Abstract
Subchondral bone pathology (SBP) includes a wide range of pathologies, including trauma, post-cartilage surgery, osteoarthritis, transient bone marrow lesions (BML) syndromes, spontaneous insufficiency fractures, and osteonecrosis. They show common magnetic resonance imaging (MRI) findings termed bone marrow lesions (BMLs). However, the etiology and evolution of SBP in multiple conditions remains unclear. A key factor to address when studying a patient with BMLs is the distinction between reversible and irreversible lesions. MRI plays a significant role in the differential diagnosis based on recognizable typical patterns that have to be considered together with coexistent abnormalities, age, and clinical history. This chapter will focus on the current understanding of subchondral bone pathologies. Future research of BML will be mandatory to address the different pathologies better and determining appropriate treatment strategies.
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References
Kon E, Ronga M, Filardo G, et al. Bone marrow lesions and subchondral bone pathology of the knee. Knee Surg Sports Traumatol Arthrosc. 2016;24:1797–814.
Roemer FW, Frobell R, Hunter DJ, et al. MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis. Osteoarthr Cartil. 2009;17:1115–31.
Yates PJ, Calder JD, Stranks GJ, Early MRI. Diagnosis and non-surgical management of spontaneous osteonecrosis of the knee. Knee. 2007;14(2):112–6.
Mont M, Marker DR, Zywiel MG, et al. Osteonecrosis of the knee and related conditions. J Am Acad Orthop Surg. 2011;19:482–94.
Marcacci M, Andriolo L, Kon E, et al. Etiology and pathogenesis of bone marrow lesions and osteonecrosis of the knee. EFORT Open Rev. 2016;1:219–24.
Lecouvet FE, Van de Berg BC, Be M, et al. Early irreversible osteonecrosis versus transient lesions of the femoral condyles: prognostic value of subchondral bone and marrow changes on MR imaging. AJR Am J Roentgenol. 1998;170:71–7.
Viskontas DG, Giuffre BM, Duggal N, et al. Bone bruises associated with ACL rupture: correlation with injury mechanism. Am J Sports Med. 2008;36:927–33.
Soder RB, Simões JD, Soder JB, et al. MRI of the knee joint in asymptomatic adolescent soccer players: a controlled study. AJR Am J Roentgenol. 2011;196(1):W61–5.
Pappas GP, Vogelsong MA, Staroswiecki E, et al. Magnetic resonance imaging of asymptomatic knees in collegiate basketball players: the effect of one season of play. Clin J Sport Med. 2016;26(6):483–9.
Major NM, Helms CA. MR imaging of the knee: findings in asymptomatic collegiate basketball players. AJR Am J Roentgenol. 2002;179:641–4.
Sanders T, Medynski MA, Feller JF, et al. Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. Radiographics. 2000;20 Spec No:S135–51.
Berger N, Andreisek G, Karer AT, et al. Association between traumatic bone marrow abnormalities of the knee, the trauma mechanism and associated soft-tissue knee injuries. Eur Radiol. 2017;27(1):393–403.
Koga H, Nakamae A, Shima Y, et al. Mechanisms for noncontact anterior cruciate ligament injuries. Am J Sports Med. 2010;38(11):2218–25.
Bretlau T, Tuxøe J, Larsen L, et al. Bone bruise in the acutely injured knee. Knee Surg Sports Traumatol Arthros. 2002;10:96–101.
Lee BK, Nam SW. Rupture of posterior cruciate ligament: diagnosis and treatment principles. Knee Surg Relat Res. 2011;23(3):135–41.
Sonin AH, Fitzgerald SW, Hoff FL, et al. MR imaging of the posterior cruciate ligament: nor- mal, abnormal, and associated injury patterns. Radiographics. 1995;15(3):551–61.
Sanders TG, Paruchuri NB, Zlatkin MB. MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. AJR Am J Roentgenol. 2006;187:1332–7.
Rangger C, Kathrein A, Freund MC, et al. Bone bruise of the knee: histology and cryosections in 5 cases. Acta Orthop Scand. 1998;69:291–4.
