Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging

Abstract

Objective. Results of cross-sectional studies have suggested that bone marrow lesions (BMLs) visualized on magnetic resonance imaging (MRI) are related to knee pain, but no longitudinal studies have been done. This study was undertaken to determine whether enlarging BMLs are associated with new knee pain.Methods. Subjects ages 50-79 years with knee osteoarthritis (OA) or at high risk of knee OA were asked twice at baseline about the presence of knee pain, aching, or stiffness (classified as frequent knee pain) on most days; absence of knee pain was the baseline eligibility criterion. At 15 months' followup, subjects were again queried twice about frequent knee pain. A case knee was defined as absence of knee pain at baseline but presence of knee pain both times at followup. Controls were selected randomly from among knees with absence of pain at baseline. All MR images were scored for volume of BMLs in the medial, lateral, and patellofemoral compartments. We focused on the maximal change in BML score among the knee compartments from baseline to 15 months. Multiple logistic regression, with adjustments for demographic and clinical variables, was used to assess whether an increased BML score is predictive of the development of knee pain.Results. Among case knees, 54 of 110 (49.1%) showed an increase in BML score within a compartment, whereas only 59 of 220 control knees (26.8%) showed an increase (P < 0.001 by chi-square test). A BML score increase of at least 2 units was much more common in case knees than in control knees (27.5% versus 8.6%; adjusted odds ratio 3.2, 95% confidence interval 1.5-6.8). Among case knees with increased BMLs, most already had BMLs at baseline, with enlarging BMLs at followup, but among the subset of knees with no BMLs at baseline, new BMLs were more common in case knees (11 [32.4%] of 34) than in control knees (9 [10.8%] of 83).Conclusion. Development of knee pain is associated with an increase in BMLs as revealed on MRI.

Magnetic Resonance Imaging–Assessed Vastus Medialis Muscle Fat Content and Risk for Knee Osteoarthritis Progression: Relevance From a Clinical Trial

“…The present results and those from previous knee MRI studies (28)(29)(30) highlight the importance of evaluating risk factors predictive of cartilage volume loss in knee OA. For instance, it is known that the presence of meniscal lesions or BML is predictive of disease progression (5,11,26,(31)(32)(33)(34).…”

Treatment of a Lateral Tibial Plateau Osteochondritis Dissecans Lesion With Subchondral Injection of Calcium Phosphate

“…Felson et al 18,19 were the first authors to show a correlation between BME and symptomatic OA because patients with painful knee OA were 2.5 times more likely to have BME on MRI. Although there is no current literature relating to treatment of OCD lesions by use of this technique, Sharkey et al 20 recently reported its use in the treatment of BME associated with OA in a 51-year-old woman.…”

Osteoarthritis revisited—again!

“…Initial reports were extremely enthusiastic about the role of BMLs in knee OA. They suggested that BMLs were associated with knee pain [15], could be predictive of progression [16] especially if they enlarged [17] or were associated with varus or valgus angulation [16]. Later reports, however, were less clear-cut even suggesting that BMLs were not only unassociated with Western Ontario and McMaster Universities index of OA scores (WOMAC™) [18,19] and other measures of patient symptoms but also fluctuated over a period of time, resolving and/or worsening with new lesions coming and going elsewhere in the same joint [20,21].…”