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Zmerly H, Moscato M, Akkawi I. Assessment and Management of Loose Bodies in the Knee Joint and Related Disease: A Narrative Review. Curr Rheumatol Rev 2021; 18:12-19. [PMID: 34674623 DOI: 10.2174/1573397117666211021165807] [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: 12/01/2020] [Revised: 03/09/2021] [Accepted: 08/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Loose bodies are frequently encountered during clinical activity and a common finding during knee arthroscopy. Usually, treatment consists of the removal of the loose bodies, which can be challenging even for experienced surgeons. The excision alone is not always the complete treatment, because loose bodies are generally secondary to other diseases that can cause persistent symptoms with the risk of new loose body formation. The aim of this narrative review is to show the clinical, imaging and arthroscopic evaluation of loose bodies in order to plan optimal treatment. METHODS A comprehensive search of PubMed was conducted to find the most recent and relevant studies investigating the aetiopathogenesis, the assessment tools and the therapeutic strategies for knee loose bodies and their related diseases. RESULTS When dealing with a loose body, the first issue is the evaluation of the intra-articular fragment (location, size, number, symptoms) and its aetiopathogenesis by identifying the underlying pathology (e.g., osteochondritis dissecans, osteoarthritis, chondral defect, tumour-like lesions, rheumatoid arthritis, etc.). In the case of symptomatic intra-articular loose bodies, treatment consists of fragment removal and the management of related diseases (e.g., lifestyle modification, physiotherapy, pharmacological and surgical treatment). CONCLUSION Loose bodies are not separate entities and in addition to their pathological aspect, must be evaluated within the context of the underlying disease. Correct assessment and comprehensive management allow for relief of symptomatology and prevention of loose body formation by removal and treatment of the associated diseases.
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Affiliation(s)
- Hassan Zmerly
- Orthopaedic Department, Villa Erbosa Hospital, Via Dell'Arcoveggio 50/2, 40129, Bologna. Italy
| | - Manuela Moscato
- Orthopaedic Department, Villa Erbosa Hospital, Via Dell'Arcoveggio 50/2, 40129, Bologna. Italy
| | - Ibrahim Akkawi
- Orthopaedic Department, Villa Erbosa Hospital, Via Dell'Arcoveggio 50/2, 40129, Bologna. Italy
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Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? Radiology 2019; 293:656-663. [PMID: 31617798 DOI: 10.1148/radiol.2019190341] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Osteoarthritis (OA) of the hip and knee is among the most common joint disorders. Intra-articular corticosteroid (IACS) injections are frequently performed to treat OA and other joint-related pain syndromes; however, there is conflicting evidence on their potential benefit. There is a lack of prospective and large retrospective studies evaluating potential joint findings, including increased risk for accelerated OA progression or adverse joint events, after treatment with IACS injection. Four main adverse joint findings have been structurally observed in patients after IACS injections: accelerated OA progression, subchondral insufficiency fracture, complications of osteonecrosis, and rapid joint destruction, including bone loss. Physicians, including radiologists, should be familiar with imaging findings and patient characteristics that may help them identify potential joints at risk for such events. The purpose of this report is to review the existing literature, describe observed adverse joint events after IACS injections, and provide an outlook on how this may affect clinical practice. Additional research endeavors are urgently needed to better understand and identify risk factors prior to intervention and to detect adverse joint events after injection as early as possible to prevent or minimize complications.
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Affiliation(s)
- Andrew J Kompel
- From the Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.J.K., F.W.R., A.M.M., L.E.D., M.D.C., A.G.); Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany (F.W.R.); Department of Radiology, Veterans Affairs Hospital, Boston, Mass (L.E.D., A.G.); and Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France (M.D.C.)
| | - Frank W Roemer
- From the Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.J.K., F.W.R., A.M.M., L.E.D., M.D.C., A.G.); Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany (F.W.R.); Department of Radiology, Veterans Affairs Hospital, Boston, Mass (L.E.D., A.G.); and Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France (M.D.C.)
| | - Akira M Murakami
- From the Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.J.K., F.W.R., A.M.M., L.E.D., M.D.C., A.G.); Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany (F.W.R.); Department of Radiology, Veterans Affairs Hospital, Boston, Mass (L.E.D., A.G.); and Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France (M.D.C.)
| | - Luis E Diaz
- From the Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.J.K., F.W.R., A.M.M., L.E.D., M.D.C., A.G.); Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany (F.W.R.); Department of Radiology, Veterans Affairs Hospital, Boston, Mass (L.E.D., A.G.); and Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France (M.D.C.)
| | - Michel D Crema
- From the Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.J.K., F.W.R., A.M.M., L.E.D., M.D.C., A.G.); Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany (F.W.R.); Department of Radiology, Veterans Affairs Hospital, Boston, Mass (L.E.D., A.G.); and Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France (M.D.C.)
| | - Ali Guermazi
- From the Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.J.K., F.W.R., A.M.M., L.E.D., M.D.C., A.G.); Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany (F.W.R.); Department of Radiology, Veterans Affairs Hospital, Boston, Mass (L.E.D., A.G.); and Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France (M.D.C.)
