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Malghem J, Lecouvet F, Vande Berg B, Kirchgesner T, Omoumi P. Subchondral insufficiency fractures, subchondral insufficiency fractures with osteonecrosis, and other apparently spontaneous subchondral bone lesions of the knee-pathogenesis and diagnosis at imaging. Insights Imaging 2023; 14:164. [PMID: 37782395 PMCID: PMC10545656 DOI: 10.1186/s13244-023-01495-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/17/2023] [Indexed: 10/03/2023] Open
Abstract
Subchondral insufficiency fractures (SIFs) and SIFs with osteonecrosis (SIF-ONs) of the knee (previously misnamed spontaneous osteonecrosis of the knee (SONK)) are bone lesions that appear without prior traumatic, tumoral, or inflammatory event.Both conditions are characterized in the early stages by epiphyseal bone marrow edema (BME)-like signal at MRI. However, while SIFs usually heal spontaneously, they can also evolve to osteonecrosis (i.e., SIF-ON), which may progress to an irreversible collapse of the articular surface. Careful analysis of other MRI signs may help differentiate the two conditions in the early phase. In SIFs, the BME edema-like signal extends to the area immediately adjacent to the subchondral plate, while in SIF-ONs, this subchondral area shows low signal intensity on fluid-sensitive MR images due to altered bone marrow. The thickness and length of subchondral areas with low fluid-sensitive signal intensity are important factors that determine the prognosis of SIF-ONs. If they are thicker than 4 mm or longer than 14 mm, the prognosis is poor. The differential diagnosis of SIFs and SIF-ONs include bone lesions associated with the "complex regional pain syndrome" (CRPS), epiphyseal osteonecrosis of systemic origin, and those related to cartilage pathology.Clinical relevance statement Imaging plays an essential role in diagnosing subchondral insufficiency fractures (SIFs) from subchondral insufficiency fractures with osteonecrosis (SIF-ONs) and collapse, as well as in distinguishing them from other spontaneous knee subchondral bone lesions presenting with bone marrow edema-like signal.Key points• Subchondral insufficiency fractures may affect the knee, especially in older adults.• Subchondral insufficiency fractures usually heal spontaneously.• Sometimes, subchondral osteonecrosis and collapse may complicate subchondral insufficiency fractures.• Bone marrow-like edema is an aspecific sign seen in all these lesions.• Degraded marrow in osteonecrosis complicating fractures is hypointense on fluid-sensitive sequences.
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Affiliation(s)
- Jacques Malghem
- Department of Radiology, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Frédéric Lecouvet
- Department of Radiology, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Bruno Vande Berg
- Department of Medical Imaging, Clinique CHC Montlégia, Boulevard Patience Et Beaujonc 2, 4000, Liège, Belgium
| | - Thomas Kirchgesner
- Department of Radiology, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne, Rue du Bugnon 46, 1010, Lausanne, Switzerland.
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Musbahi O, Waddell L, Shah N, Smith SE, Chen AF, Bisson L, Katz JN. Subchondral Insufficiency Fractures of the Knee: A Clinical Narrative Review. JBJS Rev 2023; 11:01874474-202310000-00005. [PMID: 37812676 DOI: 10.2106/jbjs.rvw.23.00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
» Subchondral insufficiency fractures of the knee (SIFKs) are subchondral plate fractures with a prevalence of 2% to 4% of all knee injuries.» Magnetic resonance imaging is the gold standard for evaluating SIFK, while plain radiographs have limited the use in the diagnosis of SIFK.» Among patients with SIFK, 50% to 100% have meniscal pathology.» Medical therapies and standard treatments traditionally used in the management of knee osteoarthritis differ from recommended management of SIFK patients.» Randomized controlled trials and cohort studies with long-term follow-up are needed to determine the optimal rehabilitation protocol, interventional therapy, and prognosis of SIFK patients.
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Affiliation(s)
- Omar Musbahi
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Imperial College London, London, United Kingdom
| | - Lily Waddell
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nehal Shah
- Harvard Medical School, Boston, Massachusetts
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stacy E Smith
- Harvard Medical School, Boston, Massachusetts
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Antonia F Chen
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Leslie Bisson
- Department of Orthopedic Surgery, University of Buffalo, Buffalo, New York
| | - Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, Massachusetts
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3
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Za P, Tecame A, Papalia GF, Rizzello G, Adravanti P, Papalia R. Time to reconsider post arthroscopic osteonecrosis of the knee: a systematic review. Musculoskelet Surg 2023; 107:269-277. [PMID: 37014550 DOI: 10.1007/s12306-023-00783-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 03/26/2023] [Indexed: 04/05/2023]
Abstract
The etiology of post-arthroscopic osteonecrosis of the knee (PAONK) is still unknown. The aims of this systematic review were to analyze the main characteristics of patients who developed osteonecrosis after arthroscopy. We considered for inclusion in the review case reports, case series, retrospective and prospective clinical trial, that involved patients who developed osteonecrosis of the knee within 1 year of arthroscopy for meniscal lesion or anterior cruciate ligament rupture with or without chondropathy. In all cases, there was a pre-operative magnetic resonance imaging that excluded the presence of osteonecrosis. We used the MINORS criteria to estimate the risk of bias. A total of 13 studies that involved 125 patients were included in the review. Only 14 out of 55 patients performed the pre-operative MRI after the "window period", which we considered 6 weeks between the onset of symptoms and positive MRI findings. A diagnosis of PAONK was made for 55 patients within 1 year of surgery. Of these, 29% was treated conservatively, while 71% repeated surgery. Osteonecrosis after knee arthroscopy is a reality and surgeon shouldn't underestimate the persistence or re-emergence of symptoms after arthroscopy. It may be due to subchondral insufficiency fractures in osteopenic bone, without evidence of necrosis. However, there are not elements enough to differentiate clinical and radiological characteristics of PAONK from SPONK. Terminology should be simplified, distinguishing subchondral insufficiency fractures of the knee as a precursor of primary osteonecrosis of the knee.
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Affiliation(s)
- P Za
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - A Tecame
- Department of Orthopaedic and Trauma Surgery, Casa di Cura Città of Parma, 43123, Parma, Italy
| | - G F Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
| | - G Rizzello
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - P Adravanti
- Department of Orthopaedic and Trauma Surgery, Casa di Cura Città of Parma, 43123, Parma, Italy
| | - R Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Serrano DV, Saseendar S, Shanmugasundaram S, Bidwai R, Gómez D, D’Ambrosi R. Spontaneous Osteonecrosis of the Knee: State of the Art. J Clin Med 2022; 11:jcm11236943. [PMID: 36498517 PMCID: PMC9737125 DOI: 10.3390/jcm11236943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
Osteonecrosis is a terrible condition that can cause advanced arthritis in a number of joints, including the knee. The three types of osteonecrosis that can affect the knee are secondary, post-arthroscopic, and spontaneous osteonecrosis of the knee (SPONK). Regardless of osteonecrosis classification, treatment for this condition seeks to prevent further development or postpone the onset of knee end-stage arthritis. Joint arthroplasty is the best course of action whenever there is significant joint surface collapse or there are signs of degenerative arthritis. The non-operative options for treatment at the moment include observation, nonsteroidal anti-inflammatory medications (NSAIDs), protective weight bearing, and analgesia if needed. Depending on the severity and type of the condition, operational procedures may include unilateral knee arthroplasty (UKA), total knee arthroplasty (TKA), or joint preservation surgery. Joint preservation techniques, such as arthroscopy, core decompression, osteochondral autograft, and bone grafting, are frequently used in precollapse and some postcollapse lesions, when the articular cartilage is typically unaffected and only the underlying subchondral bone is affected. In contrast, operations that try to save the joint following significant subchondral collapse are rarely successful and joint replacement is required to ease discomfort. This article's goal is to summarise the most recent research on evaluations, clinical examinations, imaging and various therapeutic strategies for osteonecrosis of the knee, including lesion surveillance, medicines, joint preservation methods, and total joint arthroplasty.
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Affiliation(s)
| | | | | | - Rohan Bidwai
- Senior Clinical Fellow, York Teaching Hospital NHS Foundation Trust, York YO31 8HE, UK
| | - Diego Gómez
- Hospital Britanico of Buenos Aires, Buenos Aires C1280 AEB, Argentina
| | - Riccardo D’Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milan, Italy
- Correspondence:
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Pearl MC, Mont MA, Scuderi GR. Osteonecrosis of the Knee: Not all Bone Edema is the Same. Orthop Clin North Am 2022; 53:377-392. [PMID: 36208881 DOI: 10.1016/j.ocl.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Knee pain is among the most common complaints that an orthopedic surgeon may see in practice. It is often worked up with X-rays and MRI, leading to a myriad of potential diagnoses ranging from minimal edema patterns to various types of osteonecrosis. Similarities in certain causes can pose diagnostic challenges. The purpose of this review was to present the 3 types of osteonecrosis observed in the knee as well as additional causes to consider to help aid in the diagnosis and treatment..
