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Loose body - internal derangement in the knee
 An internal derangement because of a loose body can occur in the elbow, knee, hip, ankle and subtalar joints. Most frequently it is seen in the arthrotic knee.
There is a very typical history which mostly is more important than the clinical image itself.
Loose bodies can be manipulated by means of a traction-rotation maneuver.
Loose body - internal derangement in the knee
Internal derangement from a loose body in an osteoarthrotic joint is, from middle age onwards, quite common, particularly at the medial side. The correct diagnosis, however, is less frequently made, because medical imaging only shows the osteoarthrosis but not the loose fragment(s).
The history is swelling and local pain for no apparent reason. Either the patient notices it on waking, or suddenly each step starts to hurt when walking ; one can expect sharp twinges, possibly with giving way, especially when descending stairs.
Most often, the pain is medial, sometimes lateral or right inside the knee, but it is never diffuse in the entire knee ; it may also move from one side to the other.
Besides the osteoarthrosis and a slight traumatic arthritis, the examination shows mainly the clinical pattern of a ligamentous lesion, although there has been no real trauma. Cyriax called this image "a sprain without a sprain" ; in other words, the lesion is intrinsic instead of extrinsic, it has taken place inside the joint.
The signs may vary according to the position of the fragment. One usually finds :
warmth and fluid
flexion slightly more limited than usually (in normal situations the flexion is already slightly limited because of the osteoarthrosis), with pain felt medially
positive tests for the medial collateral ligament (extension, valgus strain, tenderness at the joint line)
possible pain medially on varus strain (this can be explained as a "space-occupying lesion").
(Part I ; Part II, p9-10, 22-24, 27-28, 39-40)
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