Tuberculosis of the knee

    • Tuberculosisof the knee
      • Tuberculosis of the knee
        • More commonly, the disease begins in the synovial membrane (synovial tuberculosis), leading to hypertrophy of the synovium.
        • In early stages, the disease may be confined to the synovium without significant damage to the joint.
        • In later stages, the articular cartilage and bone are destroyed irrespective of the site of origin.
        • Long standing distension of the joint and destruction of the ligaments produces subluxation of the tibia
        • The tibia flexes, slips backwards and rotates externally on the femoral condyles (triple subluxation). (A very common MCQ in AIPGMEE)
        • Healing is by fibrosis (fibrous ankylosis).(MCQ)
        • Presenting complaints:
          • The patient, usually in the age group of 10-25 years
          • presents with complaints of pain and swelling in the knee
        • Following findings may be present on examination:
          • Swelling
          • Muscle atrophy:
            • Atrophy of the thigh muscles is more than what can be accounted for by disuse alone.
          • Cold abscess
          • Sinus
          • Deformity:
            • In early stages, there is a mild flexion deformity of the knee because of effusion in the knee, and muscle spasm.
            • Later, triple   displacement   (flexion, posterior subluxation and external rotation) occurs due to ligament laxity..(MCQ)
            • The movements at the joint are limited.
        • Treatment –Operative procedures
            • Synovectomy:
              • It may be required in cases of purely synovial tuberculosis
              • Very often one finds ‘melon seed’ bodies within the joint. (A very common MCQ in AIPGMEE)
            • Joint debridement:
              • This may be required in cases where the articular cartilage is essentially preserved. The pus is drained, the synovium excised, and all the cavities curetted.
            • Arthrodesis:
              • In advanced stages of the disease with triple subluxation and complete cartilage destruction,   the  knee  is  arthrodesed  in functional position, i.e., about 5-10° of flexion and neutral rotation..(MCQ)
              • One popular method of knee arthrodesis is Charnley’s compression arthrodesis.(MCQ)

Knee Arthrodesis Per-op Picture
This short video show the degenerative changes in the articular surface of the knee joint. These changes has made the surgeon to go for knee arthrodesis surgery.
TB of the knee? DOTS can make you DANCE!
This young lad developed a painful swelling of his left knee three and a half years ago. He consulted four specialists who called for X-rays and gave medicines. But the condition worsened, he could not stand, walk long distances. He could not sleep at nights because of the pain. he could not bend his knee backwards. the muscles above and below the knee joint began to waste away. He had to stop working altogether for 3 months. When the doctor at ESI Hospital called for an MRI scan, it was diagosed to be tuberculosis and was referred to our TB center at Jagadgirigutta 6 months ago. The lad took his medicines regularly and has completed his treatment. He is now free from the swelling and pain, can walk without pain, can sleep peacefully, bend his knee backwards and is now even able to jump! He can even dance! He has resumed his job again. DOTS has blessed yet another person.
Knee Arthroscopic synovectomy (partial meniscectomy)
.Tear at body portion of left medial meniscus
2.R/O tear at anterior horn of left medial meniscus
3.Heterogenous increased SI of left anterior cruciate ligament
–R/O partial tear
4.Small amount of effusion in left knee joint
Triple arthrodesis