GOFFA DISEASE

From Big Medical Encyclopedia

GOFFA DISEASE (A. Hoffa, is mute. the surgeon-orthopedist, 1859 — 1907) — the lipomatous regenerations of fatty tissue of a knee joint causing disturbance of its function. Alate folds of a joint are damaged. As the independent disease is in detail described in 1904 by Goffoy. G. A. Valyashko (1932) entered wider concept about a traumatic lipoarthritis, allocating acute, subacute and hron, a stage. The last two combine the term «disease of Goffy».

The knee joint in subsynovial cellulose has a large amount of friable fatty tissue. Fatty accumulations are located in the form of layers under those departments of a synovial membrane where the joint bag covers the sites of a bone deprived of cartilaginous tissue. They fill free spaces between the muscular and copular device and the bone ends and carry out a role of shock-absorbers — reduce tension of a synovial membrane at the movements in a joint. In this fabric there are a lot of blood vessels, limf, vessels and nerves. Fatty accumulations play a large role in exchange processes.

Hron. Traumatization of fatty folds of a knee joint is observed at people whose profession is connected with long walking, sharp repeated squats, i.e. bystry bending and extension of a shin (acrobats, sprinters, ballet dancers, floor polishers, etc.). More often women of 20 — 40 years are ill.

At hron, an injury there is an aseptic inflammation of fatty folds, and the repeating hemorrhages in them cause their consolidation. The condensed folds often are restrained. As a result of it there is substitution of fatty tissue rough connecting fabric.

Clinical picture

Artropnevmogramma of a knee joint at a disease of Goffy: against the background of the joint of oxygen entered into a cavity the dense cellular sclerosed adipose body is contrasted (it is specified by an arrow).

The clinical picture is very characteristic. The patient is disturbed by joint pains, «crunch» at the movements, the palpation of a joint is painful in own ligament of a patella; the exudate in a joint is defined; at extension of a shin protrusion of two rollers on both sides of own ligament of a patella is characteristic, the movements in a joint are limited, especially during the bending. On an artropnevmogramma the sclerosed fatty folds are visible in the form of a dense cellular triangle (fig). Diagnosis is facilitated by existence of typical anamnestic data (a long injury of a joint or an overload its uniform movements).

Treatment

G.'s Treatment. begin with conservative actions: rest to 2 — 3 weeks, an immobilization a plaster or plastic splint, thermal procedures, bathtubs, semi-spirit compresses, fonoforez corticosteroid drugs across Martens (a hydrocortisone, Prednisolonum).

They remove hypostasis and improve blood circulation. Bystry to lay down. the effect is provided by injections of a hydrocortisone locally on 2 ml (50 mg) in 3 days 3 — 4 times. Lack of effect of conservative treatment, long periodic disability, pains, hypostasis of a joint and existence of rough changes on an artropnevmogramma (see. Artrografiya ) are the indication to operational treatment. An internal parapatellyarny section make an arthrotomy knee joint (see), audit and removal of the changed fatty folds that is prevention of arthrosis of a knee joint. Synovial membranes keep in such measure that it was possible to use them for closing of an internal wound. The careful hemostasis, and in the postoperative period — a puncture of a joint is necessary.

In the postoperative period early appoint remedial gymnastics; from the 2nd day — tension the four-head of a muscle, after a removal of sutures with 8 — the 9th day — bending and extension in a joint (lying in a bed); to 11 — the 12th day — walking by means of crutches, and then — with a stick, at the same time electrostimulation by the four-head of a muscle.

Forecast at G. always favorable, and after treatment patients are returned to the former work.

Prevention

G.'s Prevention. consists in elimination of the reason causing a disease: injury prevention by the correct performance of elements of dance and sports exercises; constant medical and pedagogical control at sports activities. The people who are constantly working on a lap (tsiklevshchik, etc.), shall put on the heated defenders.


Bibliography: Abidov T. X. and Voytekhovsky G. I. Diagnosis of a disease of Goff by method of a pnevmoartrotomografiya, Ortop, and travmat., JVs 2, page 67, 1968; In I am scarlet sh to about G. A. Znacheniye of fatty tissue at a bruise of a knee joint, an acute traumatic lipoarthritis, in the same place, No. 5-6, page 7, 1932, bibliogr.; In about l to about in M. V. and B of ia d N and I. A N. Damages of adipose bodies of a knee joint at ballet dancers and their treatment, Kazansk. medical zhurn., No. 2, page 41, 1974, bibliogr.; Martens A. S. About use of a fonoforez of a hydrocortisone at treatment of injuries of joints and their effects at athletes, Ortop, and travmat., No. 4, page 69, 1965; The Guide to orthopedics and traumatology, under the editorship of M. V. Volkov, t. 2, page 660, M., 1968, bibliogr.; Stamatin S. The closed damages and diseases of a knee joint, page 174, Chisinau, 1971; H about f f an A. Zur Bedeutung des Fettgewebes fur die Pathologie des Knie-gelenks, Dtsch, med. Wschr., S. 337, 388, 1904

M. V. Volkov, I. A. Badnin.

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