any cases of M. Ahlbäck have been observed in childhood or adolescence. In addition, it can be seen in everyday clinical practice that the affected patients are predominantly Women over the age of 60 acts. In M. Ahlbäck it occurs in the course of the disease Fractions (Fractures) des necrotic bone tissue. This has in the long run a severe deformation of the upper articular surfaces of the Knee joint result. On the basis of the bone changes, the affected patents can bad posture come, which in severe cases even the entire Body axis affect.

Causes of Ahlbäck's disease

The exact cause of the occurrence of M. Ahlbäck has not yet been conclusively clarified. What is certain, however, is that a circulatory disorder in the area of ​​the lower thigh bone leads directly to death (necrosis) of the bone tissue that forms the joints. The exact reason for this circulatory disorder is not yet clear.

Read more about this under Osteonecrosis in the knee

Both so-called traumatic (caused by an accident) and non-traumatic causes are currently being considered. In the case of bone necrosis of the thigh caused by an accident, for example, the damage to the smallest blood vessels can disrupt the supply of the bone tissue to such an extent that nutrients and other substances cannot be adequately supplied and the bone tissue dies. In addition, experts assume that the occurrence of Ahlbäck disease through long-term use of cortisone-containing substances (during steroid doping or drug treatment) can lead to the development of Ahlbäck disease. Furthermore, regular consumption of alcohol and / or nicotine should also be considered as possible causes.
Studies of the patient groups suffering from M. Ahlbäck have shown that this form of bone necrosis occurs particularly frequently in patients who suffer from congenital circulatory disorders. A connection between these circulatory disorders and the development of Ahlbäck disease cannot therefore be ruled out. In addition, at this point in time it can be assumed that there is a connection between various hemophilia and the development of M. Ahlbäck.In elderly affected patients, it is assumed that misalignments of the lower half of the body (so-called genu varum; bowleg) can lead to an overuse-related circulatory disorder and thus to Ahlbäck disease.

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Symptoms

The symptoms of M. Ahlbäck are correct unspecific and can cause a number of diseases of the Joints or the bone. In the early stages In many cases the M. Ahlbäck even runs completely symptomless. This fact makes both an early diagnosis and a prompt initiation of therapeutic measures difficult. Ahlbäck disease is symptom-free in the majority of the affected patients until the first destruction of the bone tissue occurs. With the beginning of the destruction of the bone structures involved in joint development, pain only occurs heavy physical exertion on. At this point, very few patients experience symptoms Resting conditions perceived. Even when inspecting (looking at) the Knee joint From the outside, no changes whatsoever can be perceived in the early stages.
However, over time, the affected patients develop progressively more Joint effusionsthat lead to a strong mobility of the Kneecap (Phenomenon of dancing patella) to lead. After direct pressure on the kneecap, it begins to swing up and down on the effusion. In addition, many of those affected give a pronounced Tenderness at the Inside of the knee joint gap on. In the further course of the Ahlbäck muscle, pain in the knee joint, some of which is severe, suddenly occurs. In contrast to the early stages of the disease, this pain also occurs after a while under resting conditions. In addition, many patients also report these pain phenomena at night perceive. The joint effusions, which are initially invisible from the outside, also increase significantly over time and become strong swelling perceptible. In the case of very pronounced forms of the M. Ahlbäck there is even a limitation of the normal range of motion of the knee joint.

