Transient Bone Marrow Edema Syndrome of the Knee: Clinical and Magnetic Resonance Imaging Results at 5 Years After Core Decompression

Berger, Christian E.; Kröner, A.; Kristen, Karl-Heinz; Grabmeier, G.; Kluger, Robert; Minai-Pour, Michael; Leitha, Thomas; Engel, A.

doi:10.1016/j.arthro.2006.04.095

Cited by 51 publications

(41 citation statements)

References 25 publications

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“…Several studies have reported signs of microfracture in areas containing BML. 8,9 This finding together with the presence of active bone formation and live osteocytes in the area, 10 however, points to increased repair capacity, which seems the key for the spontaneously reversible course of this syndrome. Increased marrow adiposity has also been reported in some case reports on BML.…”

Section: Imagingmentioning

confidence: 95%

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Treatment of bone marrow lesions (bone marrow edema)

Eriksen

2015

BoneKEy Reports

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Bone marrow lesions (BMLs) or using older terminology 'Bone marrow edema' is characterised by excessive water signals in the marrow space on magnetic resonance imaging or ultrasound; BMLs constitute a central component of a wide variety of inflammatory and non-inflammatory rheumatologic conditions affecting the musculoskeletal system: BMLs are not only considered significant sources of pain but also linked to increased disease activity in many musculoskeletal conditions (for example, osteoarthritis, rheumatoid arthritis). The purpose of this review is to summarise current knowledge about the treatment of BMLs, with an emphasis on the clinical and histological features of this entity in inflammatory and non-inflammatory disease. We also try to pair this hypothesis with the apparent beneficial effects of various treatment regimens, mainly within the group of bone antiresorptive drugs (calcitonin, bisphosphonates) on symptoms associated with BMLs.

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Section: Imagingmentioning

confidence: 95%

“…It has been shown that BME correlates to necrotic volume at the femoral head, 20 but another study looking at core specimens in patients 'spontaneous osteonecrosis of the knee' (SONK) revealed no sign of necrotic tissue, as all trabeculae contained viable osteocytes and osteoblasts. 10 …”

Section: Bone Marrow Edema Ef Eriksenmentioning

confidence: 99%

Treatment of bone marrow lesions (bone marrow edema)

Eriksen

2015

BoneKEy Reports

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“…However, its use with bone marrow edema lesions of the knee is not well documented. Only a few cases of successful core decompression with bone marrow edema syndrome of the knee have been reported [3,4,22].…”

Section: Discussionmentioning

confidence: 99%

Subchondral Calcium Phosphate is Ineffective for Bone Marrow Edema Lesions in Adults With Advanced Osteoarthritis

Chatterjee

McGee

Strauss

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Injury to subchondral bone is associated with knee pain and osteoarthritis (OA). A percutaneous calcium phosphate injection is a novel approach in which subchondral bone marrow edema lesions are percutaneously injected with calcium phosphate. In theory, calcium phosphate provides structural support while it is gradually replaced by bone. However, little clinical evidence supports the efficacy of percutaneous calcium phosphate injections. Questions/purposes We asked: (1) Does percutaneous calcium phosphate injection improve validated patient-reported outcome measures? (2) What proportion of patients experience failure of treatment (defined as a low score on the Tegner Lysholm Knee Scoring Scale)? (3) Is there a relationship between outcome and age, sex, BMI, and preoperative grade of OA? Methods Between September 2012 and January 2014, we treated 33 patients with percutaneous calcium phosphate injections. Twenty-five satisfied our study inclusion criteria; of those, three patients were lost to followup and 22 (88%; 13 men, nine women) with a median age of 53.5 years (range, 38-70 years) were available for retrospective chart review and telephone evaluation at a minimum of 6 months (median, 12 months; range, 6-24 months). Our general indications for this procedure were the presence of subchondral bone marrow edema lesions observed on MR images involving weightbearing regions of the knee associated with localized pain on weightbearing and palpation and failure to respond to conservative therapy ([ 3 months). Patients with pain secondary to extensive nondegenerative meniscal tears with a flipped displaced component at the level of bone marrow edema lesions, or with mechanical axis deviation greater than 8°were excluded. All patients had Grades III or IV chondral lesions (modified Outerbridge grading system for chondromalacia) overlying MRI-identified subchondral bone marrow edema lesions. Percutaneous calcium phosphate injection was performed on the medial tibial condyle (15 patients), the medial femoral condyle (five patients), and the lateral femoral condyle (two patients). Concomitant partial meniscectomy was performed in 18 patients. Preoperative and postoperative scores from the Knee Injury and Arthritis Outcome Score (KOOS) and the Tegner Lysholm Knee Scoring Scale were analyzed. Results For patients available for followup, the outcome scores improved after treatment. The KOOS improved from a mean of 39.5 ± 21.8 to 71.3 ± 23 (95% CI, 18.6-45.2; p \ 0.001) and the Tegner and Lysholm score from 48 ± 15.1 to 77.5 ± 20.6 (95% CI, 18.8-40.2; p \ 0.001).

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“…Larger lesions ([50% of the femoral condyle or [5 cm 2 ) in general require osteotomy or arthroplasty [31]. In early stages, treatment with core decompression of the bone has been successfully used [11,19,33]. Some authors report medical therapy with Iloprost, a prostacyclin analogue, which has been used in patients with bone marrow oedema and osteonecrosis, and in children with aseptic osteonecrosis of the proximal femur [5,16,41].…”

Section: Discussionmentioning

confidence: 99%

Possible beneficial effect of bisphosphonates in osteonecrosis of the knee

Kraenzlin

Gräf

Meier

et al. 2010

Knee Surg Sports Traumatol Arthrosc

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Osteonecrosis (ON) in the knee occurs as a localized inflammatory disease in relation to spontaneous or non-traumatic ON. Conservative treatment possibilities are limited, and prognosis appears to be poor; in most cases, ON results in knee arthroplasty. Bisphosphonates are suggested to prevent bone resorption and collapse of necrotic bone. In this observational, prospective study we investigated the effect of bisphosphonate treatment in patients with spontaneous or arthroscopy-induced ON of the knee. Twenty-eight patients with osteonecrotic lesions and bone marrow oedema in the knee were included. In 22 patients (80%), ON was identified after arthroscopic surgery of the knee; six patients were diagnosed with spontaneous ON. Patients were initially given pamidronate 120 mg i.v. divided in 3-4 perfusions over 2 weeks, followed by oral bisphosphonate treatment with alendronate 70 mg weekly for 4-6 months. Bisphosphonate treatment resulted in a rapid pain relief, VAS decreasing from 8.2 ± 1.2 at baseline to 5.02 ± 0.6 after 4-6 weeks (p \ 0.001). After 6 months, the VAS decreased by 80%

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Transient Bone Marrow Edema Syndrome of the Knee: Clinical and Magnetic Resonance Imaging Results at 5 Years After Core Decompression

Cited by 51 publications

References 25 publications

Treatment of bone marrow lesions (bone marrow edema)

Treatment of bone marrow lesions (bone marrow edema)

Subchondral Calcium Phosphate is Ineffective for Bone Marrow Edema Lesions in Adults With Advanced Osteoarthritis

Possible beneficial effect of bisphosphonates in osteonecrosis of the knee

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