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Affiliation(s)
- Matthew C Pearl
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA; Northwell Orthopedic Institute, 130 East 77th Street, 11th Floor, Black Hall, New York, NY 10075, USA.
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA; Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Avenue, Baltimore, MD, USA
| | - Giles R Scuderi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA; Northwell Orthopedic Institute, 210 East 64th Street, New York, NY 10065, USA
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BALTA O, ŞAHİN K, ZENGİN Ç, EREN MB, ALTINAYAK H, DEMİR O. Severity of subchondral insufficiency knee fracture: is it associated with increasing age, femorotibial angle, and severity of meniscus extrusion? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1065127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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7
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[Aseptic osteonecrosis of the medial femoral condyle in a patient with acute SARS-CoV-2 infection]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:664-666. [PMID: 34586423 PMCID: PMC8479260 DOI: 10.1007/s00113-021-01082-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 02/07/2023]
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Yamaguchi J, Yasuda K, Kondo E, Kaibara T, Ueda D, Yabuuchi K, Onodera J, Iwasaki N, Saito M, Yagi T. Extrusion of the medial meniscus is a potential predisposing factor for post-arthroscopy osteonecrosis of the knee. BMC Musculoskelet Disord 2021; 22:852. [PMID: 34610805 PMCID: PMC8493670 DOI: 10.1186/s12891-021-04730-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Post-arthroscopic osteonecrosis of the knee (PAONK) is a rare condition. No studies have analyzed the relationship between the meniscus extrusion and PAONK. The purpose of this retrospective study is to test a hypothesis that the degree of the medial meniscus (MM) extrusion might be significantly greater in the knees with PAONK than in the matched control knees both before and after the meniscectomy. Methods Ten knees with PAONK were detected out of a total of 876 knees which had undergone arthroscopic partial meniscectomy of the MM. Ten matched control knees were randomly selected out of the remaining 866 knees without PAONK. The clinical data of these 20 patients were retrospectively collected from the medical records. To evaluate the location of the menisci on the joint line, Extrusion width and Inner width were defined on a coronal section of magnetic resonance imaging (MRI). The intra- and inter-rater reliability was evaluated by calculating the intra- and inter-class coefficients. Statistical comparisons between the 2 groups were made using the 3 non-parametric tests. Results Before the meniscectomy, the Extrusion width of the MM (mean 4.7 ± 1.4 mm) was significantly greater than that (3.0 ± 1.3 mm) in the Control group (P = 0.0195). In the MRI taken in a range from 3 to 50 weeks after the meniscectomy, the Extrusion width of the MM (5.9 ± 1.1 mm) in the PAONK group was significantly greater than that (3.4 ± 1.4 mm) in the Control group (P = 0.0009), and the Inner width of the MM (0.6 ± 1.7 mm) in the PAONK group was significantly less than that (3.9 ± 1.0 mm) in the Control group (P = 0.0001). Conclusion A significant relationship was found between the degree of the MM extrusion and the onset of PAONK. This study suggested that the extrusion of the MM is a potential predisposing factor for PAONK.
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Affiliation(s)
- Jun Yamaguchi
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, 3-Jo 5-Chome, Nishino, Nishi-ku, Sapporo, 063-0033, Japan.,Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazunori Yasuda
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, 3-Jo 5-Chome, Nishino, Nishi-ku, Sapporo, 063-0033, Japan.
| | - Eiji Kondo
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Takuma Kaibara
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, 3-Jo 5-Chome, Nishino, Nishi-ku, Sapporo, 063-0033, Japan.,Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Daisuke Ueda
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, 3-Jo 5-Chome, Nishino, Nishi-ku, Sapporo, 063-0033, Japan
| | - Koji Yabuuchi
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, 3-Jo 5-Chome, Nishino, Nishi-ku, Sapporo, 063-0033, Japan
| | - Jun Onodera
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, 3-Jo 5-Chome, Nishino, Nishi-ku, Sapporo, 063-0033, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomonori Yagi
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, 3-Jo 5-Chome, Nishino, Nishi-ku, Sapporo, 063-0033, Japan
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Barras LA, Pareek A, Parkes CW, Song BM, Camp CL, Saris DBF, Stuart MJ, Krych AJ. Post-arthroscopic Subchondral Insufficiency Fractures of the Knee Yield High Rate of Conversion to Arthroplasty. Arthroscopy 2021; 37:2545-2553. [PMID: 33774060 DOI: 10.1016/j.arthro.2021.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate both the potential causes and resultant outcomes in patients in whom subchondral insufficiency fracture of the knee (SIFK) develops after arthroscopy. METHODS We performed a retrospective review of all patients with a magnetic resonance imaging diagnosis of SIFK after arthroscopic meniscectomy and chondroplasty over a 12-year period. RESULTS A total of 28 patients were included, with a mean age of 61 years and mean follow-up period of 5.7 years. SIFK showed a predilection for the medial compartment (n = 25, 89%), specifically the medial femoral condyle (n = 21, 75%). In 7 patients (25%), SIFK developed in both the femoral condyle and tibial plateau in the ipsilateral compartment. Fifteen patients (54%) went on to conversion to arthroplasty at a mean of 0.72 years. The rate of survival free of conversion to arthroplasty was 57%, 45%, and 40% at 1 year, 2 years, and 5 years, respectively. Furthermore, 63% of patients with a meniscal tear and SIFK in the same compartment went on to arthroplasty (P = .04). There was an increased risk of conversion to arthroplasty if SIFK was present in both the femur and tibia in the same compartment (P = .04). A higher Kellgren-Lawrence grade at the time of the SIFK diagnosis increased the likelihood of eventual arthroplasty (P = .03). The presence of SIFK in both the femur and tibia in the ipsilateral compartment, an increased Kellgren-Lawrence grade, and a meniscal tear or prior meniscectomy in the same compartment as SIFK were associated with an increased risk of eventual arthroplasty. CONCLUSIONS Post-arthroscopic SIFK most commonly occurs in the medial compartment, particularly in patients who underwent a prior meniscectomy. The presence of meniscal root and radial tears in these patients is notable (75%). Ultimately, there is a high rate of progression of arthrosis (33%) and eventual conversion to arthroplasty. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Laurel A Barras
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Ayoosh Pareek
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Chad W Parkes
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Bryant M Song
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Michael J Stuart
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A..
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Zhuang Z, Chhantyal K, Shi Y, Zhuang Q, Zhang F, Shi D, He B, Wang K. Post-arthroscopic osteonecrosis of the knee: A case report and literature review. Exp Ther Med 2020; 20:3009-3016. [PMID: 32855667 PMCID: PMC7444417 DOI: 10.3892/etm.2020.9056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 05/15/2020] [Indexed: 01/23/2023] Open
Abstract
Post-arthroscopic osteonecrosis is a rare complication of arthroscopic surgery. The present study reported on a case of knee osteonecrosis after arthroscopic surgery. The patient, an 81-year-old male, presented with left knee pain and limited range of motion without any history of trauma. MRI revealed medial meniscus tear. Medial partial meniscectomy was performed using arthroscopy. The pain was found to be relieved due to the operation. However, there was an aggravation of pain after two months post-operatively. X-ray revealed that the subchondral bone in the medial femoral condyle (MFC) had collapsed. MRI revealed a large area of bone marrow edema in the MFC with cartilage delamination and subchondral flattening. Considering the age of the patient and the large area of bone necrosis, total knee arthroplasty was performed. At the 1-year follow-up, the Knee Society Knee Score improved from 44 points pre-operatively to 90 points and the Knee Society Functional Score was elevated from 35 to 90 points. Patient-reported outcome measures were assessed in the form of the Oxford Knee Score, which was 16. Furthermore, previous case reports of post-arthroscopic osteonecrosis were reviewed and the clinical and radiographic features, as well as the treatment, were summarized. If the patient complains of persistent and worsening pain after arthroscopy, particularly in elderly osteoporotic patients with meniscal tears or chondral lesions, the possibility of post-arthroscopic knee osteonecrosis should be considered. Diagnosis and treatment at the early stages are likely to be beneficial for the outcome.
