pathology: ahlbäck disease

yogabook / pathology / morbus ahlbäck

Definition

Ahlbäck’s disease, named after the first person to describe it in 1968, is a rare acute aseptic femoral condyle necrosis caused by a deficiency in the supply of blood, which predominantly affects women over the age of 60. It occurs bilaterally in 7% of cases. The prevalence is estimated at 9.4% of all women with knee pain over the age of 65. 80% of cases require arthroplasty, less than 20% heal or stop before the need for arthroplasty. As the clinical picture is similar to that of a meniscus lesion, Ahlbäck’s disease can easily be overlooked or recognised too late. Typically, inadequate arterial blood supply leads to the deficiency.
The medial condyle is usually affected. According to Koshino, it can be divided into 4 stages:

  1. sichtbar nur in MRT und Szintigraphie
  2. leichte Aufhellung im Röntgen
  3. deutliche Sichtbarkeit im Röntgen
  4. Einbrüche, Deformitäten

In stage 4, sintering fractures are present, which deform the joint surface and impair joint function accordingly. Aglietti divides it into 5 stages radiographically. The scintigraphy is usually conspicuous 1-2 months after the onset of symptoms, the MRI from 6 months, the X-ray even later. Cases that are recognised and treated early can heal completely and, in principle, any stage can resolve. As the disorder is usually localised medially, this results in increasing varicosity of the knee joint up to the O-leg. It is characterised by the sudden onset or rapid worsening of initially diffuse pain from apparent knee health. There is currently no standardised conservative treatment.

Ursache

  1. traumatic
  2. ischaemic

Prädisponierend

  1. Cardiovascular diseases
  2. Metabolic disorders such as diabetes mellitus
  3. Obesity
  4. Hyperlipidaemia, hypercholesterolaemia
  5. Hyperuricaemia (gout)
  6. Haematological diseases such as coagulation disorders, haemolytic anaemia
  7. Gonarthrosis
  8. Fractures near the knee joint
  9. Meniscus damage
  10. axial misalignments (X-legs, O-legs)
  11. Tumours or their chemotherapy
  12. alcohol abuse
  13. prolonged steroid treatment
  14. Some other diseases such as SLE, Caisson’s disease (diver’s disease), radiation sickness, Gaucher’s disease

Diagnosis

  1. Sonography shows joint effusion
  2. X-ray excludes other bone events and shows the extent of the damage, but the X-ray is often only conclusive at a late stage
  3. MRI detects the damage at an earlier stage
  4. Tests and signs: Pässler rotational compression test,

symptoms

  1. Usually unilateral and often sudden knee pain, usually medial, more rarely lateral, which can worsen rapidly
  2. Sometimes joint effusion
  3. Sometimes restricted mobility
  4. pressure tenderness of the knee joint, usually mainly medial
  5. Often progressive development of O-legs
  6. Initial stiffness
  7. Pain on exertion and gait changes due to pain avoidance
  8. Muscle atrophy due to avoidance of exertion
  9. possibly rest pain
  10. Joint blockage, if applicable

Complications

  1. Need for partial or total joint replacement

Therapy

  1. Therapy depends on the prognosis (stage, relative and absolute size of the lesion, according to Aglietti), conservative in the initial stage: relief, for example with crutches, orthosis
  2. Infusions to promote blood circulation
  3. Analgesics, anti-inflammatory drugs
  4. Off label if necessary: bisphosphonates
  5. If necessary, puncture of the joint cavity against the effusion
  6. In 40% of cases, the disease is progressive and requires a sled prosthesis or TEP
  7. no intra-articular corticosteroid injections!
  8. pulsating magnetic field therapy
  9. If necessary repositioning osteotomy
  10. Exercise therapy with strength training of all relevant muscles
  11. Stretching training of all relevant muscles
  12. Early recognition and treatment makes healing likely. Restitutio ad integrum is possible.
  13. After healing, especially low-impact sports such as swimming, cross-training, cycling, hiking, yoga

External links

https://www.springermedizin.de/emedpedia/detail/orthopaedie-und-unfallchirurgie/morbus-ahlbaeck?epediaDoi=10.1007%2F978-3-642-54673-0_4
https://scidok.sulb.uni-saarland.de/bitstream/20.500.11880/33058/1/DASONK%20Word.%2008.06.2022%20ohne%20Lebenslauf.pdf
https://flexikon.doccheck.com/de/Morbus_Ahlb%C3%A4ck