Dolore acuto non traumatico del ginocchio nell’adulto: ruolo della risonanza magnetica

Abstract

Acute nontraumatic pain in the adult knee can be seen in many settings, such as transient bone marrow oedema syndrome (TBMOS), regional migratory osteoporosis (RMO), spontaneous osteonecrosis (SONK) and insufficiency fractures. Early differentiation among them is crucial to avoid unnecessary treatment. TBMOS and RMO are considered to be self-limiting conditions without longterm sequelae. On the other hand, the clinical course of SONK is thought to be dependent on the size of osteonecrosis. Recent data suggest the term SONK is misleading one and should be replaced. Insufficiency fractures may demonstrate a similar clinical syndrome without a history of a single traumatic injury. The imaging pathway for knee pain has evolved considerably with the advent of magnetic resonance (MR) imaging, which is very sensitive in the early depiction of bone marrow oedema. Therefore, in patients with acute nontraumatic knee pain whose radiographs are negative or inconclusive, MR imaging is the method of choice for further evaluation. This article discusses the potential aetiologies and reviews MR imaging findings of the most common disorders afflicting the subchondral knee-joint area.

Spontaneous Osteonecrosis of the Knee: A Retrospective Analysis by Using MRI and DEXA

“…Kesemenli et al [21] noted that SONK is regarded as a microfracture. Fotiadis et al [1] also noted that osteoporotic joint subchondral bone can lead to bone fragility, causing repeated microfractures, and its accumulation finally leads to osteonecrosis.…”

“…There are many multifactorial pathogeneses of spontaneous osteonecrosis of the knee (SONK) which were derived from oeteoporosis and the continuous cycle, the repeated impact and stress on the subcondral bone [1]. These may induce microfracture, thus leading to subcondral insufficiency fracture [2-7] the prognosis of which is thought to be dependent on the lesion as detected in the MRI [8-12], few studies with the combination of BMD and MRI have been reported [13].…”

Bone bruise of the knee associated with the lesions of anterior cruciate ligament and menisci on magnetic resonance imaging

“…The terms: bone bruise, bone contusion and posttraumatic edema of the bone marrow have been seen for the last ten years in scientific literature and are in fact synonyms in the case of posttraumatic findings of bone marrow contusion. It must be emphasized however that edema of the bone marrow is not specific and that it can be present not only in trauma but also in infection, ischemia, migratory osteoporosis, early osteonecrosis, as a reaction to a neoplasm or even it can be idiopathic [2][3][4][5] . Sensitivity of MR imaging for detecting bone bruise of the knee is 83%-96% and specificity is 86%-96% 6 .…”

The Relationship between Osteoporosis and Osteoarthritis of the Knee: A Report of 2 Cases with Suspected Osteonecrosis

“…The former advocated that high BMD overloaded the knee joint surface, causing joint cartilage damage that induces joint space narrowing as if it were severe degeneration. The latter suggested that subchondral bone of osteoporotic patients was exposed to direct mechanical stress via joint cartilage, causing the cancellous bone surrounding the subchondral bone to change, implying microfracture and osteonecrosis [9] and leading to promotion of valgus deformity of the knee, such as through joint surface decompression [10]. Furthermore, it is also thought that SONK is a faulty union of the bone due to ischemic change [11].…”