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Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome

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Abstract

Objective

To propose an magnetic resonance imaging (MRI) grading system for subchondral insufficiency fracture of the knee (SIFK) to predict outcome and assess risk factors.

Materials and methods

A total of 50 SIFK patients were retrospectively reviewed utilizing two MRI examinations approximately a year apart and compared them with 51 control subjects. A grading system was introduced that classifies lesions as low- vs high-grade. Lesion location 3D dimensions, extent of bone marrow edema (BME), location of meniscal tears and associated extrusion, degree of chondrosis and among other parameters were stratified according to lesion grade and compared with follow-up examinations. Statistical analyses were performed (Pearson’s correlation, binary logistic regression, and Chi-squared analysis).

Results

The majority of SIFK lesions were low-grade (LG; 78%) and most of them (70%) were observed in the medial femoral condyle. Predictor variables comparing low-grade and high-grade SIFK lesions included meniscal tear (p = 0.01), degree of extrusion (p < 0.003), chondrosis (p = 0.01), medial chondrosis grade (p = 0.001), medial femoral condyle (p = 0.01), surface collapse (p < 0.0001), marrow edema improvement (p < 0.0001), first MRI anteroposterior dimension (p = 0.001), transverse dimension (p < 0.001), and ellipsoid volume (p = 0.02). Predictor variables found to be significantly different between controls and patients were meniscal tear (p = 0.024), location of the medial meniscal tear (p < 0.0001), degree of extrusion (p < 0.0001), chondrosis (p < 0.0001), joint effusion (p < 0.0001), Baker’s cyst (p < 0.0001), knee lock (p = 0.03) and buckle (p = 0.01), and history of trauma (p = 0.01).

Conclusion

A SIFK grading system for MRI is introduced. Surrogate markers of high-grade lesions include medial meniscus posterior root tears with associated moderate to severe extrusion, high-grade chondrosis, larger lesion sizes (anteroposterior/transverse), and articular surface collapse. Improvement of BME on follow-up was highly predictive of low-grade disease.

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Abbreviations

BME:

Bone marrow edema

MMPRT:

Medial meniscal tears at the posterior root attachment

MRI:

Magnetic resonance imaging

SIFK:

Subchondral insufficiency fracture of the knee

SONK:

Spontaneous osteonecrosis of the knee

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA

    Samia Sayyid, Adam Singer & Felix M. Gonzalez

  2. Department of Radiology and Imaging Sciences, University of Massachusetts Medical School, Worcester, MA, USA

    Yara Younan

  3. University of Calgary, Calgary, Alberta, Canada

    Gulshan Sharma

  4. Department of Radiology and Imaging Sciences, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    William Morrison & Adam Zoga

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  1. Samia Sayyid
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Correspondence to Felix M. Gonzalez.

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Sayyid, S., Younan, Y., Sharma, G. et al. Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome. Skeletal Radiol 48, 1961–1974 (2019). https://doi.org/10.1007/s00256-019-03245-6

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  • DOI: https://doi.org/10.1007/s00256-019-03245-6

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