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Affiliation(s)
- Ze Zhuang
- Department of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Kishor Chhantyal
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Yi Shi
- Department of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Qi Zhuang
- Department of Laboratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Fei Zhang
- Department of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Dehai Shi
- Department of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Bo He
- Department of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Kun Wang
- Department of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
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Spontaneous osteonecrosis of the knee: what do we know so far? A literature review. INTERNATIONAL ORTHOPAEDICS 2020; 44:1063-1069. [PMID: 32249354 DOI: 10.1007/s00264-020-04536-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/13/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Spontaneous osteonecrosis of the knee (SONK) is said to be a relatively common disease which may lead to an end-stage osteoarthritis of the knee. The aim of this paper was to review the literature on this field published until now, discuss the results of both conservative and surgical treatment options, as well as to introduce new methods of treatment, which may be applicable in SONK treatment. METHODS We searched the PubMed and Cochrane databases until November 2019 and presented the most recent findings in this work. RESULTS The exact aetiology of SONK still remains unclear; however, recent studies suggested that early stage of SONK is rather a result of the subchondral fracture than primary osteonecrosis. So far described conservative treatment includes non-weight bearing or protected weight bearing with a knee brace, nonsteroidal anti-inflammatory drugs, analgesics, and bisphosphonates. Surgical management includes arthroscopic debridement, core decompression, osteochondral autograft, high tibial osteotomy, and unicompartmental knee arthroplasty or total knee arthroplasty. CONCLUSIONS Although the aetiology of SONK remains unknown, there are many treatment options, and the choice of the most suitable one is challenging. We think that subchondroplasty may be one of the effective methods.
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Fukui K, Shioya A, Tachi Y, Yonezawa K, Hirata H, Kawahara N. Subchondral fracture caused by unevenly stiffened meniscus after radiofrequency-assisted arthroscopic knee meniscectomy: A case report and review of the literature. Int J Surg Case Rep 2019; 65:135-140. [PMID: 31707301 PMCID: PMC6849066 DOI: 10.1016/j.ijscr.2019.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/22/2019] [Indexed: 11/19/2022] Open
Abstract
Although the worsening of symptoms following knee arthroscopy in older patients is often labeled as progression of arthritic symptoms, subchondral insufficiency fracture following arthroscopy may be underdiagnosed. There is a possibility that uneven stiffening of the meniscus causes concentration of stress that resulted in postarthroscopic subchondral fracture. Surgeons should consider avoiding subsequent subchondral fracture when to use radiofrequency in the debridement of a torn meniscus.
Introduction Causality for postarthroscopic osteonecrosis of the knee is unknown, and related mechanisms have been poorly characterized. Presentation of case This report describes a case of a 69-year-old man with subchondral fracture occurring after arthroscopic meniscectomy using a radiofrequency assisted shaver. The patient experienced increasingly intense knee pain 10 months after the meniscectomy. MR imaging revealed postarthroscopic osteonecrosis of the knee in the femoral medial condyle, requiring unicompartmental knee arthroplasty. A mid-coronal cut section of the resected medial femoral condyle showed a linear fracture line parallel to the subchondral bone endplate. Histopathological examination showed prominent callus formation on both sides of the fracture, comprised of reactive woven bone and granulation tissue. The middle portion of the resected medial meniscus was of uneven height, with significant stiffening of the higher side. The stiffened region of the medial meniscus corresponded to the subchondral fracture in the medial femoral condyle. Discussion The etiology of post-arthroscopic osteonecrosis of the knee is controversial, but it seems possible that altered knee biomechanics after meniscectomy may predispose patients to osteonecrosis. The findings of the current case suggested that uneven stiffening of the meniscus caused concentration of stress that resulted in postarthroscopic subchondral fracture. Conclusion Subchondral insufficiency fracture following arthroscopy may be underdiagnosed. Surgeons need to carefully consider the risk of subchondral fracture following uneven stiffening of the meniscus when to use radiofrequency in the debridement of a torn meniscus.
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Affiliation(s)
- Kiyokazu Fukui
- Department of Orthopedic Surgery, Kanazawa Medical University, Japan.
| | - Akihiro Shioya
- Department of Pathology and Medical Laboratory, Kanazawa Medical University, Japan
| | - Yoshiyuki Tachi
- Department of Orthopedic Surgery, Kanazawa Medical University, Japan
| | | | - Hiroaki Hirata
- Department of Orthopedic Surgery, Kanazawa Medical University, Japan
| | - Norio Kawahara
- Department of Orthopedic Surgery, Kanazawa Medical University, Japan
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13
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Lösungen für häufige Komplikationen bei Meniskusoperation. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-019-00302-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Greco NJ, Lombardi AV, Hurst JM, Morris MJ, Berend KR. Medial Unicompartmental Knee Arthroplasty for the Treatment of Focal Femoral Osteonecrosis. J Bone Joint Surg Am 2019; 101:1077-1084. [PMID: 31220024 DOI: 10.2106/jbjs.18.00913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous research has indicated that unicompartmental arthroplasty may be an effective treatment for focal osteonecrosis in the knee; however, these reports have been composed of small patient cohorts and without characterization of the osteonecrotic lesions. Therefore, the purpose of this study was to investigate the effectiveness of unicompartmental arthroplasty for the treatment of focal osteonecrosis within the medial femoral condyle including an assessment of lesion size. METHODS A consecutive series of >5,000 unicompartmental knee arthroplasties performed at a single institution was retrospectively reviewed to identify cases of medial femoral condyle osteonecrosis with a minimum 2-year follow-up. Lesion size was classified according to the ratio of lesion width to condylar width, as well as lesion depth relative to condylar depth. Patient-reported outcome measures and need for a revision procedure were studied. RESULTS Sixty-four patients (32 males, 32 females; 65 knees) with a mean age of 64 years were included. The mean patient follow-up was 5.3 years (range, 2 to 12 years). The mean ratio of lesion width to condylar width was 64%, the mean lesion depth was 1.11 cm, and 82% of cases demonstrated subchondral collapse. At the time of the latest follow-up, patients demonstrated substantial improvements in the pain, function, and clinical components of the Knee Society Score, by 36, 25, and 51, respectively. Four patients (6%) required a revision, of which only 1 was for aseptic loosening of the femoral component. CONCLUSIONS Unicompartmental arthroplasty is an effective treatment for advanced-stage focal osteonecrosis of the medial femoral condyle. Loss of component fixation to the femoral condyle did not appear to be a substantial concern because there was only 1 femoral failure as a result of aseptic loosening, despite lesions affecting a significant portion of the femoral condyle. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nicholas J Greco
- Joint Implant Surgeons, New Albany, Ohio.,White Fence Surgical Suites, New Albany, Ohio.,Mount Carmel Health System, New Albany, Ohio
| | - Adolph V Lombardi
- Joint Implant Surgeons, New Albany, Ohio.,White Fence Surgical Suites, New Albany, Ohio.,Mount Carmel Health System, New Albany, Ohio.,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jason M Hurst
- Joint Implant Surgeons, New Albany, Ohio.,White Fence Surgical Suites, New Albany, Ohio.,Mount Carmel Health System, New Albany, Ohio
| | - Michael J Morris
- Joint Implant Surgeons, New Albany, Ohio.,White Fence Surgical Suites, New Albany, Ohio.,Mount Carmel Health System, New Albany, Ohio
| | - Keith R Berend
- Joint Implant Surgeons, New Albany, Ohio.,White Fence Surgical Suites, New Albany, Ohio.,Mount Carmel Health System, New Albany, Ohio
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15
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Sargeant HW, Rehman H, Zafiropoulos G. Core Decompression for Post-Arthroscopic Osteonecrosis of the Lateral Tibial Plateau. Knee Surg Relat Res 2019; 31:76-80. [PMID: 30871297 PMCID: PMC6425898 DOI: 10.5792/ksrr.18.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022] Open
Abstract
Post-arthroscopic osteonecrosis is a rare complication that mostly occurs in the over 50s. It most commonly occurs in the medial femoral condyle, followed by the lateral femoral condyle then medial tibial plateau. We report the first case of lateral tibial plateau osteonecrosis in a young patient after arthroscopic lateral meniscectomy. This patient developed progressively deteriorating symptoms after uncomplicated arthroscopy; with a subsequent magnetic resonance imaging (MRI) showing bone oedema and some overlying cartilage damage. Conservative measures were unsuccessful, so core decompression was undertaken. This has resulted in improved symptoms and subsequent follow-up MRI demonstrates resolution of oedema with no progressive cartilage change. This is a rare condition with a poor outcome, usually resulting in arthroplasty. This technique may work in the younger patient. However, since post-arthroscopic osteonecrosis is so rare in this age group, there is limited evidence for its success, and it should be evaluated with further study.
