Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome

Kitajima

Case Reports in Orthopedics

et al. 2021

The changes occurring in knee osteoarthritis often cause alterations in the spinal loading condition, which further lead to degenerative changes. This close relationship of the knee and spine has been reported as knee-spine syndrome. A 60-year-old woman with Parkinson’s disease (PD; Hoehn-Yahr stage IV) had severe knee pain with moderate lateral osteoarthritis of the knee (Kellgren-Lawrence classification grade II). Conservative therapy had no effect at all, and the knee developed destructive osteoarthritis rapidly without any traumatic episodes. The radiographic findings progressed to Kellgren-Lawrence grade IV within a month. Magnetic resonance imaging revealed partial depression of the joint surface, including shredded ossicles and substantial amounts of synovial fluid. The imaging findings were considered to be caused by a subchondral insufficiency fracture (SIF). Total knee arthroplasty was performed using a semiconstrained prosthesis. The alignment of her lower extremity improved, and the patient could walk without knee pain. The patient had Pisa syndrome, a lateral flexion of the trunk, which is a postural deformity of the trunk secondary to long-standing PD. The postural deformity in PD is not based on spinal deformity itself but on the loss of postural reflexes and the imbalance of muscle tonus. Her left knee pain appeared 1 month after L1-L4 posterior lumbar interbody fusion (PLIF) as the Pisa syndrome to her left side worsened. The more the trunk tilts to the lateral side, the center of the gravity axis will shift and pass through more lateral points of the knee and result in higher knee load. The stress concentration from the spine to the lateral joint of the knee caused lateral knee osteoarthritis, namely, knee-spine syndrome. When patients undergo correction surgery for adult spinal disorder with impairment of postural reflexes, they need to be followed up carefully regarding not only the spinal alignment but also the lower extremities.

“…SIFs occur frequently at femoral heads or femoral medial epicondyles in osteoporotic older women [ 16 , 17 ]. A SIF often develops with minor trauma.…”

Section: Discussionmentioning

confidence: 99%

Rapid Destructive Arthropathy of the Knee in Parkinson’s Disease with Pisa Syndrome: A Case of Knee-Spine Syndrome

Kitajima

Case Reports in Orthopedics

et al. 2021

Revista Argentina de Radiología / Argentinian Journal of Radiol

“…Para esto se acude al tratamiento conservador con bifosfonatos, incluyendo oxigenoterapia hiperbárica y medidas de descarga, 9 en ocasiones la descompresión o resección focal, siendo este último utilizado incluso en estadio III complementándose con injertos óseos, debido a que el pronóstico es mejor cuando se aplican en estadios más precoces. 11 La enoxaparina puede prevenir la progresión de la ON con etiología de trombofilia o trastornos hipofibrinolíticos. 10 En los estadios avanzados, de III en adelante, el tratamiento de elección es la artroplastia total de cadera, especialmente en edades avanzadas, obteniéndose un buen resultado.…”

Section: Figunclassified

“…Al avanzar su estadio, estas lesiones osteonecróticas muestran cambios distales por una cicatrización deficiente, lo que genera reacción y formación de cartílago con tejido fibroso indicativo de retraso o falta de unión. 11 En RM en secuencia ponderada en T1, la intensidad de señal de la grasa de la médula ósea del cóndilo femoral afectado es reemplazada por un área con baja señal, asociada a una periferia de aún más baja señal (►Figs. 4 y 5).…”

Section: Osteonecrosis De Rodillaunclassified

“…6). 11 Tiene un buen pronóstico cuando el segmento que se afecta es pequeño o el tratamiento es adecuado (descarga completa de la pierna afectada asociado a analgésicos). En caso contrario, evoluciona a una artrosis grave de rodilla con dolor mecánico invalidante.…”

Section: Osteonecrosis De Rodillaunclassified

“…El hallazgo que más influye en la evolución, es el volumen de la zona condílea de carga que se ha afectado, siendo un pronóstico desfavorable al afectarse >50% del tamaño con tendencia al colapso óseo y artrosis secundaria. 5,11…”

Section: Osteonecrosis De Rodillaunclassified

See 2 more Smart Citations

No dejemos morir al hueso: interiorizándonos con los procesos óseos avasculares

Mena

Mendoza

Galván

et al. 2020

ResumenEl objetivo de este artículo es realizar una revisión de las localizaciones, causas y hallazgos radiológicos específicos de los procesos avasculares óseos.Se define como isquemia ósea a las alteraciones ocasionadas por déficit de irrigación, llevando a la destrucción del hueso. Existen diferencias entre necrosis isquémica e infarto óseo, en base al sitio óseo de afectación. La etiología traumática es la más frecuente y suele ser unilateral. Los sitios de presentación más frecuentes son: cabeza femoral y humeral, rodilla y semilunar.La resonancia magnética (RM) es considerada la modalidad de imagen más sensible y específica, tanto para el diagnóstico temprano como estadificación y control.El conocimiento de las causas, características radiológicas y sus diferentes fases evitan el diagnóstico erróneo de otras etiologías, como las primarias o infecciosas, facilitando un correcto algoritmo terapéutico.

Knee surg. sports traumatol. arthrosc.

More than 3 mm of preoperative medial meniscal extrusion is identified as a key risk factor for varus progression in limb alignment after arthroscopic repair of medial meniscus posterior root tear

Yoon,

Bae,

Ahn

et al. 2024

PurposeTo investigate the risk factors for varus progression after arthroscopic medial meniscal posterior root tear (MMPRT) repair and to compare the clinical outcomes between two groups: one with more varus progression and the other with less varus progression.MethodsPatients who underwent isolated arthroscopic repair of MMPRT between 2015 and 2020 were enroled, and 2‐year follow‐up data were collected. Participants were categorized into two groups based on preoperative values of the weight‐bearing line (WBL) ratio: group A with <5.9% increase and group B with ≥5.9% increase. Various factors, including demographic features and radiological findings, were analysed and compared between the two groups. Intra‐meniscal signal intensity, meniscal healing, medial meniscal extrusion (MME), and articular cartilage grade were assessed preoperatively and 1‐year postoperatively using coronal magnetic resonance imaging.ResultsThe final cohort consisted of 34 patients in group A and 46 in group B, with a mean age of 55.8 ± 11.2 and 59.8 ± 6.6 years, respectively. Preoperative WBL ratio and cartilage lesions in the medial compartment did not differ between the groups. Preoperative MME were significantly lower in group A than those in group B (2.6 ± 0.6 mm in group A and 3.5 ± 0.7 mm in group B, p < 0.05). Patient‐reported outcomes at the 2‐year follow‐up did not differ between the two groups (n. s.). In a logistic analysis, the odds ratio of MME was 2.1 (p < 0.05), and the cutoff value of MME was 3.02 mm.ConclusionPreoperative MME is a risk factor for varus progression. However, no differences in patient‐reported outcomes were observed at 2‐year follow‐up, even in the group with greater varus progression.Level of EvidenceLevel IV.