Miller M, Osborne JR, Gordon WT, et al. The natural history of bone bruises. A prospective study of magnetic resonance imaging-detected trabecular microfractures in patients with isolated medial collateral ligament injuries. Am J Sports Med. 1998;26:15–9.
Costa-Paz M, Muscolo D, Ayerza M, et al. Magnetic resonance imaging follow-up study of bone bruises associated with anterior cruciate ligament ruptures. Arthroscopy. 2001;17:445–9.
Vellet A, Marks P, Fowler P. Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and short-term sequelae evaluated with MR imaging. Radiology. 1991;178:271–6.
Nakamae A, Engebretsen L, Bahr R, et al. Natural history of bone bruises after acute knee injury: clinical outcome and histopathological findings. Knee Surg Sports Traumatol Arthrosc. 2006;14:1252–8.
Johnson DL, Bealle DP, Brand JC Jr, et al. The effect of a geographic lateral bone bruise on knee inflammation after acute anterior cruciate ligament rupture. Am J Sports Med. 2000;28(2):152–5.
Filardo G, Kon E, Tentoni F, et al. Anterior cruciate ligament injury: post-traumatic bone marrow edema correlates with long-term prognosis. Int Orthop. 2016;40(1):183–90.
Lee JW, Lee SK, Choy WS. Complex regional pain syndrome type 1: diagnosis and management. J Hand Surg Asian Pac Vol. 2018;23(1):1–10.
Kotwal A, Hurtado MD, Sfeir JG. Transient osteoporosis: clinical spectrum in adults and associated risk factors. Endocr Pract. 2019;25(7):648–56.
Takeda M, Higuchi H, Kimura M, et al. Spontaneous osteonecrosis of the knee: histopathological differences between early and progressive cases. J Bone Joint Surg Br. 2008;90(3):324–9.
Karantanas AH, Drakonaki E, Karachalios T, et al. Acute non-traumatic marrow Edema syndrome in the knee: MRI findings at presentation, correlation with spinal DEXA and outcome. Eur J Radiol. 2008;67(1):22–33.
Gorbachova T, Melenevsky Y, Cohen M, et al. Osteochondral lesions of the knee: differentiating the Most common entities at MRI. Radiographics. 2018;38(5):1478–95.
Vidoni A, Shah R, Mak D, et al. Metaphyseal burst sign: a secondary sign on MRI of subchondral insufficiency fracture of the knee. J Med Imaging Radiat Oncol. 2018;62(6):764–8.
Pareek A, Parkes CW, Bernard C, et al. Spontaneous osteonecrosis/subchondral insufficiency fractures of the knee: high rates of conversion to surgical treatment and arthroplasty. J Bone Joint Surg Am. 2020;102(9):821–9.
Plett SK, Hackney LA, Heilmeier U, et al. Femoral condyle insufficiency fractures: associated clinical and morphologi- cal findings and impact on outcome. Skelet Radiol. 2015;44(12):1785–94.
Sayyid S, Younan Y. Sharma Gulshan. Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome. Skelet Radiol. 2019;48(12):1961–74.
Yao L, Stanczak J, Boutin RD. Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear patterns. Skelet Radiol. 2004;33(5):260–4.
Roemer FW, Neogi T, Nevitt MC, et al. Subchondral bone marrow lesions are highly associated with, and predict subchondral bone attrition longitudinally: the MOST study. Osteoarthr Cartil. 2010;18(1):47–53.
Ahlbäck S, Bauer GC, Bohne WH. Spontaneous osteonecrosis of the knee. Arthritis Rheum. 1968;11:705–33.
Karim A, Cherian JJ, Jauregui J, et al. Osteonecrosis of the knee: review. Ann Transl Med. 2015;3(1):6.
Yamamoto T, Bullough PG. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Joint Surg Am. 2000;82(6):858–66.
Hussain ZB, Chahla J, Mandelbaum BR, et al. 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(2):501–7.
Shah KN, Racine J, Jones LC, Aaron RK. Pathophysiology and risk factors for osteonecrosis. Curr Rev Musculoskelet Med. 2015 Sep;8(3):201–9.
