Ozone is a highly soluble gas with great oxidizing activity. In contact with biological fluids ozone forms lipid oxidation products and reactive oxygen species. These substances react with white blood cells triggering the production of cytokines, proteins strongly conditioning inflammatory reactions, and red blood cells enhancing the oxygen supply to tissues
Ozone is used to treat many painful syndromes affecting the joints, muscles and tendons even when peripheral neurological impairment is present . Its painkilling mechanism is thought to be based on stimulation of the anti-nociceptive apparatus mediated by endogenous opioids and serotonin thereby raising the pain threshold. In addition, the marked anti-inflammatory properties of ozone reduce edema, joint swelling and compression on nerve root structures. Ozone favors tissue hyper oxygenation following increased vascularization due to neoangiogenesis improving local tissue trophism and the inhibitory capacity of inflammatory metabolites
The knee is the intermediate joint of the lower limb. It is mainly a joint with only one degree of freedom – flexion-extension – even though it also has a second accessory degree of freedom: rotation around the longitudinal axis of the leg which occurs only when the knee is flexed. The knee essentially works in compression, under the effect of gravity. Even though the knee joint has a good mobility under the considerable body load it must sustain, it is composed of two refined joints (one could say three). The first is the inferior distal face of the femur with two distinct joint regions and articular parts and the superior proximal face of the tibia which meets the femur with two articular parts. This anatomical arrangement suggests two separate joints each working independently and placed parallel to one another. The second joint composing the knee is the femoral-rotular (or patellar) . During flexion, an unstable position, the knee is particularly exposed to injury to the ligaments and meniscus. In extension, when the knee is in a highly stable joint position, joint fractures or ligament rupture are more common
Indications for Ozone Therapy
Pain may be invalidating and progressive,
Exacerbated by movement (while walking or going up and down stairs).
Swollen knee reflects the synovial membrane reacting to joint inflammation
Inflammatory disease due to overloading,
Synovitis during inflammatory arthritis, bursitis, knee pain caused by joint cartilage degeneration due to femoral-rotularchondropathy, knee pain following surgery.
The patient is placed in a supine position with the knee in extension. After having located the patella its medial margin is pressed to subluxation in the lateral margin to increase the articular rim as much as possible. A 21G needle is inserted along the superolateral margin of the patella (to the superior third). After through sepsis and aspiration, 10-15 cc of the gas mixture is injected slowly at variable concentrations depending on the disease and in any case not more than 25 µg/ml. The patient is invited to perform some flexion-extension movements of the knee to better distribute the drug throughout the joint including the recesses.
Knee is one of the largest and complex joint of human body with lots of muscles, bones, cartilages, ligaments and tendons. Most of knee joint pains are due to muscle, tendon or ligament injuries resulting in edema, inflammation and joint swelling. Mostly they are due to minor joint injuries, obesity, inflammation and osteoarthritis. Pain killers are mostly used which result in GIT changes and gradual resistance. Intra articular steroids are used with lot of side effects due to high dose steroids and infection introduced as steroids are injected into the joint compromising its integrity. Sever osteoarthritis can end up in knee replacement which is very expansive and painful procedure.
Ozone is the treatment of choice for many painful syndromes affecting the joints, muscles and tendons. The marked anti-inflammatory properties of ozone reduce edema, joint swelling and compression on nerve roots. Increased amount of oxygen due to ozone injections can produce hormones like substances which not only relieve inflammation but also result in reducing pain. It can cause regrowth of cartilages and menisci which can be major reason for pain.
Ozone is injected in skin and sub cutaneous tissue with minimal pain with the help of small 27G needle. Very rarely it needs to be injected into joint. It needs few minutes of rest and then patient can go back home. Few sessions may be needed depending upon extent of disease and nature of response. Ozone therapy for knee pain is effective, economical and safe procedure which takes less time and minimal hospital stay.