Abstract
We histopathologically examined a surgically resected full specimen obtained from an early-stage spontaneous osteonecrosis of the knee (SPONK). On a mid-coronal cut section of the resected medial femoral condyle, a linear fracture line paralleling the subchondral bone endplate was found. Histopathologically, prominent callus formation was seen comprising of reactive woven bone and granulation tissue on both sides of the fracture. Fracture-related bone debris was focally observed at the osteochondral side of the fracture. Definitive features of antecedent bone infarction such as creeping substitution and bone marrow necrosis were not detected. These findings suggested that SPONK was the result of a subchondral fracture rather than primary osteonecrosis.
Similar content being viewed by others
References
Ahlbäck S, Bauer GC, Bohne WH. Spontaneous osteonecrosis of the knee. Arthritis Rheum. 1968;11:705–33.
Aglietti P, Insall JN, Buzzi R, Deschamps G. Idiopathic osteonecrosis of the knee: aetiology, prognosis and treatment. J Bone Joint Surg (Br). 1983;65:588–97.
Heyse TJ, Khefacha A, Fuchs-Winkelmann S, Cartier P. UKA after spontaneous osteonecrosis of the knee: a retrospective analysis. Arch Orthop Trauma Surg. 2011;131:613–7.
Koshino T. The treatment of spontaneous osteonecrosis of the knee by high tibial osteotomy with and without bone-grafting or drilling of the lesion. J Bone Joint Surg Am. 1982;64(1):47–58.
Lotke PA, Abend JA, Ecker ML. The treatment of osteonecrosis of the medial femoral condyle. Clin Orthop Relat Res. 1982;171:109–16.
Cruess RL. Osteonecrosis of bone: current concepts as to etiology and pathogenesis. Clin Orthop Relat Res. 1986;208:30–9.
Jones JP. Fat embolism, intravascular coagulation, and osteonecrosis. Clin Orthop Relat Res. 1993;292:294–308.
Lotke PA, Ecker ML, Alavi A. Painful knees in older patients: radionuclide diagnosis of possible osteonecrosis with spontaneous resolution. J Bone Joint Surg Am. 1977;59(5):617–21.
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.
Jose J, Pasquotti G, Smith MK, Gupta A, Lesniak BP, Kaplan LD. Subchondral insufficiency fractures of the knee: review of imaging findings. Acta Radiol. 2015;56(6):714–9.
Kattapuram TM, Kattapuram SV. Spontaneous osteonecrosis of the knee. Eur J Radiol. 2008;67(1):42–8.
Kidwai AS, Hemphill SD, Griffiths HJ. Radiologic case study: spontaneous osteonecrosis of the knee reclassified as insufficiency fracture. Orthopedics. 2005;28(3):236, 333–6.
Nakamura N, Horibe S, Nakamura S, Mitsuoka T. Subchondral microfracture of the knee without osteonecrosis after arthroscopic medial meniscectomy. Arthroscopy. 2002;18(5):538–41.
Takeda M, Higuchi H, Kimura M, Kobayashi Y, Terauchi M, Takagishi K. Spontaneous osteonecrosis of the knee: histopathological differences between early and progressive cases. J Bone Joint Surg (Br). 2008;90:324–9.
Mears SC, McCarthy EF, Jones LC, Hungerford DS, Mont MA. Characterization and pathological characteristics of spontaneous osteonecrosis of the knee. Iowa Orthop J. 2009;29:38–42.
Yamamoto T, Schneider R, Bullough PG. Insufficiency subchondral fracture of the femoral head. Am J Surg Pathol. 2000;24(3):464–8.
Acknowledgements
This work was partially supported by a Research Grant for Intractable Diseases from Japan Agency for Medical Research and Development, AMED(H26-Itaku(Nan)-Ippan-031), and a research grant from Japan society for the Promotion of Science(15 K10479).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Rights and permissions
About this article
Cite this article
Hatanaka, H., Yamamoto, T., Motomura, G. et al. Histopathologic findings of spontaneous osteonecrosis of the knee at an early stage: a case report. Skeletal Radiol 45, 713–716 (2016). https://doi.org/10.1007/s00256-016-2328-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-016-2328-4