MRI-Demonstrated Outcome of Subchondral Stress Fractures of the Knee After Treatment with Iloprost or Tramadol: Observations in 14 Patients

Mayerhoefer, Marius E.; Kramer, Josef; Breitenseher, Martin; Norden, Cornelia; Vakil-Adli, Anosheh; Hofmann, S.; Meizer, R; Siedentop, Harald; Landsiedl, F; Aigner, N

doi:10.1097/jsm.0b013e31817f3e1c

Cited by 15 publications

(15 citation statements)

References 12 publications

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“…The positive impact of Iloprost in bone healing was already demonstrated in a small case study in the clinic for the treatment of subchondral stress fractures of the knee. Patients receiving Iloprost showed an improved healing of the stress fractures in comparison to the control group receiving the opioid analgesic Tramadol (39). Even though Iloprost is beneficial for bone healing applied systemically, this also bears considerable risks which would be circumvented by a local application as we proved in our proof of concept in vivo study.…”

Section: Discussionmentioning

confidence: 99%

Immune Modulation to Enhance Bone Healing—A New Concept to Induce Bone Using Prostacyclin to Locally Modulate Immunity

et al. 2019

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Within an aging population, fracture incidences will rise and with the augmented risks of impaired healing the overall risk of delayed bone regeneration will substantially increase in elderly patients. Thus, new strategies to rescue fracture healing in the elderly are highly warranted. Modulating the initial inflammatory phase toward a reduced pro-inflammation launches new treatment options for delayed or impaired healing specifically in the elderly. Here, we evaluated the capacity of the prostacyclin analog Iloprost to modulate the inflammatory phase toward a pro-regenerative milieu using in vitro as well as in vivo model systems. In vitro , Iloprost administration led to a downregulation of potential unfavorable CD8+ cytotoxic T cells as well as their pro-inflammatory cytokine secretion profile. Furthermore, Iloprost increased the mineralization capacity of osteogenic induced mesenchymal stromal cells through both direct as well as indirect cues. In an in vivo approach, Iloprost, embedded in a biphasic fibrin scaffold, decreased the pro-inflammatory and simultaneously enhanced the anti-inflammatory phase thereby improving bone healing outcome. Overall, our presented data confirms a possible strategy to modulate the early inflammatory phase in aged individuals toward a physiological healing by a downregulation of an excessive pro-inflammation that otherwise would impair healing. Further confirmation in phase I/II trials, however, is needed to validate the concept in a broader clinical evaluation.

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Section: Discussionmentioning

confidence: 99%

Immune Modulation to Enhance Bone Healing—A New Concept to Induce Bone Using Prostacyclin to Locally Modulate Immunity

et al. 2019

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“…Clinical findings can be non‐specific, with insidious, diffuse or radiating pain16–21. Treatment emphasizes analgesic medication and, in athletes with chronic pain and/or pubic bone marrow edema or stress‐related fractures, up to 3 months of rest without athletic weight‐bearing activities15, 16, 22. Clinical healing of most stress injuries occurs in 6–8 weeks, although the pubic rami may need 2–5 months13.…”

Section: Discussionmentioning

confidence: 99%

Pubic bone injuries in primiparous women: magnetic resonance imaging in detection and differential diagnosis of structural injury

Brandon

Jacobson

Low

et al. 2012

Ultrasound in Obstet & Gyne

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Objective Evaluate utility of MR in diagnosing structural injury in primiparous women with pelvic floor injury risks. Methods Observational study of 77 women with 3T MR imaging after delivery. Women (n=45) were operationally defined as High Risk for levator ani muscle tears (2nd stage labor> 150 minutes, anal sphincter tear, forceps, age> 35, birth weight > 4000 grams) or Low Risk (n=32): vaginally delivered without these risk factors (n=12); delivered by cesarean after 2nd stage labor >150 minutes (n=14), and cesarean without labor (n=6). All women were imaged using MR fluid sensitive sequences. Two musculoskeletal radiologists reviewed images for bone marrow edema, fracture, pubic symphysis measurements, and levator ani tear. Results MR imaging showed pubic bone fractures in 38% of women at High Risk and 13% of at Low Risk for pelvic floor injury (χ2(3)= 9.27, p=0.03). Levator ani muscle tears were present in 44% of the High Risk and 9% of Low Risk women (X2(3)=11.57, p=0.010). Bone marrow edema in the pubic bones was present in 61% of women studied across delivery categories. Complex patterns of injury included combinations of bone marrow edema, fractures, levator ani tears and pubic symphysis injuries. No MR documented injuries were present in 18% of women at High Risk and 44% at Low Risk (χ2(1)=6.2, p=.013). Conclusions Criteria identifying primiparous women at risk for pelvic floor injury can predict increased risk of bone and soft tissues changes at the pubic symphysis. Fluid sensitive MR imaging has utility for differential diagnosis of structural injury in postpartum women.

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“…Other than few larger studies, most papers report on fewer patients. 1,3,5,8,16,17,20,24 Nevertheless, this is by far the largest cohort study on BME of the foot and ankle. 2,3,24 A final limitation is the lack of a control group.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Treatment of Bone Marrow Edema of the Foot and Ankle With the Prostacyclin Analog Iloprost

et al. 2018

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MRI-Demonstrated Outcome of Subchondral Stress Fractures of the Knee After Treatment with Iloprost or Tramadol: Observations in 14 Patients

Abstract: This small case series suggests that healing of SSF is more pronounced after Iloprost treatment.

Cited by 15 publications

References 12 publications

Immune Modulation to Enhance Bone Healing—A New Concept to Induce Bone Using Prostacyclin to Locally Modulate Immunity

Immune Modulation to Enhance Bone Healing—A New Concept to Induce Bone Using Prostacyclin to Locally Modulate Immunity

Pubic bone injuries in primiparous women: magnetic resonance imaging in detection and differential diagnosis of structural injury

Treatment of Bone Marrow Edema of the Foot and Ankle With the Prostacyclin Analog Iloprost

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