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Marom N, Koch JEJ, Beer Y, Ellis M, Ganot G, Nyska M, Maoz G, Hetsroni I. Thrombophilia-Associated Factors in Patients with Spontaneous Osteonecrosis of the Knee. Cartilage 2019; 10:53-60. [PMID: 29308659 PMCID: PMC6376567 DOI: 10.1177/1947603517749920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To test whether patients with spontaneous osteonecrosis of the knee (SONK) are characterized by abnormal levels of thrombophilia-associated factors. DESIGN Twenty-five patients with SONK were recruited. Inclusion criteria were (1) age >40 years, (2) acute onset knee pain not precipitated by trauma, and (3) MRI findings consistent with SONK. Exclusion criteria were (1) history of cancer and chemotherapy and (2) factors associated with secondary osteonecrosis. Blood tests included 13 thrombophilia-associated factors that were either heritable mutations or acquired factors. Descriptive statistics included medians, ranges, means, and standard deviations. Mann-Whitney test was used to compare thrombophilia-associated factor levels between the sexes. Spearman's rank test was used to test correlations between smoking status and each thrombophilia-associated factor. Level of significance was set at 0.05. RESULTS Median patient age was 62 years (range, 44-77 years). There were 16 (64%) men. Thirteen (52%) patients had thrombophilia-associated factor abnormalities of which 9 were elevated fibrinogen but this was less than 1 standard deviation above norm threshold. Other findings were 3 patients with marginally decreased antithrombin below norm threshold, low protein S Ag in only 1 patient, and factor V Leiden mutation heterozygosity in 2 patients, which was not higher than normal population prevalence. Thrombophilia-associated factors neither differed between sexes ( P = nonsignificant) nor correlated with smoking status ( P = nonsignificant). CONCLUSION Thrombophilia-associated factor abnormalities in patients with SONK were minimal. Therefore, clinical workup and treatment strategy in this disease should focus on addressing alternative etiologies leading to abnormal subchondral bone metabolism with focal osteopenia.
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Affiliation(s)
- Niv Marom
- Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan EJ. Koch
- Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yiftah Beer
- Department of Orthopedic Surgery, Assaf Harofeh General Hospital, Zeriffin, Israel
| | - Martin Ellis
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Hematology Institute and Blood Bank, Meir General Hospital, Kfar Saba, Israel
| | - Gil Ganot
- Department of Orthopedic Surgery, Assaf Harofeh General Hospital, Zeriffin, Israel
| | - Meir Nyska
- Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Maoz
- Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iftach Hetsroni
- Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Iftach Hetsroni, Department of Orthopedic Surgery, Meir General Hospital, Tsharnichovski Street 59, Kfar Saba 44281, Israel.
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Nelson F, Bokhari O, Oravec D, Kim W, Flynn M, Lumley C, McPhilamy A, Yeni YN. The Use of Tomosynthesis in the Global Study of Knee Subchondral Insufficiency Fractures. Acad Radiol 2017; 24:175-183. [PMID: 28010915 DOI: 10.1016/j.acra.2016.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/11/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
Abstract
RATIONALE AND OBJECTIVES Subchondral insufficiency fractures (SIF), previously termed spontaneous osteonecrosis of the knee, are marked by a sudden onset of severe pain. Other than the size of the lesion, prediction for progression to joint replacement is difficult. The objective was to determine if quantitative analysis of bone texture using digital tomosynthesis imaging would be useful in predicting more rapid progression to joint replacement. MATERIALS AND METHODS Tomosynthesis studies of 30 knees with documented SIF were quantified by fractal, mean intercept length (MIL), and line fraction deviation analyses. Fractal dimension, lacunarity, MIL, and line fraction deviation variables measured from these analyses were then correlated to short interval progression to joint replacement surgery. RESULTS Higher odds for joint replacement were related to higher values of the standard deviation of slope lacunarity and to morphometric measures (eg, MIL). CONCLUSIONS Using digital tomosynthesis images for bone texture assessment may help distinguish condylar bone response in SIF, potentially acting as a clinically relevant predictive tool. In the future, contrasting SIF to the more gradual long-term process of osteoarthritis, there may be a better understanding of the different mechanisms for the two conditions.
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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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