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Affiliation(s)
- Harry W Sargeant
- Department of Trauma and Orthopaedic, Raigmore Hospital, NHS Highland, Inverness, UK
| | - Haroon Rehman
- Department of Trauma and Orthopaedic, Raigmore Hospital, NHS Highland, Inverness, UK
| | - George Zafiropoulos
- Department of Trauma and Orthopaedic, Raigmore Hospital, NHS Highland, Inverness, UK
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16
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Hussain ZB, Chahla J, Mandelbaum BR, Gomoll AH, LaPrade RF. The Role of Meniscal Tears in Spontaneous Osteonecrosis of the Knee: A Systematic Review of Suspected Etiology and a Call to Revisit Nomenclature. Am J Sports Med 2019; 47:501-507. [PMID: 29253348 DOI: 10.1177/0363546517743734] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The cause of spontaneous osteonecrosis of the knee (SONK) and postarthroscopic osteonecrosis of the knee is unknown, and the mechanisms involved have been poorly characterized. HYPOTHESIS/PURPOSE The purpose of this study was to perform a detailed systematic review of the literature to examine proposed etiological mechanisms for SONK in order to establish an improved understanding of the processes involved. We hypothesized that the etiology of SONK would be multifactorial. STUDY DESIGN Systematic review. METHODS A systematic review of the literature was performed by searching PubMed, Medline, Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. Inclusion criteria were all original research articles presented in the English language that reported on the suspected etiology of SONK. Reviews, case reports with fewer than 3 patients, cost-effectiveness studies, technical reports, editorial articles, surveys, special topics, letters to the editor, personal correspondence, and studies that only proposed factors for the progression of SONK were excluded. RESULTS After a comprehensive review of 255 articles, 26 articles were included for final analysis. Twenty-one (80.7%) of 26 articles implicated the role of the meniscus in the development of SONK, in an association with either meniscal tears or its development after meniscectomy. The medial meniscus and posterior meniscal root tears were implicated more frequently. All 4 studies incorporating histological findings supported the insufficiency fracture hypothesis as a pathological basis of SONK. CONCLUSION Physicians should be cognizant of the high prevalence of medial meniscus root tears in patients with SONK. Meniscectomy and meniscal tears, particularly of the medial meniscus posterior root, increase contact pressures and create an environment from which insufficiency fractures can emanate. We believe the term SONK is a misrepresentation of the etiology and pathogenesis of the condition and should be replaced with subchondral insufficiency fractures of the knee. Further elucidation of the etiology is required.
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Affiliation(s)
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Andreas H Gomoll
- Cartilage Repair Center and Center for Regenerative Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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17
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Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. Radiographics 2018; 38:1478-1495. [PMID: 30118392 DOI: 10.1148/rg.2018180044] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
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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Affiliation(s)
- Tetyana Gorbachova
- From the Department of Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141 (T.G, M.C., B.W.C.) and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (Y.M.)
| | - Yulia Melenevsky
- From the Department of Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141 (T.G, M.C., B.W.C.) and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (Y.M.)
| | - Micah Cohen
- From the Department of Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141 (T.G, M.C., B.W.C.) and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (Y.M.)
| | - Brett W Cerniglia
- From the Department of Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141 (T.G, M.C., B.W.C.) and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (Y.M.)
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18
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Di Caprio F, Meringolo R, Navarra MA, Mosca M, Ponziani L. Postarthroscopy Osteonecrosis of the Knee: Current Concepts. JOINTS 2017; 5:229-236. [PMID: 29270561 PMCID: PMC5738467 DOI: 10.1055/s-0037-1608666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Knee osteonecrosis is a severe disease rapidly leading to end-stage osteoarthritis, which was classified into three categories: spontaneous, secondary, and postarthroscopy. To understand postarthroscopy osteonecrosis of the knee, all the three types of knee osteonecrosis have to be deepened. This article reviewed spontaneous and secondary osteonecroses of the knee, with special focus upon postarthroscopy osteonecrosis, which is a rare form, affecting patients operated for arthroscopic knee surgery, most commonly for meniscectomy. Due to its rarity, patients and surgeons are often unprepared for this complication. A correct diagnosis is essential for appropriate treatment, and also to determine if a preexisting osteonecrosis was present, avoiding medicolegal sequelae, although many authors agree that osteonecrosis (both spontaneous and postarthroscopy) represent unpreventable and unpredictable conditions. In spontaneous osteonecrosis, the treatment is defined according to the size and the degree of the lesion, whereas in postarthroscopy osteonecrosis, the size of the lesion has no prognostic value, and therefore, the choice of the correct treatment is based more on the timing of the diagnosis. A diagnostic and therapeutic algorithm was outlined on the basis of the actual knowledge.
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Affiliation(s)
- Francesco Di Caprio
- Operating Unit of Orthopedics and Traumatology, AUSL of Romagna, Ceccarini Hospital, Riccione, Italy
| | - Renato Meringolo
- Operating Unit of Orthopedics and Traumatology, AUSL of Romagna, Ceccarini Hospital, Riccione, Italy
| | - Maria Adiletta Navarra
- Operating Unit of Orthopedics and Traumatology, AUSL of Romagna, Ceccarini Hospital, Riccione, Italy
| | - Massimiliano Mosca
- Second Orthopedics and Traumatology Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Lorenzo Ponziani
- Operating Unit of Orthopedics and Traumatology, AUSL of Romagna, Ceccarini Hospital, Riccione, Italy
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19
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Tírico LEP, Early SA, McCauley JC, Bugbee WD. Fresh Osteochondral Allograft Transplantation for Spontaneous Osteonecrosis of the Knee: A Case Series. Orthop J Sports Med 2017; 5:2325967117730540. [PMID: 29051901 PMCID: PMC5637976 DOI: 10.1177/2325967117730540] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Spontaneous osteonecrosis of the knee (SONK) is a clinical entity identified by acute knee pain usually associated with joint effusion, with radiographic findings of a radiolucent defect on the weightbearing area of the femoral condyle. Conservative treatment is initially undertaken; however, surgical procedures are often necessary. Historically, surgical options have included core decompression, cartilage repair, high tibial osteotomy, or joint arthroplasty. Few studies in the literature have reported the use of fresh osteochondral allograft (OCA) for the treatment of SONK lesions. Hypothesis: OCA transplantation is an effective treatment for SONK lesions on the medial femoral condyle. Study Design: Case series; Level of evidence, 4. Methods: A case series was analyzed of 7 patients treated with OCA for large SONK lesions of the medial femoral condyle with a minimum 4-year follow-up. All patients experienced failure of at least 6 months of conservative treatment and declined arthroplasty as the form of definitive treatment for medial femoral condyle lesion. All patients underwent OCA of the medial femoral condyle. Mean lesion size was 4.6 cm2 (range, 3.24-6.25 cm2), with a mean condylar width of 41.7 mm (range, 35.4-48.6 mm), resulting in a median proportion (lesion size/condylar width) of 56.8% (range, 32.7%-62.6%). The median surface allograft area was 5.1 cm2 (range, 3.2-6.3 cm2). Results: The median follow-up was 7.1 years (range, 4.5-14.1 years). No patient had additional surgery following OCA transplant; the allograft failure rate was 0%. Subjective outcome scores from the International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, and modified Merle d’Aubigné-Postel scale improved from preoperative assessment to the latest follow-up. All patients were extremely satisfied with the results of the OCA transplant. Conclusion: Fresh OCA transplantation demonstrated excellent efficacy, durability, and satisfaction in this group of patients with isolated stage 2 and 3 SONK lesions who had experienced failure of conservative treatment. Fresh osteochondral allografts are an attractive method for surgical management of selected patients with spontaneous osteonecrosis of the knee.
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Affiliation(s)
- Luís E P Tírico
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - Samuel A Early
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA.,University of California San Diego Medical School, La Jolla, California, USA
| | - Julie C McCauley
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - William D Bugbee
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
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20
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Kawata M, Sasabuchi Y, Inui H, Taketomi S, Matsui H, Fushimi K, Chikuda H, Yasunaga H, Tanaka S. Annual trends in knee arthroplasty and tibial osteotomy: Analysis of a national database in Japan. Knee 2017; 24:1198-1205. [PMID: 28797877 DOI: 10.1016/j.knee.2017.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/29/2017] [Accepted: 06/08/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Various nationwide studies have reported differing annual trends in utilization of knee arthroplasty and tibial osteotomy. Using the Diagnosis Procedure Combination database in Japan, the present series examined annual trends and demographics in total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) and tibial osteotomy. METHODS All patients were identified who underwent TKA, UKA or tibial osteotomy for osteoarthritis, osteonecrosis or rheumatoid arthritis of the knee between July 2007 and March 2015. RESULTS A total of 170,433 cases of TKA, 13,209 cases of UKA and 8760 cases of tibial osteotomy were identified. The proportion of patients undergoing UKA rose from 4.0% in 2007 to 8.1% in 2014 (P<0.001), and that of tibial osteotomy from 2.6% in 2007 to 5.5% in 2014 (P<0.001); the proportion undergoing TKA fell from 93.4% in 2007 to 86.3% in 2014 (P<0.001). Between 2007 and 2014 the proportions of patients with osteonecrosis who underwent UKA and tibial osteotomy increased from 34.7% and 11.6% to 38.6% and 16.2%, respectively (P=0.001 for UKA and P=0.004 for tibial osteotomy). The proportions of patients with osteonecrosis undergoing UKA or tibial osteotomy were significantly greater than those with other diagnoses (P<0.001 for both). CONCLUSIONS The popularity of UKA and tibial osteotomy in Japan increased during the period 2007-2014 at the expense of TKA. The proportions of UKA and tibial osteotomy in patients with osteonecrosis also increased, and were larger than those in patients with other causative diseases.
