Loose Bodies in Joint

The occurrence in joints of a variety of types of loose bodies has long been recognized. Practically every joint in the body has been reported as containing such bodies, but they are most frequently found in the knee joint.

The loose bodies have been classified according to their composition. But it should be understood that the majority of these are either rare or of little clinical significance as they are nothing more than a minor manifestation of some other disease.

For practical purposes, the differential diagnosis usually rests between osteoarthritis loose bodies, synovial chondromata and loose bodies associated with osteochondritis dissecans or osteochondral fracture.

Still here are the causes for completion of the list

Classification of Loose Bodies in Joint

Fibrinous

Composed of fibrinous material or of necrotic synovial membrane

• Traumatic -after haemorrhage
• Pathological
  • Tuberculosis
  • Rheumatoid arthritis
  • Osteoarthritis

Cartilaginous

These loose bodies are composed entirely of hyaline cartilage

• Intra-articular fractures
• Separation of whole or part of intra-articular fibro-cartilaginous meniscus

Osteocartilaginous loose bodies

• Osteochondral fractures of femoral condyles and patella
• Pathological
  • Detachment of portion of articular surface from osteochondritis dessicans
  • Synovial chondromatosis
  • Pigmented vilonodular synovitis
  • A detachment of osteophytes in:
    • Osteoarthritis
    • Neuropathic joints
    • Separation of sequestra in tuberculosis

Miscellaneous

• Introduced foreign bodies
• Lipoma
• Angioma
• Secondary carcinoma, etc.

Loose bodies in joint are fragments of cartilage or bone that freely float inside the knee joint space.

Loose bodies can occur due to an injury or due to general wear and tear over time.

There can be a single or multiple loose bodies depending on the severity of the condition

A loose body is said to be stable if they do not move about inside the joint or unstable if they float through the inside of the joint.

The loose bodies can vary in size from a few millimeters to a few centimeters.

Clinical Presentation of Loose Bodies in Joint

Loose bodies in the joint can hinder the joint moment as they get caught in movements.

by getting caught in flexion and extension movements..  The fragments can lead to damage to the articular cartilage, causing osteoarthritis.

The patient complains of painful movements or feeling of something moving in the knee. The joint may get locked or blocked causing e pain or loss of motion.

Imaging

Xray would reveal the loose body. It may throw some light on contributing joint pathology.

MRI helps to locate and tells about the type of loose body in joint. It would also tell about the disease process that is responsible for the formation of a loose body. It is a useful tool to see the size, number, and location of the loose bodies.

Treatment of Loose Bodies in Joint

Nonsurgical means have a minimum role in the management of loose bodies. In case of the mobile loose body, wait and watch could be applied to wait for the loose body to move out of joint and become asymptomatic.

Intra-articular fractures need to fix anatomically. The causative disease like tuberculosis would require medical treatment.

Physical therapy and anti-inflammatory drugs can be used to help with the symptoms and to keep the joint flexible.

Surgery offers permanent relief, the bodies should be removed when d the general condition of the patient permits.

Generally, loose bodies would require surgical removal, either arthroscopic or through open surgery.