Skip to main content
SpringerLink
Log in

Subchondral bone cysts regress after correction of malalignment in knee osteoarthritis: comply with Wolff’s law

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to discuss the mechanical function of subchondral bone cysts and its relationship with Wolff’s law.

Methods

One hundred forty symptomatic knees (120 patients) with osteoarthritis were subjected to MRI before high tibial osteotomy (HTO). Subchondral bone cysts (SBCs) were detected on 72 knees of these 140 knees. SBCs, bone marrow lesion (BML), and hip-knee-ankle (HKA) axis were measured by using validated methods. After HTO, the evolution of cysts was evaluated on MRI performed with a five year follow-up on the 72 knees with pre-operative cysts.

Results

At baseline, 70 (97%) of these 72 knees had a BML surrounding the SBCs; the maximum cyst volume was 874 mm3 and the average cyst volume 9. 6 ± 4.1 mm3. In the subregions where cysts were present, adjacent cartilage was still present without full thickness defects. The mean pre-operative hip-knee-ankle angle was 7.3 ± 3 degrees (0° to 14°) of varus and differed significantly (p = 0.01) between the 68 knees without cysts (average 3 ± 2 degrees) and the 72 knees with cysts (average 9.2 ± 4 degrees). Five years after HTO, the number of cysts had decreased, the maximum cyst volume was 532 mm3, and the average cyst volume was 6.3 ± 2.8 mm3.

Conclusion

Regression of subchondral bone cysts may be related to restoration of an appropriate load at the subchondral bone. With applying poroelasticity to bone mechaincs, this finding may suggest that SBCs and BMLs may be a physiological adaptation to mechanic overload. More basic research is needed to prove this matter.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kon E, Ronga M, Filardo G, Farr J, Madry H, Milano G, Andriolo L, Shabshin N (2016) Bone marrow lesions and subchondral bone pathology of the knee. Knee Surg Sports Traumatol Arthrosc 24(6):1797–1814. https://doi.org/10.1007/s00167-016-4113-2

    Article  PubMed  Google Scholar 

  2. Crema MD, Roemer FW, Zhu Y, Marra MD, Niu J et al (2010) Subchondral cystlike lesions develop longitudinally in areas of bone marrow edema-like lesions in patients with or at risk for knee osteoarthritis: detection with MR imaging--the MOST study. Radiology 256(3):855–862

    Article  Google Scholar 

  3. Brand RA (2010) Biographical sketch: Julius Wolff, 1836–1902. Clin Orthop Relat Res 468(4):1047–1049

    Article  Google Scholar 

  4. Andriacchi TP (1994) Dynamics of knee malalignment. Orthop Clin North Am 25(3):395–403

    CAS  PubMed  Google Scholar 

  5. Scuderi GR, Sikorskii A, Bourne RB, Lonner JH, Benjamin JB, Noble PC (2016) The knee society short form reduces respondent burden in the assessment of patient-reported outcomes. Clin Orthop Relat Res 474(1):134–142. https://doi.org/10.1007/s11999-015-4370-2

    Article  PubMed  Google Scholar 

  6. Kellgren J, Lawrence J (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494

    Article  CAS  Google Scholar 

  7. Hernigou P, Giber D, Dubory A, Auregan JC (2020) Safety of simultaneous versus staged bilateral opening-wedge high tibial osteotomy with locked plate and immediate weight bearing. Int Orthop 44(1):109–117. https://doi.org/10.1007/s00264-019-04385-z

    Article  PubMed  Google Scholar 

  8. Dürr H, Martin H, Pellengahr C, Schlemmer M, Maier M, Jansson V (2004) The cause of subchondral bone cysts in osteoarthrosis a finite element analysis. Acta Orthop Scand 75(5):554–558

    Article  Google Scholar 

  9. Arjmand H, Nazemi M, Kontulainen SA, McLennan CE, Hunter DJ, Wilson DR, Johnston JD. (2018) Mechanical metrics of the proximal tibia are precise and differentiate osteoarthritic and normal knees: a finite element study Sci Rep 31;8(1):11478. https://doi.org/10.1038/s41598-018-29880-y

  10. Bogdanov LV, Zakharov VE (2002) The Boussinesq equation revisited. J Physica D: Nonlinear Phenomena 165(3):137–162

    Article  CAS  Google Scholar 

  11. Wilkes CH, Visscher MB (1975) Some physiological aspects of bone marrow pressure. J Bone Joint Surg (Am Vol) 57(1):49–57

    Article  CAS  Google Scholar 

  12. Gurkan UA, Akkus O (2008) The mechanical environment of bone marrow: a review. Ann Biomed Eng 36(12):1978–1991

    Article  Google Scholar 

  13. Wolff J (1986) The law of bone remodeling. Berlin Heidelberg New York: Springer, (translation of the German 1892 edition)

  14. Detournay E and Cheng AH.-D (1993) Fundamentals of poroelasticity, chapter 5 in comprehensive rock engineering: principles, practice and projects, Vol. II, Analysis and Design Method, ed. C. Fairhurst, Pergamon Press, p. 113–171

  15. Carter DR, Hayes WC (1977) The compressive behavior of bone as a two-phase porous structure. J Bone Joint Surg Am 59:954–962

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, People’s Republic of China

    Weiguo Wang, Ran Ding & Nianfei Zhang

  2. Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France

    Philippe Hernigou

Authors
  1. Weiguo Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ran Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nianfei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Philippe Hernigou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nianfei Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Weiguo Wang and Ran Ding are the Co-first author

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, W., Ding, R., Zhang, N. et al. Subchondral bone cysts regress after correction of malalignment in knee osteoarthritis: comply with Wolff’s law. International Orthopaedics (SICOT) 45, 445–451 (2021). https://doi.org/10.1007/s00264-020-04809-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04809-1

Keywords

Search

Navigation