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Bone marrow lesions in the knee are associated with meniscal lesions and cartilage pathologies according to the six-letter system

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aims to find a correlation between bone marrow lesions (BMLs) in knee MRI and pathologies of joint structures. In addition, according to the six-letter system classification, the authors analyzed a potential association between the area affected by BMLs and the specific type of joint lesion.

Methods

The authors screened all the knee MRIs performed in the investigation center between 2017 and 2018 to identify the presence of BMLs. The lesions were then categorized following the “six-letter system”. The authors searched the presence of associated meniscal, chondral or ligamentous lesions. Finally, the authors researched a correlation between the lesion type described by the six-letter system classification and the associated lesions.

Results

MRI exams of 4000 patients were studied, identifying 666 BMLs. The associated lesions were collected for all patients, resulting in an overall prevalence of related lesions in almost 90% of patients. The authors found a statistical significance for type TLD (Tibia-Lateral-Articular) and ACL rupture. The study suggests a strong positive correlation between type E (Edge) and meniscal fracture or extrusion.

Conclusion

BMLs in the knee are associated in 90% of cases with a radiological sign of related injury to the joint structures. The six-letter system of BMLs type TLD can be considered a sign of ACL rupture and type E as a high suspicious sign for meniscal extrusion.

Those very typical BML patterns can help the clinician in the diagnosis of ACL tears and meniscal extrusion. Furthermore, the presence of a BML must be, for the clinician, a high suspicious sign of joint-related injuries.

Level of evidence

Level 1.

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Funding

The study received no founding.

Author information

Author notes

  1. Pietro Simone Randelli and Alessandra Menon contributed equally to this work.

Authors and Affiliations

  1. U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy

    Riccardo Compagnoni, Carlo Minoli, Paolo Ferrua, Alessandra Menon & Pietro Simone Randelli

  2. Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy

    Riccardo Compagnoni, Alessandra Menon & Pietro Simone Randelli

  3. Clinic of Orthopedics, Medical University of Łódź, Łódź, Poland

    Jędrzej Lesman & Marcin Domżalski

  4. Dipartimento di Scienze Cliniche e di Comunità, Università degli studi di Milano, Milan, Italy

    Alessandra Menon

  5. Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy

    Pietro Simone Randelli

  6. Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

    Camilla Mondini Trissino da Lodi

Authors
  1. Riccardo Compagnoni
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  2. Jędrzej Lesman
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  3. Carlo Minoli
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  4. Paolo Ferrua
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  5. Camilla Mondini Trissino da Lodi
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  6. Marcin Domżalski
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  7. Alessandra Menon
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  8. Pietro Simone Randelli
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Contributions

All authors contributed equally to the article research and writing.

Corresponding author

Correspondence to Carlo Minoli.

Ethics declarations

Conflict of interest

Riccardo Compagnoni, Carlo Minoli and Paolo Ferrua declare that they have no conflict of interest. Pietro Randelli is consultant for Depuy, Arthrex, Microport and Medacta. Alessandra Menon is consultant for Adler and Medacta.

Ethical approval

The Regional Ethical Committee approved the study protocol (authorization number Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Milano Area 2, Lombardia, Milan (n°394_2019bis, Milan, 08.05.2019) and was registered on ClinicalTrials.gov (Clinical Trials.gov ID: NCT03976141; June 5, 2019).

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All patients involved in the study have received and approved an informed consent form.

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Compagnoni, R., Lesman, J., Minoli, C. et al. Bone marrow lesions in the knee are associated with meniscal lesions and cartilage pathologies according to the six-letter system. Knee Surg Sports Traumatol Arthrosc 31, 286–291 (2023). https://doi.org/10.1007/s00167-022-07089-x

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  • DOI: https://doi.org/10.1007/s00167-022-07089-x

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