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Affiliation(s)
- Manabu Kawata
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Sasabuchi
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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21
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Yasuda T, Ota S, Fujita S, Onishi E, Iwaki K, Yamamoto H. Association between medial meniscus extrusion and spontaneous osteonecrosis of the knee. Int J Rheum Dis 2017; 21:2104-2111. [DOI: 10.1111/1756-185x.13074] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tadashi Yasuda
- Department of Orthopaedic Surgery; Kobe City Medical Center General Hospital; Kobe Japan
| | - Satoshi Ota
- Department of Orthopaedic Surgery; Kobe City Medical Center General Hospital; Kobe Japan
| | - Satoshi Fujita
- Department of Orthopaedic Surgery; Kobe City Medical Center General Hospital; Kobe Japan
| | - Eijiro Onishi
- Department of Orthopaedic Surgery; Kobe City Medical Center General Hospital; Kobe Japan
| | - Koichi Iwaki
- Department of Orthopaedic Surgery; Kobe City Medical Center General Hospital; Kobe Japan
| | - Hiroshi Yamamoto
- Department of Orthopaedic Surgery; Kobe City Medical Center General Hospital; Kobe Japan
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22
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Russo A, Capasso R, Varelli C, Laporta A, Carbone M, D'Agosto G, Giovine S, Zappia M, Reginelli A. MR imaging evaluation of the postoperative meniscus. Musculoskelet Surg 2017; 101:37-42. [PMID: 28210945 DOI: 10.1007/s12306-017-0454-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 06/06/2023]
Abstract
MR imaging has been widely evaluated in the assessment of patients with recurrent or residual symptoms following meniscal surgery. Importantly, the causes of such symptoms may relate to failure or complication of the surgical procedure, a possible recurrent or residual meniscal tear, or may be related to other causes of joint symptoms, including tears of the contralateral meniscus, or local hyaline cartilage, or marrow abnormalities subjacent to or distant to the meniscal surgical site. The complex diagnostic issues involved in the MR imaging evaluation of the postoperative meniscus were identified in early MR imaging studies. The knowledge of the normal MR imaging appearance of the knee after the more common repair procedures will allow radiologists to recognize complications associated with such procedures. In this article, we discuss the MR imaging evaluation of the knee after meniscal surgery.
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Affiliation(s)
- A Russo
- Department of Radiology, S. G. Moscati Hospital, Via Gramsci, 81031, Aversa, Italy.
| | - R Capasso
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - C Varelli
- Varelli Diagnostic Institute of Naples, Naples, Italy
| | - A Laporta
- Department of Radiology, Solofra Hospital, Avellino, Italy
| | - M Carbone
- Department of Radiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - G D'Agosto
- Diagnostic DAM Institute, Nocera Inferiore (Salerno), Italy
| | - S Giovine
- Department of Radiology, S. G. Moscati Hospital, Via Gramsci, 81031, Aversa, Italy
| | - M Zappia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - A Reginelli
- Department of Internal Clinical and Experimental Medicine and Surgery, Second University of Naples, Caserta, Italy
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23
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Berruto M, Ferrua P, Uboldi F, Pasqualotto S, Ferrara F, Carimati G, Usellini E, Delcogliano M. Can a biomimetic osteochondral scaffold be a reliable alternative to prosthetic surgery in treating late-stage SPONK? Knee 2016; 23:936-941. [PMID: 27592357 DOI: 10.1016/j.knee.2016.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to assess the reliability of the Maioregen® biomimetic osteochondral scaffold (Finceramica Faenza SpA, Faenza, Italy) as a salvage and joint-preserving procedure in the treatment of late-stage osteonecrosis of the knee. METHODS Eleven active patients aged under 65years and presenting with clinical and radiological signs of SPONK were treated with Maioregen®. All were clinically evaluated pre-operatively and yearly thereafter for a minimum of two years. Subjective IKDC and Lysholm Knee Scale scores were used to assess clinical outcome. A VAS scale served to quantify pre-operative pain and post-operative pain. Activity levels were evaluated pre-operatively and at follow-up using the Tegner Activity Scale. RESULTS Subjective IKDC (40±15.0 to 65.7±14.8 (mean±SD)) and Lysholm Knee Scale (49.7±17.9 to 86.6±12.7 (mean±SD)) scores improved significantly from pre-operative evaluation (p<.01). VAS scores decreased from a pre-operative mean (±SD) of 6.3±2.5 to 1.6±2.7 at two years. The Tegner Activity Scale showed no significant differences between pre-injury and two-year follow-up. Two out of the 11 patients were symptomatic at 18months post implant and progressed to condylar collapse. These patients required total knee arthroplasty. CONCLUSIONS Use of a biomimetic scaffold can be a valid option in the surgical treatment of SPONK in relatively young active patients. Indeed, this surgical technique, originally developed for osteochondritis dissecans, has been found to give good clinical results at medium-term follow-up of late-stage osteonecrosis treatment and could postpone or even avoid the need for joint replacement procedures.
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Affiliation(s)
- M Berruto
- SSD Chirurgia Articolare del Ginocchio Istituto Ortopedico Gaetano Pini, Milan, Italy.
| | - P Ferrua
- SSD Chirurgia Articolare del Ginocchio Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - F Uboldi
- SSD Chirurgia Articolare del Ginocchio Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - S Pasqualotto
- SSD Chirurgia Articolare del Ginocchio Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - F Ferrara
- SSD Chirurgia Articolare del Ginocchio Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - G Carimati
- SSD Chirurgia Articolare del Ginocchio Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - E Usellini
- SSD Chirurgia Articolare del Ginocchio Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - M Delcogliano
- Ospedale Regionale di Lugano, Civico e Italiano, Reparto di Ortopedia e Traumatologia, Lugano, Switzerland
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24
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Marx A, Beier A, Taheri P, Röpke M, Kalinski T, Halder AM. Post-arthroscopic osteonecrosis of the medial tibial plateau: a case series. J Med Case Rep 2016; 10:291. [PMID: 27756382 PMCID: PMC5069801 DOI: 10.1186/s13256-016-1063-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 09/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background Avascular necrosis after arthroscopic surgery of the knee has already been published. The purpose of this article is to report on the frequently misdiagnosed entity of osteonecrosis of the medial tibial plateau. Case presentation Charts and radiographs of a consecutive series with isolated medial tibial plateau osteonecrosis were analyzed. The criterion for inclusion was the absence of trauma. Six caucasian female patients with an average age of 76.5 years complied with this criterion. Three of these cases had had arthroscopic intervention for medial meniscal lesion within the previous year. Conclusions The etiology of these necroses remains unclear. Osteonecrosis must be taken into account as a possible cause of persistent knee pain after surgery. Correlation between arthroscopic treatment and necrotic processes in the tibial plateau must still be regarded with skepticism.
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Affiliation(s)
- Axel Marx
- Clinic for Orthopaedics, Sana Kliniken Sommerfeld, 16766, Sommerfeld, Germany.
| | - Alexander Beier
- Clinic for Orthopaedics, Sana Kliniken Sommerfeld, 16766, Sommerfeld, Germany
| | - Pouria Taheri
- Clinic for Orthopaedics, Sana Kliniken Sommerfeld, 16766, Sommerfeld, Germany
| | - Martin Röpke
- Clinic for Orthopaedics, University Magdeburg, 39120, Magdeburg, Germany
| | - Thomas Kalinski
- Department of Pathology, University Magdeburg, 39120, Magdeburg, Germany
| | - Andreas M Halder
- Clinic for Orthopaedics, Sana Kliniken Sommerfeld, 16766, Sommerfeld, Germany
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Jordan RW, Aparajit P, Docker C, Udeshi U, El-Shazly M. The importance of early diagnosis in spontaneous osteonecrosis of the knee - A case series with six year follow-up. Knee 2016; 23:702-7. [PMID: 27198760 DOI: 10.1016/j.knee.2016.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 03/17/2016] [Accepted: 04/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Spontaneous osteonecrosis of the knee has an unknown aetiology. Management options include conservative, surgical and pharmacological interventions. The aim of this study was to report the experience of the authors in conservative management of SONK using non-operative measures by analysing the functional outcome and need for surgical intervention. MATERIALS AND METHODS All patients treated for SONK between 1st August 2001 and 1st April 2014 were retrospectively reviewed. Treatment consisted of touch-down weight bearing for around six weeks. MR imaging was evaluated for size of lesion, the condyles involved and the time taken for resolution. Tegner Activity Scale, VAS pain, Lysholm, WOMAC and IKDC scores were recorded at presentation and final follow-up (mean six years, range six months to 13years). RESULTS Forty cases were included; the mean age of the group was 55.3years and 67.5% were male. The medial femoral condyle was the most commonly affected (52.5%). A statistically significant improvement was reported in all functional outcome measures (p<0.001). Only one patient required arthroscopic surgical intervention and no patients required arthroplasty during the follow-up period. CONCLUSION Early stage spontaneous osteonecrosis of the knee can be managed successfully without surgery if diagnosed early. Thus early investigation of acute knee pain with MRI scanning is recommended.