diagnosis

The diagnosis of Ahlbäck's disease proceeds in several steps. The most important of these steps is the detailed one Doctor-patient conversation (anamnese), in which the description of the symptoms observed by the patient can provide an initial indication of the underlying disease. Are particularly important in this context previous accidents or other known Injuries. The treating specialist then conducts an extensive physical examination by. In the course of this examination, not only the sick knee but all adjacent joints are examined. Even during the examination of the affected knee joint, the phenomenon of the dancing patella can indicate the presence of a Joint effusion Clues.
The actual diagnosis of Ahlbäck's disease then proceeds rather than exclusion other possible diseases of the knee joint that can cause similar symptoms. In order to narrow down the cause of the complaints further, in most cases the production of X-rays arranged in different levels (from the front, from the side, etc.). The problem in connection with M. Ahlbäck is the fact that bone changes such as the loss of bone substance only occur in the advanced stage can be proven. An important warning sign in the X-ray, however, is the so-called Sclerotherapy. This means that at the boundary between healthy and dead bone tissue, a strengthening of the bone becomes apparent.
M. Ahlbäck can usually only be able to do this in the early stages by making a magnetic resonance imaging (MRI of the knee) can be safely diagnosed. Characteristic for M. Ahlbäck in the MRT is a visible bone marrow edemawhich is the main reason for the pain associated with this condition. Furthermore, a Bone density measurement be performed. This procedure is necessary for a osteoporosis (Bone decline as a result of a systemic disease) as a possible cause of the joint problems. Should the suspected diagnosis “M. Ahlbäck “can be confirmed with the help of a Knee reflection (Knee arthroscopy) the exact stage the disease can be assessed.

therapy

The success of the treatment and thus the prognosis of Ahlbäck's disease are generally better, the earlier the disease can be recognized as such. The therapy of M. Ahlbäck is basically divided into so-called conservative (i.e. non-operative) and operative measures. The non-surgical treatment methods include above all those measures that improve the symptoms of the respective patient. In order to alleviate the pain caused by the Ahlbäck disease, various pain relievers (analgesics) can be taken. The treating physician should choose the appropriate pain reliever depending on the severity of the pain. For the time being, the affected patient can help himself with light drugs such as ibuprofen and paracetamol. However, since inflammatory processes also occur in the course of the Ahlbäck disease, taking the additional anti-inflammatory ibuprofen often appears to be more sensible. In addition, the attending physician will order various general measures in a first treatment step. These measures include, among other things, the protection of the affected knee joint through relief, sports leave and the temporary use of forearm crutches. In addition, taking bisphosphonates to stimulate bone formation is the first measure for M. Ahlbäck. In general, all therapy methods should serve to stimulate the dead bone tissue to regenerate and thus to increase the stability in the knee joint. In the early stages of Ahlbäck's disease, the so-called "hyperbaric oxygen therapy" (HBO for short) is particularly promising. With the help of this method, a natural healing reaction can be demonstrably stimulated, especially in relatively young patients. In addition, this can be done after successful hyperbaric oxygen therapy Observe the ingrowth of new blood vessels into the joint-forming thigh bones. The hyperbaric oxygen therapy is quite simple. The patient suffering from Ahlbäck's disease inhales pure oxygen in a pressure chamber at high ambient air pressure. In this way, the so-called oxygen partial pressure in the tissue is increased and the Healing of the bone stimulated.Despite the excellent treatment results, hyperbaric oxygen therapy in M. Ahlbäck is still not financed by the statutory health insurances be heard. With this treatment method for the Ahlbäck disease, short, high-energy current impulses are directed into the affected knee joint. The shock wave therapy can have both metabolism-enhancing and regenerative effects on the dead bone tissue.
The regeneration of the knee joint is also in the foreground in the surgical treatment methods of Ahlbäck disease. Various measures are used to provoke a healing reaction in the affected bone tissue and to restore the stability of the knee joint. In patients with Ahlbäck's disease in the early stages and / or with a minor extent of the bone necrosis, the so-called conversion osteotomy is the surgical method of choice. This procedure relieves the part of the joint space that points towards the center of the body. In addition, the affected knee can be drilled in the course of the Pridie drilling and in this way the new formation of cartilage can be stimulated. In most cases, this method is no longer an option for patients with an advanced course of the disease. Alternatively, a sled prosthesis (surface replacement of the knee) can be used. Depending on the extent of the Ahlbäck disease, a decision can be made as to whether only half of the knee joint (unicondylar sledge prosthesis) or even both halves (bicondylar resurfacing) need to be replaced.

Read more about this under Hyperbaric oxygen therapy

Prognosis of Ahlbäck's disease

The prognosis for patients suffering from Ahlbäck's disease is quite different. Depending on Age of onset and stage des M. Ahlbäck, different results can be achieved with a suitable treatment. In addition, the prognosis also differs for the individual therapy methods. Ultimately, however, in most patients, at least one can be achieved through the insertion of an artificial knee joint good care guaranteed.