Sakai T, Sugano N, Ohzono K, Matsui M, Hiroshima K, Ochi T. MRI evaluation of steroid- or alcohol-related osteonecrosis of the femoral condyle. Acta Orthop Scand. 1998;69(6):598.
Pape D, Seil R, Anagnostakos K, Kohn D. Postarthroscopic osteonecrosis of the knee. Arthroscopy. 2007;23(04):428–38.
Brahme SK, Fox JM, Ferkel RD, Friedman MJ, Flannigan BD, Resnick DL. Osteonecrosis of the knee after arthroscopic surgery: diagnosis with MR imaging. Radiology. 1991;178(03):851–3.
Fukuda Y, Takai S, Yoshino N, et al. Impact load transmission of the knee joint-influence of leg alignment and the role of meniscus and articular cartilage. Clin Biomech (Bristol, Avon). 2000;15(7):516–21.
Jones RS, Keene GC, Learmonth DJ, et al. Direct measurement of hoop strains in the intact and torn human medial meniscus. Clin Biomech (Bristol, Avon). 1996;11(5):295–300.
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(5):1007–12.
Hall FM. Osteonecrosis in the postoperative knee. Radiology. 2005;236(01):370–1. author reply 371
Roemer FW, Guermazi A, Javaid MK, et al. MOST study investigators. Change in MRI-detected subchondral bone marrow lesions is associated with cartilage loss: the MOST study. A longitudinal multicentre study of knee osteoarthritis. Ann Rheum Dis. 2009;68:1461–5.
Hunter DJ, Zhang Y, Niu J, et al. Increase in bone marrow lesions associated with cartilage loss: a longitudinal magnetic resonance imaging study of knee osteoarthritis. Arthritis Rheum. 2006;54:1529–35.
PR K, Kloppenburg M, Sharma R, et al. Bone marrow edema-like lesions change in volume in the majority of patients with osteoarthritis; associations with clinical features. Eur Radiol. 2007;17:3073–8.
Xu L, Hayashi D, Roemer FW, et al. Magnetic resonance imaging of subchondral bone marrow lesions in association with osteoarthritis. Semin Arthritis Rheum. 2012;42(2):105–18.
Felson DT, Niu J, Guermazi A, et al. Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging. Arthritis Rheum. 2007;56:2986–92.
Yusuf E, Kortekaas MC, Watt I, Huizinga TW, Kloppenburg M. Do knee abnormalities visualised on MRI explain knee pain in knee osteoarthritis? A systematic review. Ann Rheum Dis. 2011;70:60–7.
Gobbi A, Karnatzikos G, Kumar A. Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes. Knee Surg Sports Traumatol Arthrosc. 2014;22:1986–96.
Niethammer TR, Valentin S, Gülecyüz MF, et al. Bone marrow edema in the knee and its influence on clinical outcome after matrix-based autologous chondrocyte implantation: results after 3-year follow-up. Am J Sports Med. 2015;43:1172–9.
Orth P, Goebel L, Wolfram U, et al. Effect of subchondral drilling on the microarchitecture of subchondral bone: analysis in a large animal model at 6 months. Am J Sports Med. 2012;40:828–36.
Filardo G, Kon E, Di Martino A, et al. Is the clinical outcome after cartilage treatment affected by subchondral bone edema? Knee Surg Sports Traumatol Arthrosc. 2014;22:1337–44.
Ebert JR, Smith A, Fallon M, et al. Degree of preoperative subchondral bone Edema is not associated with pain and graft outcomes after matrix-induced autologous chondrocyte implantation. Am J Sports Med. 2014;42(11):2689–98.
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Gobbi, A., Alvarez, R., Irlandini, E., Dallo, I. (2022). Current Concepts in Subchondral Bone Pathology. In: Gobbi, A., Lane, J.G., Longo, U.G., Dallo, I. (eds) Joint Function Preservation. Springer, Cham. https://doi.org/10.1007/978-3-030-82958-2_15
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