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Affiliation(s)
- Robert W Jordan
- University Hospitals Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Prasad Aparajit
- Aparajit Orthopaedic and Maternity Nursing Home, 22, Near State Bank Of India, West High Court Road, Surendranagar, Nagpur 440015, India.
| | - Charles Docker
- Worcester Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, United Kingdom.
| | - Umesh Udeshi
- Worcester Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, United Kingdom.
| | - Mohi El-Shazly
- Droitwich Knee Clinic, 27 New Road, Bromsgrove, Worcestershire B60 2JL, United Kingdom.
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Defining the role of bisphosphonates for osteonecrosis of the knee: a systematic review. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mayr H, Stoehr A. Komplikationen arthroskopischer Eingriffe am Kniegelenk. DER ORTHOPADE 2015; 45:4-12. [DOI: 10.1007/s00132-015-3182-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Son IJ, Kim MK, Kim JY, Kim JG. Osteonecrosis of the knee after arthroscopic partial meniscectomy. Knee Surg Relat Res 2013; 25:150-4. [PMID: 24032105 PMCID: PMC3767902 DOI: 10.5792/ksrr.2013.25.3.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 03/21/2013] [Accepted: 06/07/2013] [Indexed: 10/31/2022] Open
Abstract
Osteonecrosis of the femoral condyle is known as an uncommon complication after arthroscopic meniscectomy. The lesion of osteonecrosis can be irreversible, thus early detection of the disease is crucial for treatment. A 50-year-old male patient without known risk factors of osteonecrosis developed increasing knee pain after arthroscopic partial meniscectomy. Magnetic resonance imaging showed rapid progression of osteonecrosis of the medial femoral condyle. Unicompartmental knee arthroplasty was performed after 9 months of conservative therapy. The patient is now free from pain during daily activities. It might be important to remind that if the patient's pain after arthroscopic partial meniscectomy is severe than expected, clinical doctors should pay attention to the possibility of ongoing osteonecrosis of the femoral condyle.
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Affiliation(s)
- Il Jin Son
- Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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29
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Breer S, Oheim R, Krause M, Marshall RP, Amling M, Barvencik F. Spontaneous osteonecrosis of the knee (SONK). Knee Surg Sports Traumatol Arthrosc 2013; 21:340-5. [PMID: 22534975 DOI: 10.1007/s00167-012-2017-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 04/12/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE Spontaneous osteonecrosis of the knee (SONK/Morbus Ahlback) mainly affects the medial condyle of elderly women. It is assumed that localized vascular insufficiency leads to necrosis of the subchondral bone with subsequent disruption of the nutrition supply to the cartilage above. The aetiology remains unclear in detail. Operative treatment procedures compete against non-operative strategies, whereas the outcome is unpredictable in many cases. METHOD A consecutive case series of five patients suffering from SONK was analysed. All patients underwent a clinical examination, magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry scan, as well as laboratory analyses and visual analogue scale (VAS) evaluation. Our treatment regime is based on high-dose vitamin D administered orally and intravenous application of 3 mg ibandronate two times within 8 weeks. Another 8 weeks later, all patients were followed up including a follow-up MRI. RESULTS Within 4 weeks, all patients were free of symptoms. The MRI follow-up showed remission of the bone marrow oedema in every case studied. VAS decreased significantly from 7.4 ± 1.0 pre-interventional to 0.8 ± 1.0 post-interventional. No allergic reactions or other side effects were documented. CONCLUSION We showed that our treatment regime not only eliminated the pathological findings in the MRI of all cases studied, but also decreased the pain level and functional limitations within a short-time period. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- S Breer
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany
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Possible beneficial effect of bisphosphonates in osteonecrosis of the knee. Knee Surg Sports Traumatol Arthrosc 2010; 18:1638-44. [PMID: 20376625 DOI: 10.1007/s00167-010-1106-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2009] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED 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% (p < 0.001). At the 6-month follow-up, symptoms had resolved completely in 15 patients out of 28; in 6 patients, minimal symptoms (VAS 1-2) remained. In two patients, treatment effect was unsatisfactory, and surgical intervention was needed (arthroplasty). Bone marrow oedema on MRI resolved completely in 18 patients out of 28 with substantial reduction in the remaining. Furthermore, osteonecrotic area resolved completely or demarcation with sclerotic changes of the necrotic area could be observed. Bisphosphonate treatment in patients with osteonecrosis of the knee was associated with a rapid improvement in pain score and radiological consolidation of the area of osteonecrosis. Further randomized, controlled trials are warranted to confirm the potential beneficial role of bisphosphonates in the treatment of osteonecrosis of the knee. LEVEL OF EVIDENCE observational study, level IV.
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32
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Pape D, Filardo G, Kon E, van Dijk CN, Madry H. Disease-specific clinical problems associated with the subchondral bone. Knee Surg Sports Traumatol Arthrosc 2010; 18:448-62. [PMID: 20151111 DOI: 10.1007/s00167-010-1052-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 01/08/2010] [Indexed: 11/29/2022]
Abstract
The subchondral bone is involved in a variety of diseases affecting both the articular cartilage and bone. Osteochondral defects in distinct locations and of variable sizes are the final results of different etiologies. These include traumatic osteochondral defects, osteochondritis dissecans, osteonecrosis, and osteoarthritis. Traumatic osteochondral defects are caused by osteochondral fractures, separating an osteochondral fragment that includes articular cartilage and both subchondral and trabecular bone from the joint surface. In osteochondritis dissecans, the disease originates in the subchondral bone and secondarily affects the articular cartilage. Location, stage, size, and depth of osteochondral lesions play a role in the treatment of traumatic osteochondral defects and osteochondritis dissecans. Surgical options include fragment refixation, transplantation of osteochondral autografts, or bone restoration by impacted cancellous bone grafts combined with autologous chondrocyte transplantation. An insufficiency fracture of the subchondral bone may be the initiating factor of what was formerly believed to be a spontaneous osteonecrosis of the knee (SPONK). Recent histopathological studies suggest that each stage of SPONK reflects different types of bone repair reactions following a fracture of the subchondral bone plate. Osteoarthritis is a disease that does affect not only the articular cartilage, but also the subchondral bone. Reconstructive surgical techniques aim at preserving joint function, inducing fibrocartilaginous repair, and at correcting malalignment. This review summarizes the current status of the clinical treatment of traumatic osteochondral defects, osteochondritis dissecans, osteonecrosis, and osteoarthritis as they affect the subchondral bone region and its adjacent structures.
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Affiliation(s)
- Dietrich Pape
- Department of Orthopaedic Surgery, Centre de l'Appareil Locomoteur de Médicine du Sport et de Prévention, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg
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Zywiel MG, McGrath MS, Seyler TM, Marker DR, Bonutti PM, Mont MA. Osteonecrosis of the knee: a review of three disorders. Orthop Clin North Am 2009; 40:193-211. [PMID: 19358905 DOI: 10.1016/j.ocl.2008.10.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteonecrosis of the knee is a debilitating disease that is poorly understood. Originally described as a single disorder, it encompasses three distinct conditions: spontaneous osteonecrosis of the knee (SPONK), secondary osteonecrosis of the knee, and post-arthroscopic osteonecrosis of the knee. This article reviews the current knowledge of these distinct conditions by describing their etiology, pathology, and pathogenesis, as well as their clinical and radiographic presentations. The various treatment options available for each condition are reviewed, with a discussion of their rationale and indications, and a summary of results with various techniques. A thorough understanding of these conditions and their distinguishing features is critical to selecting the best treatment option for an individual patient.
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Affiliation(s)
- Michael G Zywiel
- Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
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Robertson DD, Armfield DR, Towers JD, Irrgang JJ, Maloney WJ, Harner CD. Meniscal root injury and spontaneous osteonecrosis of the knee: an observation. ACTA ACUST UNITED AC 2009; 91:190-5. [PMID: 19190052 DOI: 10.1302/0301-620x.91b2.21097] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe injuries to the posterior root of the medial meniscus in patients with spontaneous osteonecrosis of the medial compartment of the knee. We identified 30 consecutive patients with spontaneous osteonecrosis of the medial femoral condyle. The radiographs and MR imaging were reviewed. We found tears of the posterior root of the medial meniscus in 24 patients (80%). Of these, 15 were complete and nine were partial. Complete tears were associated with > 3 mm of meniscal extrusion. Neither the presence of a root tear nor the volume of the osteonecrotic lesion were associated with age, body mass index (BMI), gender, side affected, or knee alignment. The grade of osteoarthritis was associated with BMI. Although tears of the posterior root of the medial meniscus were frequently present in patients with spontaneous osteonecrosis of the knee, this does not prove cause and effect. Further study is warranted.
