Spontaneous osteonecrosis of the knee: what do we know so far? A literature review

Sibilska, Aleksandra; Góralczyk, Adrian; Hermanowicz, Krzysztof; Malinowski, Konrad

doi:10.1007/s00264-020-04536-7

Cited by 30 publications

(30 citation statements)

References 47 publications

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“…On MRI scans, findings such as bone marrow edema, subchondral crescent linear focus on T1-weighted and potentially T2-weighted sequences, focal epiphyseal contour depression, or subchondral low signal may suggest the presence of SIFK. 8,22,38 Subchondral bone marrow edema in SIFK can lead to subchondral collapse and secondary OA, often requiring major knee surgery such as osteotomy or arthroplasty. 14,38 In addition, other studies have reported a relationship between the size of BMLs and subchondral collapse.…”

Section: Discussionmentioning

confidence: 99%

“…8,22,38 Subchondral bone marrow edema in SIFK can lead to subchondral collapse and secondary OA, often requiring major knee surgery such as osteotomy or arthroplasty. 14,38 In addition, other studies have reported a relationship between the size of BMLs and subchondral collapse. 15,27 We decided to use the MOAKS BML grade classification system for follow-up of bone marrow because MOAKS allocates BMLs into grades 0 to 3 according to the percentage of volume of each BML.…”

Section: Discussionmentioning

confidence: 99%

“…8 During disease progression, MRI findings such as further progression of bone marrow edema, subchondral cyst formation, focal epiphyseal contour depression, and lines of low signal intensity deep in the affected condyle can be found. 22,38 The relationship between subchondral BMLs and postoperative outcomes after knee surgery has been a topic of great interest in recent years. 16,32,35 However, to the best of our knowledge, it is still unknown how BMLs change after OWHTO in patients who have SIFK-dominant OA with varus malalignment.…”

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confidence: 99%

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The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures

et al. 2021

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Background: Subchondral insufficiency fracture of the knee (SIFK) is characterized by a subchondral lesion that may lead to end-stage osteoarthritis (OA). In patients who have SIFK in a precollapse state with varus malalignment, a joint-preserving technique such as open wedge high tibial osteotomy (OWHTO) should be considered. Purpose: To evaluate the efficacy of OWHTO in primary OA and SIFK-dominant OA by clinical and radiological evaluations including magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence 3. Methods: A total of 33 SIFK-dominant OA knees and 66 with primary OA that underwent biplanar OWHTO between March 2014 and February 2016 were included after 1:2 propensity score matching. The MRI Osteoarthritis Knee Score was used to assess bone marrow lesions (BMLs) preoperatively and at follow-up. The weightbearing line ratio, the hip-knee-ankle angle, and the joint line convergence angle were measured. The clinical outcomes assessed were range of motion, the American Knee Society Score, and the Western Ontario and McMaster University (WOMAC) score. Results: The mean follow-up period was 41.2 ± 12.6 months. The distribution of preoperative BML grade in the SIFK-dominant OA group was significantly higher in both the femur and tibia ( P < .001 and <.001, respectively) than that in the primary OA group. However, the difference was not significant postoperatively (femur, P = .425; tibia, P = .462). In both groups, postoperative BMLs showed significant improvement compared with preoperative BMLs (primary OA [femur, P < .001; tibia, P = .001] and SIFK-dominant OA [femur, P < .001; tibia, P < .001]). The WOMAC pain score was higher in the SIFK-dominant OA group preoperatively (primary OA, 7.0 ± 3.73; SIFK-dominant OA, 9.17 ± 2.6; P = .032) even though it was not different at the final follow-up (primary OA, 2.11 ± 1.7; SIFK-dominant OA, 1.79 ± 1.32; P = .179). Conclusion: OWHTO is an effective procedure not only for primary OA but also for SIFK-dominant OA. OWHTO can improve BMLs, which represent the main pathological feature of SIFK. Therefore, in patients who have SIFK with varus malalignment, OWHTO can be an attractive treatment option for preserving the joint and enhancing subchondral bone healing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures

et al. 2021

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“…These first two stages are diagnosed by magnetic resonance imaging (MRI) as significant changes are not detectable on plain radiographs. The third and fourth stages are classified as the 'crescent sign' and the collapse of the subchondral bone, respectively (8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

“…The early diagnosis in the first two stages is important as conservative therapy is usually effective 11,13 . The most frequently used diagnostic criteria on MRI are an area of bone marrow edema in affected condyle associated with subchondral bone changes (4,5,9,(13)(14)(15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

Metaphyseal Burst Sign; The First Case Report of Subchondral Insufficiency Fracture of the Knee in Iran

Noktehsanj

Aslani

Hosseininejad

et al. 2020

ircmj

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Metaphyseal burst sign, which is soft tissue edema in the metaepiphyseal region, is defined as a novel initial sign of subchondral insufficiency fracture of the knee (SIFK). We reported the first Iranian case of the SIFK in femoral medial condyle characterized by a metaphyseal burst sign which could be an early sign of the SIFK. Early diagnosis and treatment could dramatically relieve the sign and symptoms of patients with significant improvement of the MRI scan.

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Development of Tri‐Layered Biomimetic Atelocollagen Scaffolds with Interfaces for Osteochondral Tissue Engineering

Cao

Yang

et al. 2022

Adv Healthcare Materials

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The development of biomimetic scaffolds containing cartilage, calcified cartilage, and bone regeneration for precise osteochondral repair remains a challenge. Herein, a novel tri‐layered scaffold—with a top layer containing type II atelocollagen and chondroitin sulphate for cartilage regeneration, an intermediate layer with type II atelocollagen and hydroxyapatite for calcified cartilage formation, and a bottom layer with type I atelocollagen and hydroxyapatite for bone growth—that can be built using liquid‐phase cosynthesis, is described. The tri‐layered scaffolds are mechanically demonstrably superior and have a lower risk of delamination than monolayer scaffolds. This is due to higher cohesion arising from the interfaces between each layer. In vitro results show that although monolayer scaffolds can stimulate bone marrow stem cells to differentiate and form cartilage, calcified cartilage, and bone separately (detected using quantitative polymerase chain reaction analysis and staining with safranin‐O and Alizarin Red S), the tri‐layered scaffolds support the regeneration of cartilage, calcified cartilage, and bone simultaneously after 2 and 4 months of implantation (detected using gross and micro‐computed tomography images, histological staining, and Avizo, a software used to detect microlevel defects in metals). This work presents data on a promising approach in devising strategies for the precise repair of osteochondral defects.

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Spontaneous osteonecrosis of the knee: what do we know so far? A literature review

Cited by 30 publications

References 47 publications

The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures

The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures

Metaphyseal Burst Sign; The First Case Report of Subchondral Insufficiency Fracture of the Knee in Iran

Development of Tri‐Layered Biomimetic Atelocollagen Scaffolds with Interfaces for Osteochondral Tissue Engineering

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