The importance of early diagnosis in spontaneous osteonecrosis of the knee — A case series with six year follow-up

Jordan, Robert W.; Aparajit, Prasad; Docker, Charles; Udeshi, U. L.; El-Shazly, M

doi:10.1016/j.knee.2016.04.005

Cited by 14 publications

(17 citation statements)

References 27 publications

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“…To the authors’ knowledge, this is the first report of serial imaging with MRI in SONK. The evolution of findings in the current case is similar to previously reported follow-up imaging such as in one report ( 16 ) where a subchondral cyst had developed at nine months, similar to the appearance of the current case at five months. In another study (17), initially mild findings such as in the current report eight months later had progressed into an impression fracture in the femoral condyle, illustrating the importance of not neglecting early mild changes.…”

Section: Discussionsupporting

confidence: 90%

MR appearance of the temporal evolution and resolution of spontaneous osteonecrosis of the knee: a case report

Geijer

Juréus

Hänni

et al. 2017

Acta Radiologica Open

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Spontaneous osteonecrosis of the knee (SONK) is a feared condition of unknown cause, in its classic form appearing in the medial femoral condyle in middle-aged or elderly subjects. Diagnosis with radiography is notoriously difficult with a long latency before typical changes appear. Magnetic resonance imaging (MRI) is regarded as a diagnostic tool with the possibility to give an earlier diagnosis with improved chances for treatment. However, also with MRI there may be an initial diagnostic blind spot before typical changes appear. Little is known about the temporal evolution of the MRI changes. In the current case report, a case of SONK is reported where serial imaging with MRI was performed, from initial symptoms to eventual resolution after almost three years.

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Section: Discussionsupporting

confidence: 90%

MR appearance of the temporal evolution and resolution of spontaneous osteonecrosis of the knee: a case report

Geijer

Juréus

Hänni

et al. 2017

Acta Radiologica Open

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“…Obesity [17,24], sex [17,24] or the presence of BME were not associated with poorer prognosis. Contradictory ndings were reported for age [17], meniscal extrusion [19] and lesion size [7,17,27,31].…”

Section: Prognostic/risk Factorsmentioning

confidence: 91%

“…The MRI-based criteria used for the differential diagnosis of SONK were found to be heterogeneous. While some authors screened images for speci c features, such as focal hypointense areas on T1-or T2-weighted images, visible fracture lines or focal epiphyseal contour depressions [7,[13][14][15][16][17][18][19][20][21][22][23][24], others diagnosed SONK in the presence of bone marrow edema (BME) accompanying typical symptoms [25][26][27]. Two case reports radiologically demonstrated the primary overlay of fracture lines by BME [28,29].…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Spontaneous Osteonecrosis of the Knee: a Systematic Review of Conservative Treatment Approaches

Lair¹,

Fink

Csapo

2021

Preprint

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Background: Spontaneous osteonecrosis of the knee (SONK) is an insufficiently defined disease. Although recent research suggests that SONK may be caused by subchondral insufficiency fractures, its precise etiology remains unclear. Currently, no therapeutic guidelines exist.Purpose: This systematic review aimed to collate the scientific literature on conservative treatment approaches for SONK and to derive respective recommendations.Methods: The PUBMED database was searched for relevant articles published until November 2020. All articles in German or English language dealing with the conservative therapy of SONK were included. Animal research studies and reviews were not considered. Studies that used specific treatment outcomes as inclusion criterion and those that lacked a conservative treatment group, magnetic resonance imaging-based diagnosis, reported outcomes of conservatively managed patients or basic descriptions of the treatment modalities were excluded.Results: Twenty-two articles comprising a total sample size of 521 patients were included. Eighteen of the included studies (82%) tested the effects of some form of restriction of weight-bearing, bisphosphonates or a combination of both. Sixteen studies (73%) reported clinical and/or radiological improvements. However, outcomes varied considerably in dependency of the radiologic presentation, demography and further prognostic factors.Conclusion: Many conservative therapy methods appear effective in the treatment of orthopedic syndromes classified as SONK, with the most robust evidence existing for restriction of weight-bearing and bisphosphonates. The heterogeneity of radiologic presentations and treatment outcomes suggests that the generic term SONK might obscure the presence of different underlying pathologies. Indeed, many lesions may represent subchondral fractures, which should be referred to as subchondral fractures of the knee (SFK). A clear delineation of the disorders and standardized MRI-based diagnostic criteria are required.

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“…Initial treatment of SIF is conservative, consisting of protected weight bearing and administration of analgesic medications to prevent development or worsening of subchondral bone collapse (27). Larger lesions with progressive articular collapse and persistent pain may require surgery (often total knee arthroplasty).…”

Section: Sif and Spontaneous Osteonecrosis Of The Kneementioning

confidence: 99%

Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI

et al. 2018

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Several pathologic conditions may manifest as an osteochondral lesion of the knee that consists of a localized abnormality involving subchondral marrow, subchondral bone, and articular cartilage. Although understanding of these conditions has evolved substantially with the use of high-spatial-resolution MRI and histologic correlation, it is impeded by inconsistent terminology and ambiguous abbreviations. Common entities include acute traumatic osteochondral injuries, subchondral insufficiency fracture, so-called spontaneous osteonecrosis of the knee, avascular necrosis, osteochondritis dissecans, and localized osteochondral abnormalities in osteoarthritis. Patient demographics, the clinical presentation, and the role of trauma are critical for differential diagnosis. A localized osteochondral defect can be created acutely or can develop as an end result of several chronic conditions. MRI features that aid in diagnosis include the location and extent of bone marrow edema, the presence of a fracture line, a hypointense area immediately subjacent to the subchondral bone plate, and deformity of the subchondral bone plate. These findings are essential in diagnosis of acute traumatic injuries, subchondral insufficiency fracture, and its potentially irreversible form, spontaneous osteonecrosis of the knee. If the lesion consists of a subchondral region demarcated from the surrounding bone, the demarcation should be examined for completeness and the presence of a "double-line sign" that is seen in avascular necrosis or findings of instability, which are important for proper evaluation of osteochondritis dissecans. Subchondral bone plate collapse, demonstrated by the presence of a depression or a fluid-filled cleft, can be seen in advanced stages of both avascular necrosis and subchondral insufficiency fracture, indicating irreversibility. Once the diagnosis is established, it is important to report pertinent MRI findings that may guide treatment of each condition. RSNA, 2018 An earlier incorrect version of this article appeared online. This article was corrected on August 23, 2018.

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The importance of early diagnosis in spontaneous osteonecrosis of the knee — A case series with six year follow-up

Cited by 14 publications

References 27 publications

MR appearance of the temporal evolution and resolution of spontaneous osteonecrosis of the knee: a case report

MR appearance of the temporal evolution and resolution of spontaneous osteonecrosis of the knee: a case report

Spontaneous Osteonecrosis of the Knee: a Systematic Review of Conservative Treatment Approaches

Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI

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