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35
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Gahunia HK, Kessler MJ, Houpt JB, Renlund RC, Peel SAF, Babyn PS, Pritzker KPH. Spontaneous Osteonecrosis of the Knee in Macaca mulatta. INT J PRIMATOL 2009. [DOI: 10.1007/s10764-009-9351-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pape D, Lorbach O, Anagnostakos K, Kohn D. [Osteonecrosis in the postarthroscopic knee]. DER ORTHOPADE 2009; 37:1099-100, 1102-7. [PMID: 18958445 DOI: 10.1007/s00132-008-1303-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Osteonecrosis of the knee is a rare complication following arthroscopic surgery. Little is known about its etiology. The most important differential diagnosis is preexisting and undiagnosed early-stage spontaneous osteonecrosis of the knee. Medicolegally, arthroscopic surgery could be wrongly regarded as the primary cause for postarthroscopic osteonecrosis. Orthopedic surgeons need to be aware of the diagnostic pitfalls in differentiating between these entities. We suggest that the descriptive term "osteonecrosis in the postoperative knee" should be used rather than the captious term "postarthroscopic osteonecrosis."
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Affiliation(s)
- D Pape
- Centre de l'Appareil Locomoteur, de Médecine du Sport et de Prévention, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxembourg.
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Risk of osteonecrosis of the femoral condyle after arthroscopic chondroplasty using radiofrequency: a prospective clinical series. Knee Surg Sports Traumatol Arthrosc 2009; 17:24-9. [PMID: 18758748 DOI: 10.1007/s00167-008-0604-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2007] [Accepted: 07/23/2008] [Indexed: 10/21/2022]
Abstract
Radiofrequency (RF) energy can be used for treatment of intraarticular pathologies in knee joint. RF energy was found to be superior to mechanical techniques in smoothening the articular surface (chondroplasty), shortening the operation time and reducing the blood loss. As RF produces thermal energy it has been reported to be responsible for the postoperative osteonecrosis however, there is no clinical evidence in the literature supporting that RF causes osteonecrosis. The current study searches for an answer whether surgical arthroscopic modalities using RF energy causes osteonecrosis. We hypothesize in the presented study that chondroplasty with RF has no effect on increasing the incidence of osteonecrosis in knee joint. In a prospective clinical trial, arthroscopic chondroplasty was performed in 50 patients with degenerative changes of the articular cartilage, stage II and III according to Outerbridge. To be included in the study, the patients had to meet the following criteria: (1) Preoperative MRI and plain film radiographs showing no evidence of osteonecrosis. (2) Patients had to be symptomatic for at least 6 weeks before the preoperative MRI. (3) Arthroscopically confirmed stage II or III. Preoperative MRI was taken in all patients. For chondral lesions bipolar RF energy system (VAPR-DePuy Mitek, Norwood, USA) was used. The patients were examined at the end of the sixth month and we performed MRI. Fifty patients with an average of age 45.54 (between 18 and 64) (SD, 10.63). During arthroscopy, together with chondropathy 22 patients pure medial meniscus tears, 7 patients medial and lateral meniscus tears, 7 patients pure lateral meniscus tears, 2 patients medial plica, and 3 patients synovial hypertrophy were detected. Among all 50 patients, osteonecrosis were detected at only 2 (4%) in the postoperative period. Until now it was not clear that RF energy causes osteonecrosis; however, according to this study if proper method is used, bipolar RF energy used for arthroscopic chondroplasty does not causes subchondral osteonecrosis.
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MacDessi SJ, Brophy RH, Bullough PG, Windsor RE, Sculco TP. Subchondral fracture following arthroscopic knee surgery. A series of eight cases. J Bone Joint Surg Am 2008; 90:1007-12. [PMID: 18451392 DOI: 10.2106/jbjs.g.00445] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteonecrosis has been reported as a rare complication of arthroscopic knee surgery, with the diagnosis based on radiographic findings associated with recurrent or worsening clinical symptoms. The term osteonecrosis has been applied to this clinical entity despite a lack of pathologic evidence to support the diagnosis. The purpose of this study was to document the pathologic changes involved in this rare process. METHODS Patients who had undergone an arthroscopic procedure followed by a total knee replacement within two years were eligible for the study. Inclusion criteria included pre-arthroscopy magnetic resonance imaging findings consistent with a meniscal tear with otherwise normal bone morphology followed by a provisional diagnosis of post-arthroscopy osteonecrosis based on subsequent imaging studies. Patients were excluded if a laser-assisted device had been utilized during the arthroscopy. Seven patients (eight knees) with an average age of sixty-four years met the criteria and were included in the study group. RESULTS All patients had undergone an arthroscopic medial meniscectomy, and two also had had a chondroplasty, with use of a mechanical shaver. Seven of the post-arthroscopy lesions involved the medial femoral condyle, and one lesion involved the medial tibial plateau. Pathologic analysis revealed a subchondral fracture with callus formation, indicated by the presence of woven bone, in all cases. Four patients had essentially intact articular cartilage overlying the lesion, which was characterized by disruption of the trabecular architecture indicative of subchondral bone fracture. The other four patients had an isolated osteochondral defect with reparative tissue within the base of the defect. Only two knees had localized evidence of osteonecrosis, which appeared to be secondary to the fracture. CONCLUSIONS This study provides pathologic evidence supporting the concept that subchondral fracture, and not osteonecrosis, is the major event in this rare complication following arthroscopy. Further investigation into the etiology of this condition is warranted.
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Kattapuram TM, Kattapuram SV. Spontaneous osteonecrosis of the knee. Eur J Radiol 2008; 67:42-8. [PMID: 18359599 DOI: 10.1016/j.ejrad.2008.01.055] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 01/17/2008] [Accepted: 01/18/2008] [Indexed: 11/24/2022]
Abstract
Spontaneous osteonecrosis of the knee presents with acute onset of severe, pain in elderly patients, usually female and usually without a history of trauma. Originally described as idiopathic osteonecrosis, the exact etiology is still debated. Evidence suggests that an acute fracture occurs as a result of chronic stress or minor trauma to a weakened subchondral bone plate. The imaging characteristics on MR reflect the age of the lesion and the symptoms. More appropriate terminology may be " subchondral insufficiency fracture of the knee" or "focal subchondral osteonecrosis".
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Affiliation(s)
- Taj M Kattapuram
- Department of Radiology, Massachusetts General Hospital, MA, USA
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40
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Fox MG. MR imaging of the meniscus: review, current trends, and clinical implications. Radiol Clin North Am 2008; 45:1033-53, vii. [PMID: 17981182 DOI: 10.1016/j.rcl.2007.08.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
MR imaging is the preferred imaging modality for evaluating the meniscus. Overall, when strict criteria are followed, it is accurate in diagnosing meniscal tears in patients who have not had prior meniscal surgery. However, an accurate interpretation requires a through knowledge of the normal meniscal anatomy, common meniscal variants, and common diagnostic pitfalls. In this article, the author emphasizes the importance of describing meniscal tears properly and discusses treatment options. Diagnosing a recurrent tear is more complicated in patients who have had prior partial meniscal resection or repair, and the use of MR arthrography in this group of patients is discussed. Recent developments in areas such as 3 T and parallel imaging offer promise for accurate meniscal evaluation with even shorter scan times.
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Affiliation(s)
- Michael G Fox
- Division of Musculoskeletal Radiology, Department of Radiology, University of Virginia, Charlottesville, VA 22908, USA.
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41
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Pape D, Seil R, Anagnostakos K, Kohn D. Postarthroscopic osteonecrosis of the knee. Arthroscopy 2007; 23:428-38. [PMID: 17418337 DOI: 10.1016/j.arthro.2007.02.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 02/20/2007] [Accepted: 02/20/2007] [Indexed: 02/02/2023]
Abstract
Little is known about the etiology of postarthroscopic osteonecrosis of the knee. Its prevalence is probably very low. The most important differential diagnosis is pre-existing and undiagnosed early-stage spontaneous osteonecrosis of the knee. From the medicolegal point of view, orthopaedic surgeons need to be aware of the diagnostic pitfalls in differentiating between postarthroscopic osteonecrosis of the knee and spontaneous osteonecrosis of the knee, and they must understand that both may be unpreventable conditions. The purpose of this report is to review the presumable pathophysiology and the clinical and radiographic features as well as the pitfalls in diagnosing postarthroscopic osteonecrosis of the knee.
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Affiliation(s)
- Dietrich Pape
- Department of Orthopaedic Surgery, University of Saarland, Homburg/Saar, Germany.
