Bone marrow lesions and subchondral bone pathology of the knee

Kon, Elizaveta; Ronga, Mario; Filardo, Giuseppe; Farr, Jack; Madry, Henning; Milano, Giuseppe; Andriolo, Luca; Shabshin, Nogah

doi:10.1007/s00167-016-4113-2

Cited by 105 publications

(113 citation statements)

References 89 publications

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“…However, this analysis failed to prove significant correlations amongst the diagnostic techniques applied. This result is in line with the current literature reporting on difficulties to establish a correlation between diagnosed BML, pain, and MRI findings [7,9]. An explanation for these difficulties may be differences in the dynamics when the diagnostic techniques are applied.…”

Section: Correlationssupporting

confidence: 91%

Zoledronic acid is more efficient than ibandronic acid in the treatment of symptomatic bone marrow lesions of the knee

Müller

Appelt

Meier

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to determine the efficacy and tolerability of different antiresorptive therapeutic regimens for treating symptomatic bone marrow lesions (BML) of the knee. Methods Patient records of 34 patients with radiologically diagnosed, painful BML of the knee treated with either a bisphosphonate (zoledronic, ibandronic, or alendronic acid) or with a human monoclonal antibody (denosumab) were retrospectively evaluated. Response to treatment was assessed, as change in patient-reported pain, by evaluation of BML expansion on MRI using the Whole-Organ Magnetic Resonance Imaging Score (WORMS), and by laboratory analysis of bone turnover markers: C-terminal cross-linking telopeptide (CTx) and procollagen type 1 amino-terminal propeptide (P1NP). Tolerability was evaluated by documentation of adverse reactions. Results Zoledronic acid was more or at least equally effective as the other treatment regimens with response to treatment in 11 of 12 patients (92%). The highest rate of adverse events was noted in 4 of 12 patients (33%) treated with zoledronic acid. CTx and WORMS differentiated well between responders and non-responders, whereas P1NP failed to do so. Changes in pain correlated moderately with change in WORMS (r = − 0.32), weakly with change in CTx (r = − 0.07), and not at all with change in P1NP. Conclusion Zoledronic acid appeared to be more effective than other antiresorptive medications-at the cost of more frequent adverse events. While radiological and laboratory evaluation methods may allow for objective treatment monitoring, they appear to capture different dimensions than patient-reported pain. Level of evidence III. Keywords Bone marrow lesion • Bone marrow oedema • Transient osteoporosis • Bone bruise • Bisphosphonates • Biphosphonate • Antiresorptive medication • Bone turnover marker • Magnetic resonance imaging (MRI) Abbreviations BML Bone marrow lesion CTx C-terminal cross-linking telopeptide GFR Glomerular filtration rate MRI Magnetic resonance imaging P1NP Procollagen type 1 amino-terminal propeptide VAS Visual analogue scale WORMS Whole-organ magnetic resonance imaging score

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Section: Correlationssupporting

confidence: 91%

Zoledronic acid is more efficient than ibandronic acid in the treatment of symptomatic bone marrow lesions of the knee

Müller

Appelt

Meier

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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“…9 The cellular processes associated with BMLs have implications for the mechanical integrity of the tissue. [11][12][13] Bone turnover, local inflammation, and consequent bone attrition all translate into loss of mechanical integrity, subchondral bone collapse, rapidly progressive cartilage loss, and joint deterioration. 6,9,11,14,15 Clinically, BMLs have been correlated to signs of joints surface deformation and increased symptoms of knee pain.…”

mentioning

confidence: 99%

Are Subchondral Intraosseous Injections Effective and Safe for the Treatment of Knee Osteoarthritis? A Systematic Review

