Assessment and Management of Loose Bodies in the Knee Joint and Related Disease: A Narrative Review

Abstract

Background: Loose bodies are frequently encountered during clinical activity and are a common finding during knee arthroscopy. Usually, treatment consists of the removal of loose bodies, which can be challenging even for experienced surgeons. The excision alone is not always the complete treatment, because loose bodies are generally secondary to other diseases that can cause persistent symptoms with the risk of new loose body formation. The aim of this narrative review is to show the clinical, imaging, and arthroscopic evaluation of loose bodies in order to plan optimal treatment.

Methods: A comprehensive search of PubMed was conducted to find the most recent and relevant studies investigating aetiopathogenesis, the assessment tools, and the therapeutic strategies for loose bodies in the knee and their related diseases.

Results: When dealing with a loose body, the first issue is the evaluation of the intra-articular fragment (location, size, number, symptoms) and its aetiopathogenesis by identifying the underlying pathology (e.g., osteochondritis dissecans, osteoarthritis, chondral defect, tumour-like lesions, rheumatoid arthritis, etc.). In the case of symptomatic intra-articular loose bodies, treatment consists of fragment removal and the management of related diseases (e.g.., lifestyle modification, physiotherapy, pharmacological, and surgical treatment).

Conclusion: Loose bodies are not separate entities and in addition to their pathological aspect, must be evaluated within the context of the underlying disease. Correct assessment and comprehensive management allow for relief of symptomatology and prevention of loose body formation by removal and treatment of the associated diseases.

Keywords: Loose bodies; chondral lesion; classification; knee arthroscopy; loose body removal; osteochondritis dissecans; synovial chondromatosis.