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42
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Fox MG. MR Imaging of the Meniscus: Review, Current Trends, and Clinical Implications. Magn Reson Imaging Clin N Am 2007; 15:103-23. [PMID: 17499184 DOI: 10.1016/j.mric.2007.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
MR imaging is the preferred imaging modality for evaluating the meniscus. Overall, when strict criteria are followed, it is accurate in diagnosing meniscal tears in patients who have not had prior meniscal surgery. However, an accurate interpretation requires a through knowledge of the normal meniscal anatomy, common meniscal variants, and common diagnostic pitfalls. In this article, the author emphasizes the importance of describing meniscal tears properly and discusses treatment options. Diagnosing a recurrent tear is more complicated in patients who have had prior partial meniscal resection or repair, and the use of MR arthrography in this group of patients is discussed. Recent developments in areas such as 3 T and parallel imaging offer promise for accurate meniscal evaluation with even shorter scan times.
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Affiliation(s)
- Michael G Fox
- Division of Musculoskeletal Radiology, Department of Radiology, University of Virginia, Box 800170, Charlottesville, VA 22908, USA.
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Ishida K, Kuroda R, Sakai H, Doita M, Kurosaka M, Yoshiya S. Rapid chondrolysis after arthroscopic partial lateral meniscectomy in athletes: a case report. Knee Surg Sports Traumatol Arthrosc 2006; 14:1266-9. [PMID: 16710730 DOI: 10.1007/s00167-006-0091-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 11/16/2005] [Indexed: 10/24/2022]
Abstract
We present a patient with a severe chondrolysis after arthroscopic partial lateral meniscectomy in a 17-year-old high school basketball player. This is a rare but severe complication after arthroscopic partial lateral meniscectomy. At 7 months after the first operation, a second-look arthroscopy showed numerous cartilaginous debris floating in the knee and a high-grade cartilage damage on the lateral compartment of the tibia. This unexpected complication and a consideration of its etiology are shown.
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Affiliation(s)
- Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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Bonutti PM, Seyler TM, Delanois RE, McMahon M, McCarthy JC, Mont MA. Osteonecrosis of the knee after laser or radiofrequency-assisted arthroscopy: treatment with minimally invasive knee arthroplasty. J Bone Joint Surg Am 2006; 88 Suppl 3:69-75. [PMID: 17079370 DOI: 10.2106/jbjs.f.00533] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteonecrosis of the knee after various arthroscopic procedures associated with the use of laser or radiofrequency devices has been described in a few case reports. The purpose of this study was to report on a series of nineteen patients with osteonecrosis of the knee after arthroscopic procedures. A literature search was done to compare this series of patients to previously reported cases. In addition, we analyzed the outcome after treatment with minimally invasive knee arthroplasty. METHODS We studied patients who had development of osteonecrosis of the knee after a routine arthroscopic procedure. Preoperative and postoperative clinical notes, radiographs, and magnetic resonance images of patients were analyzed. Only those patients with no evidence of osteonecrosis on preoperative magnetic resonance imaging who later had development of osteonecrosis and subsequently required a knee arthroplasty were included. We conducted a search of the current literature to compare the results seen in our patient population with those seen in other patients with this entity. Patients were followed both clinically and radiographically for a mean of sixty-two months. RESULTS A total of nineteen patients met the inclusion criteria. There were fourteen women and five men with a mean age of sixty-nine years. Six patients underwent an arthroscopy with associated holmium or yttrium-aluminum-garnet laser treatment, ten patients had associated radiofrequency treatment, and three patients had microfracture surgery. Subsequent arthroplasty procedures included four unicompartmental knee arthroplasties and fifteen tricompartmental knee arthroplasties. At the time of final follow-up, the mean Knee Society objective score was 95 points. CONCLUSIONS Arthroscopic procedures may play a role in the development of osteonecrosis of the knee. To our knowledge, this is the largest series of patients to have development of this condition after arthroscopy with associated laser, radiofrequency, or microfracture surgery. The midterm results of knee arthroplasty in this unique patient population are comparable with those of patients undergoing knee arthroplasty for osteoarthritis of the knee. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.
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Lecouvet FE, Malghem J, Maldague BE, Vande Berg BC. MR imaging of epiphyseal lesions of the knee: current concepts, challenges, and controversies. Radiol Clin North Am 2005; 43:655-72, vii-viii. [PMID: 15893529 DOI: 10.1016/j.rcl.2005.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article focuses on spontaneous painful conditions involving the subchondral bone and marrow of mature knee epiphyses. MR imaging is the technique of choice for the work-up of these lesions and enables distinction of two main categories of lesions on the basis of T1-weighted images: avascular necrosis, and lesions presenting the bone marrow edema pattern. This latter category encompasses spontaneous osteonecrosis of the knee, and a variety of self-resolving conditions that may be differentiated by the study of the subchondral bone marrow area on T2-weighted images. Behind definite appellation of lesions, the challenge for the radiologist is to provide a prognosis: the distinction between self-resolving lesions from those that may evolve to epiphyseal collapse and joint impairment should be possible in most cases.
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Affiliation(s)
- Frédéric E Lecouvet
- Section of Musculoskeletal Radiology, Department of Radiology, Saint Luc University Hospital, Université de Louvain, Hippocrate Avenue 10/2942, Brussels B-1200, Belgium.
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Valentí JR, Illescas JA, Barriga A, Dölz R. Idiopathic osteonecrosis of the medial tibial plateau. Knee Surg Sports Traumatol Arthrosc 2005; 13:293-8. [PMID: 15875161 DOI: 10.1007/s00167-004-0513-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2003] [Accepted: 01/30/2004] [Indexed: 10/26/2022]
Abstract
Osteonecrosis of the medial tibial plateau is characterized by acute pain on the medial aspect of the knee. Progression can lead to articular collapse and requires early diagnosis and treatment. We studied seven patients affected of idiopathic osteonecrosis of the tibial plateau. The mean age was 62 years and the mean follow-up 42 months. We performed roentgenograms in all patients, bone scans in three patients and magnetic resonance image (MRI) in five. MRI shows T1-weighted low-intensity signal and T2-weighted high-intensity signal with a surrounding area of intermediate low-intensity signal. An increased focal uptake was seen at bone scan. Histological findings showed necrotic bone with empty lacunae. Surgical treatment consisted of tibial subchondral drilling in four patients-two of them by failure of conservative treatment, and a total knee arthroplasty in other two. One patient had a satisfactory evolution with conservative treatment. Idiopathic osteonecrosis of the tibial plateau must be considered in elderly patients with knee pain over the medial tibial plateau. At early stages, decompression with tibial drilling must be considered. This procedure allows a prompt and effective relief of symptoms.
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Affiliation(s)
- J R Valentí
- Department of Orthopaedics and Traumatology, University Clinic, School of Medicine, University of Navarra, Pío XII, 36, 31008, Pamplona, Spain.
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Nho SJ, Freedman KB, Bansal SL, Romeo AA, Bach BR, Bush-Joseph CA, Turner DA, Cole BJ. The effect of radiofrequency energy on nonweight-bearing areas of bone following shoulder and knee arthroscopy. Orthopedics 2005; 28:392-9. [PMID: 15887586 DOI: 10.3928/0147-7447-20050401-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This prospective randomized clinical trial evaluated whether the use of radiofrequency energy (RFE) devices for soft-tissue ablation and coagulation cause thermal injury to bone. Fifty patients underwent one of three treatment modalities: electrocautery, monopolar RFE, or bipolar RFE. Preoperative and postoperative magnetic resonance imaging was compared to evaluate for evidence of osteonecrosis. Postoperative MRI of all patients did not reveal any osteonecrosis or subchondral edema. These findings indicate electrocautery, monopolar RFE, and bipolar RFE devices can be used safely for soft-tissue blation and hemostasis.
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Affiliation(s)
- Shane J Nho
- Section of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush-Presbyterian St Luke's Medical Center, Chicago, IL, USA
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Abstract
The increased number of patients undergoing arthroscopy or surgery of the knee for sports medicine injuries is leading to increased numbers of patients who require imaging after surgery because of failure to improve, recurrent symptoms, or new injury. As in preoperative patients, magnetic resonance (MR) imaging is the most valuable imaging method for postoperative evaluation of the knee. Surgical changes increase the difficulty of diagnosis of abnormalities in the knee with MR imaging. MR arthrography with direct intraarticular injection of contrast material can help improve evaluation of the postoperative meniscus and possibly help improve evaluation of anterior cruciate ligament grafts in patients after surgery. Recognition of the normal postoperative MR imaging appearance of the structures in the knee and of abnormalities is essential to accurate MR imaging evaluation of these patients.
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Affiliation(s)
- Thomas R McCauley
- Department of Diagnostic Imaging, Yale University School of Medicine, and Radiology Consultants, 40 Temple St, Suite 2B, New Haven, CT 06510, USA.
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