Knee Pain – Ghutno Ke Dard Ka ilaj

Ozone and Its Properties

• 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, which strongly condition inflammatory reactions.
• Reactive oxygen species enhance the oxygen supply to tissues.

Therapeutic Uses of Ozone

• 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.
  • Raising the pain threshold.
• The marked anti-inflammatory properties of ozone reduce:
  • Edema.
  • Joint swelling.
  • Compression on nerve root structures.
• Ozone favors tissue hyperoxygenation following increased vascularization due to neoangiogenesis, improving local tissue trophism and the inhibitory capacity of inflammatory metabolites.

Knee Anatomy

• The knee is the intermediate joint of the lower limb.
• It mainly operates with one degree of freedom—flexion-extension—with a second accessory degree of freedom: rotation around the longitudinal axis of the leg (occurs only when the knee is flexed).
• The knee works in compression, under the effect of gravity.
• It consists of two refined joints:
  1. The inferior distal face of the femur with two distinct joint regions and articular parts.
  2. The superior proximal face of the tibia, which meets the femur with two articular parts.
• The knee also has a femoral-rotular (or patellar) joint.
• During flexion, the knee is particularly exposed to injury to the ligaments and meniscus.
• In extension, joint fractures or ligament ruptures are more common.

Indications for Ozone Therapy

• Knee Pain:
  • 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 diseases due to overloading.
  • Conditions include:
    • Patellar tendinitis.
    • Synovitis during inflammatory arthritis.
    • Bursitis.
    • Knee pain caused by joint cartilage degeneration (femoral-rotularchondropathy).
    • Knee pain following surgery.

Procedure for Ozone Therapy

• The patient is placed in a supine position with the knee in extension.
• The patella’s medial margin is pressed to subluxation in the lateral margin to increase the articular rim.
• A 21G needle is inserted along the superolateral margin of the patella (to the superior third).
• After ensuring asepsis and aspiration, 10-15 cc of the gas mixture is injected slowly at variable concentrations (not exceeding 25 µg/ml).
• The patient is invited to perform some flexion-extension movements of the knee to better distribute the drug throughout the joint.

Understanding Knee Pain

• The knee is one of the largest and most complex joints of the human body, consisting of numerous muscles, bones, cartilages, ligaments, and tendons.
• Most knee joint pains are due to muscle, tendon, or ligament injuries resulting in edema, inflammation, and joint swelling.
• Common causes include minor joint injuries, obesity, inflammation, and osteoarthritis.
• Painkillers are often used but can lead to gastrointestinal changes and gradual resistance.
• Intra-articular steroids may cause side effects due to high doses and the risk of infection when injected into the joint.
• Severe osteoarthritis may necessitate knee replacement, which is an expensive and painful procedure.

Benefits of Ozone Therapy

• Ozone is the treatment of choice for many painful syndromes affecting the joints, muscles, and tendons.
• Its anti-inflammatory properties reduce edema, joint swelling, and compression on nerve roots.
• Increased oxygen from ozone injections can produce hormone-like substances that relieve inflammation and reduce pain.
• Ozone therapy can promote the regrowth of cartilages and menisci, addressing major pain sources.
• Ozone is injected into the skin and subcutaneous tissue with minimal pain using a small 27G needle.
• Very rarely, it needs to be injected into the joint.
• Patients require only a few minutes of rest before going home.
• Several sessions may be needed depending on the extent of the disease and the nature of the response.
• Ozone therapy for knee pain is effective, economical, and a safe procedure that requires minimal hospital stay.