et al. 2019

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Knee osteoarthritis (OA) is a highly prevalent disease and treatment options for early stages of OA are needed. Intraosseous injections of bone substitute and biologic materials have been proposed to expand the therapeutic arsenal by potentially halting OA progression and delaying the need for knee arthroplasty in patients with early/moderate-stage disease. Therefore, the goal of this study was assessed the efficacy and safety of subchondral intraosseous injection for the treatment of knee OA. A systematic review was performed on PubMed-Medline, and the Cochrane Database of systematic reviews. English and Spanish retrospective and prospective studies assessing the results of subchondral intraosseous injection of bone substitute materials and/or biologicals in human patients with knee OA, with a minimum of 6 months of follow-up were collected. A total of 1,081 potential articles were identified through our search. Six studies were included with a total of 163 patients. The mean follow-up was 18 months (range: 6–24 months). Patient reported outcomes measures (PROMs), complications, and conversion to total knee arthroplasty (TKA) were collected. All six studies showed PROMs improvement relative to baseline. Overall, the five studies reporting visual-analog scale (VAS) pain outcomes improved from a baseline mean score of 6.68 to 2.74. Also, knee injury and osteoarthritis score (KOOS), Tegner-Lysholm, and/or international knee documentation committee (IKDC) scores rose compared with baseline scores in all studies. Overall, 2.5% (4/163) of patients had a complication attributed to study-related treatment. Most patients (81%, 86/106) remained TKA-free at a 1-year follow-up. Subchondral intraosseous injections of bone substitute materials and platelet-rich plasma (PRP) suggest (1) improved PROMs of pain and functional status, (2) low complication rate, and (3) relatively low rates of conversion to TKA. However, the current studies investigating these treatments exhibited high degree of heterogeneity in both measurement of outcomes and delivery of treatment, with a high risk of bias. This procedure should not be utilized in advanced knee OA. In light of the limitations of the current literature, advising in favor or against this therapy for early to moderate knee OA is challenging.

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“…Early injuries with no evidence of cartilage injury may, on occasion, be reversible similar to early subchondral bone injury in the horse. 23 A study in humans with bone marrow lesions in the knee 24 who underwent SCP for the MRI lesions associated with osteoarthritis found that 88% of patients reported improvement in pain following the procedure and 92% of patients did not need to move on to a total knee arthroplasty at the 2-year follow-up. 24 Another study in 2016 14 evaluating patients that underwent SCP in conjunction with arthroscopy found a significant improvement in pain and function scores in these patients, with 70% of these patients no longer requiring a total knee arthroplasty at the 2-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Novel Bone Substitute Injection Technique for Potential Treatment of Impact Injury to the Equine Palmar Metacarpal Condyle

Rice

Brokken

Hostnik

et al. 2019

Vet Comp Orthop Traumatol

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Objective The aim of this study was to evaluate the injection of a bone substitute material (BSM) into an impact lesion in the palmar condyle of the third metacarpal bone. Study Design This was an in vivo controlled study performed on six horses. Materials and Methods Medial metacarpal condyles were exposed via arthrotomy and a compressive lesion created in anaesthetized horses using 80 psi (27.6 MPa) onto the articular surface (n = 12). Paired limbs were randomly selected as a control or for extra-articular injection of BSM towards the subchondral bone near the compressive lesion. Parameters of the surgical techniques and BSM distribution outcomes were evaluated using magnetic resonance imaging analysis, histology and histomorphometry. Results Injection of the BSM required significant pressure, as well as the use of a pilot hole. The BSM was visible in all magnetic resonance imagings in treatment limbs. Post-impact treatment limbs had greater average grey scale values than controls (p = 0.041), and greater average grey scale values than pre-impact treatment limbs (p = 0.004). Histology demonstrated haemorrhage and microfractures at the site of compression with no evidence of bone disruption from BSM injection. Conclusion Injection of BSM into the dense subchondral bone of the equine palmar condyle could be targeted to a site of injury, distributed subchondrally and without further injury to bone or cartilage. Clinical Significance This procedure has potential for the treatment of clinical impact injury or osteoarthritis in horses, and long-term studies are warranted.

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Bone marrow lesions and subchondral bone pathology of the knee

Cited by 105 publications

References 89 publications

Zoledronic acid is more efficient than ibandronic acid in the treatment of symptomatic bone marrow lesions of the knee

Zoledronic acid is more efficient than ibandronic acid in the treatment of symptomatic bone marrow lesions of the knee

Are Subchondral Intraosseous Injections Effective and Safe for the Treatment of Knee Osteoarthritis? A Systematic Review

Evaluation of a Novel Bone Substitute Injection Technique for Potential Treatment of Impact Injury to the Equine Palmar Metacarpal Condyle

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