AYURVEDIC MANAGEMENT OF SPONTANEOUS OSTEONECROSIS OF THE KNEE- A CASE REPORT

Abstract

Spontaneous Osteonecrosis of Knee (SONK) is classically described as a focal, superficial subchondral lesion mainly involving the medial femoral condyle. The condition was first described by Ahlback in 1968 and pathology includes the necrosis of subchondral bone due to vascular insufficiency, with subsequent disruption of nutrition supply to the cartilages. The prognosis varies from complete recovery to progressive joint collapse. If detected early and the subchondral lesion is small, non-surgical management is appropriate. Through literature review the condition is understood as pathology of Asthimajjāgata vāta where the aggravated vāta invades the Asthi and Majja dhātu due to varied etiologies. In this case, a 47-year-old male was suffering from sudden onset of pain and swelling in the medial aspect of the left knee joint, which aggravated on prolonged standing, walking, climbing stairs, and also during night. Examination revealed tenderness at the medial femoral condyle. The diagnosis was based on clinical symptoms, radiographic and MRI findings. The case was considered and managed with treatment principle of Asthimajjāgata vāta. The treatment was done for 12 days with a combination of Pancakarma procedures (Sadyo Virecana with Eraṇda taila in milk and Yogabasti- Mustādi yāpana vasti with Guggulu Tiktaka ghrta anuvāsana), External therapies (Daśamūla kṣīradhāra, Nāgarādi lepa, Maṁjiṣṭādi lepa, Ellumniśādi lepa, Dhānyāmla dhāra, and Kāya seka with Kṣīrabala taila) and Oral Ayurveda medicines (Mahāmaṁjiṣṭādi kaśāya, Kaiśora guggulu, Gandha taila drops, Cap. Arjuna, Śāribādyāsava) resulted in significant improvement in symptoms of SONK. This case report provides a promising result for the successful management of SONK by incorporating the treatment principles of Asthimajjāgata vāta.