Treating loose bodies in your knee

Loose bodies are free-floating fragments of bone, cartilage, or collagen in the knee. When these fragments get trapped between the articular cartilage surfaces of the knee bones (like the femur and tibia), they can cause symptoms such as:

intermittent joint locking,
limitation of motion,
knee pain and
sometimes swelling.

While most of the loose fragments “float” around the knee. Some get trapped. Loose bodies can become wedged into the synovium membrane and cause synovial inflammation of the knee

Most loose bodies however do not produce symptoms and are found incidentally on X-ray. In fact, the diagnosis of loose bodies is essentially based on X-ray findings because there is not one specific clinical finding.1

The diagnosis of loose bodies in the knee in one of our patients

Loose bodies in the knee were one of the reasons that “clean out” arthroscopies became so popular. Here is the story of just one patient.

Preoperative Diagnosis: loose joint body, left knee.

Postoperative Diagnoses:

Multiple loose joint bodies, left knee.
Torn medial meniscus.
Grade 3 changes of the patellofemoral joint, left knee.

Procedure Performed:

Video arthroscopy
partial medial meniscectomy
chondroplasty of the patellofemoral joint with the removal of multiple loose joint bodies, left knee.

Gross Findings:
A 51-year-old male who has developed a floating loose joint body around his left knee. This has been ongoing since the end of December, not associated with any traumatic event. Occasional loose joint body will catch patellofemoral joint and causes pain. He has had some swelling. X-ray showed a probable loose joint body in the medial gutter. Due to his failure to improve with conservative treatment, he elected to proceed with surgical intervention. Procedure complication, postoperative convalescence were explained in detail. He did elect to proceed.

Description of Procedure: The patient was taken to the operating room and general anesthetic was administered by the department of anesthesia. He was given 1g of kefzol intravenous piggyback prior to surgery. Left leg was elevated, exsanguinated (blood drain), and a pneumatic tourniquet was inflated to 300mmHg. Left leg was placed in a leg holding device. The left knee was sterilely prepped and draped in the usual fashion from the ankle to the leg holding device.

Surgery began with the insertion of the arthroscope through a lateral infrapatellar puncture site. The arthroscopic instruments were inserted through a medical infrapatellar puncture site. The arthroscopic pump was inserted through a medial suprapatellar puncture site. Examination of suprapatellar pouch revealed copious synovial fluid. There were multiple cartilaginous loose joint bodies floating around within the knee. There are grade 3 changes of the patellofemoral joint including the trochlea. An oscillating chondroplasty performed. The arthroscope was taken down through the medial gutter. I did not see any bony loose joint bodies, although there are a lot of cartilaginous loose joint bodies. . .

As you can see from this report, one of the post-operative diagnoses was multiple loose bodies, as well as a torn meniscus and patellofemoral joint grade 3 chondromalacia changes. This patient had many reasons to need Prolotherapy after this arthroscopy.

Cartilage damage beneath the kneecap (grade 3 is not quite bone on bone, but it is heading there) and a torn medial meniscus are successfully treated with Hackett-Hemwall Prolotherapy. (See the following pages Stem Cell Therapy regrows meniscus tissue and Treatment of Chondromalacia Patella.

You can see in the body of the report the orthopedic surgeon wrote, “I did not see any bony loose joint bodies, although there are a lot of cartilaginous loose bodies.”

What this means is the loose bodies were made of cartilage instead of bone. How did this occur? Most likely the person experienced the gradual deterioration of cartilage from poor tracking of the patella on the femur, and eventually, some of the cartilage particles became loose and went into the joint. It is our opinion that Prolotherapy could have stopped this process. Unfortunately, we saw this patient after arthroscopy instead of before the arthroscopy!

1. Bianchi S, et al. Detection of loose bodies in joints. Radiologic Clinics of North America; 2009; 37:679-690.