Prevalence of undiagnosed subchondral insufficiency fractures of the knee in middle age adults with knee pain and suspected meniscal tear

Huizinga, Jamie L.; Shah, Nidhi; Smith, Stacy E.; Notino, Anthony; Kluczynski, Melissa A.; Jordan, Kelly; Bisson, Leslie J.; Chen, Antonia F.; Selzer, Faith; Losina, Elena; Katz, Jeffrey N.

doi:10.1016/j.ocarto.2020.100089

Cited by 11 publications

(19 citation statements)

References 14 publications

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“…Physical examination reveals tenderness in the affected area, and joint effusion is commonly observed [7,8,[18][19][20]. These symptoms are sometimes similar to other medical conditions, including meniscus and cartilage injuries [17,21,22].…”

Section: Clinical Presentationmentioning

confidence: 99%

Subchondral insufficiency fracture of the knee: review of current concepts and radiological differential diagnoses

et al. 2021

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Subchondral insufficiency fracture of the knee (SIFK) is a common cause of knee joint pain in older adults. SIFK is a type of stress fracture that occurs when repetitive and excessive stress is applied to the subchondral bone. If the fracture does not heal, the lesion develops into osteonecrosis and results in osteochondral collapse, requiring surgical management. Because of these clinical features, SIFK was initially termed “spontaneous osteonecrosis of the knee (SONK)” in the pre-MRI era. SONK is now categorized as an advanced SIFK lesion in the spectrum of this disease, and some authors believe the term “SONK” is a misnomer. MRI plays a significant role in the early diagnosis of SIFK. A subchondral T2 hypointense line of the affected condyle with extended bone marrow edema-like signal intensity are characteristic findings on MRI. The large lesion size and the presence of osteochondral collapse on imaging are associated with an increased risk of osteoarthritis. However, bone marrow edema-like signal intensity and osteochondral collapse alone are not specific to SIFK, and other osteochondral lesions, including avascular necrosis, osteochondral dissecans, and osteoarthritis should be considered. Chondral lesions and meniscal abnormalities, including posterior root tears, are also found in many patients with SIFK, and they are considered to be related to the development of SIFK. We review the clinical and imaging findings, including the anatomy and terminology history of SIFK, as well as its differential diagnoses. Radiologists should be familiar with these imaging features and clinical presentations for appropriate management.

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Section: Clinical Presentationmentioning

confidence: 99%

Subchondral insufficiency fracture of the knee: review of current concepts and radiological differential diagnoses

et al. 2021

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“…It would be costly and inefficient to obtain an MRI on all patients with knee pain in order to identify those with SIFK. The 3% prevalence of undiagnosed SIFK among adults with knee pain and suspected meniscal tear suggests that imaging select patients at high risk of SIFK may be useful for identifying these rare cases, especially given that early recognition is important for a better outcome [ 10 , 12 ]. Research is needed to identify clinical, demographic, and radiographic features of patients with knee pain who are at higher risk of SIFK.…”

Section: Suggestions For Future Researchmentioning

confidence: 99%

“…MRI was obtained by the study team as part of the research protocol to confirm meniscal tear before enrollment. The prevalence of SIFK in this study was 2.94% (95% CI, 1.15%, 4.71%), suggesting that approximately 3% of individuals with symptoms typically attributed to degenerative meniscal tear may actually have unsuspected SIFK [ 10 ]. As we shall discuss below, treatments for OA and suspected meniscal tear (such as exercise in full-weight bearing) may be contraindicated in SIFK, underscoring the importance of making the correct diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Perspective on subchondral insufficiency fracture of the knee

Zimmerman

Bisson

Katz

2021

Osteoarthritis and Cartilage Open

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“…However, nowadays, with the increasing number of older people, there is an everincreasing need for accurate assessment of knee pain in this population [4]. Plain radiographs are typically used as initial imaging to investigate knee pain in middle-aged and older patients [3]. Therefore, MRI should be considered for older people presenting with sudden-onset non-traumatic knee pain and normal radiographs to ensure that other less common diagnoses do not fail [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…The outcome of subchondral insufficiency fractures depends on several factors such as early fracture size, patient body mass index with a positive correlation with obesity, the severity of osteopenia, early diagnosis, and initial management [2,5]. These factors can influence the evolution of the lesion that can develop into osteonecrosis and osteochondral collapse, requiring surgical management, which makes us reflect on the importance of recognizing this entity to allow a correct therapeutic orientation, thus preventing a devastating outcome that could culminate in a long-term functional commitment [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Beyond Gonarthrosis in the Elderly: A Case Report of Subchondral Insufficiency Fracture of the Knee

Martins¹,

Araújo²,

Pinheiro³

et al. 2023

Cureus

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Subchondral insufficiency fracture of the knee (SIFK) is a non-traumatic condition that has been, historically, associated with the elderly. Early diagnosis and management are essential to prevent evolution to subchondral collapse and secondary osteonecrosis, developing prolonged pain and functional losses. This article presents the case of an 83-year-old patient with severe right knee pain with 15 months of evolution, with sudden onset, and no history of trauma or sprain. Upon observation, the patient presented with a limping gait, antalgic posture with the knee in semi-flexion, pain on palpation of the joint medial line, severe pain on passive mobilization, limited joint range of motion, and a positive McMurray test. The X-ray only demonstrated a gonarthrosis grade 1 in the Kellgren and Lawrence classification with medial compartment affection. Due to the exuberant clinical picture with marked functional compromise, as well as clinical radiological dissociation, MRI was requested to rule out SIFK, which was later confirmed. The therapeutic orientation was then adjusted with an indication for non-weight bearing and analgesia, as well as orientation to an orthopedics consultation to request a surgical evaluation.SIFK is difficult to diagnose and may have an unpredictable outcome due to delayed treatment approaches. This clinical case encourages clinicians to consider subchondral fracture in the differential diagnosis of knee pain when an older patient, with subnormal radiographic findings, reports severe knee pain in the absence of overt traumatic injury.

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Prevalence of undiagnosed subchondral insufficiency fractures of the knee in middle age adults with knee pain and suspected meniscal tear

Cited by 11 publications

References 14 publications

Subchondral insufficiency fracture of the knee: review of current concepts and radiological differential diagnoses

Subchondral insufficiency fracture of the knee: review of current concepts and radiological differential diagnoses

Perspective on subchondral insufficiency fracture of the knee

Beyond Gonarthrosis in the Elderly: A Case Report of Subchondral Insufficiency Fracture of the Knee

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