Spontaneous osteonecrosis of the knee involving both the medial femoral condyle and the medial tibial plateau: report of three cases

Abstract

Spontaneous osteonecrosis of the knee (SPONK) usually involves a single condyle or plateau. The medial femoral condyle (MFC) is most often involved and spontaneous osteonecrosis of the medial tibial plateau (MTP) is a rare condition, representing only 2% of all necroses reported in the knee. SPONK involving both the MFC and the MTP is extremely rare. SPONK occurring in either the MFC or the MTP individually might extend to the corresponding side of the knee in the advanced end-stage; however, in that situation, significant degenerative changes would exist and it might be difficult to differentiate end-stage SPONK form severe osteoarthritis. SPONK affecting both the MFC and the MTP without significant secondary osteoarthritic changes has not been reported, even though it is difficult to know which occurs first. We have cared for three patients with histologically proven osteonecrosis of the MFC and MTP and report their radiologic features.

Open-wedge high tibial osteotomy for spontaneous osteonecrosis of the medial tibial plateau shows excellent clinical outcomes

“…However, the aseptic loosening of the tibial component is a concern in this type of osteonecrosis because good bone quality is essential for reliable fixation of the tibial component [27]. When considering the size of the necrotic area, TKA would be a safer choice for larger areas rather than UKA [3, 10].…”

“…Spontaneous osteonecrosis of the knee (SONK) in the medial tibial plateau was first reported by D'Anglejan et al in 1976 [1]; this is a rare condition compared to SONK in the medial femoral condyle, and it represents only 2% of all osteonecrosis cases reported in the knee [2][3][4][5]. Similar to SONK in the femoral condyle, most patients with osteonecrosis of the medial tibial plateau are women older than 60 years who have sudden pain onset on the medial side of the knee, which is often related to minor trauma or an increase in activity [6].…”

“…Treatment of osteonecrosis of the medial tibial plateau remains controversial due to its rarity, and various options such as conservative non-weight-bearing treatment, arthroscopic drilling, osteochondral graft, high tibial osteotomy (HTO), unicompartmental knee arthroplasty (UKA), and total knee arthroplasty (TKA) are available [2][3][4][5][7][8][9][10]. Open-wedge HTO (OWHTO) is a well-established procedure for the treatment of SONK in the femoral condyle, and good cartilage regeneration after OWHTO has been reported [11,12].…”

Every Knee is not Osteoarthritic, Spontaneous Avascular Necrosis of the Medial Tibial Condyle

“…Medial tibial condyle accounts for only 2% of the cases. 5 It typically affects older patients (usually > 50 years) with female predominance Magnetic resonance imaging is very sensitive and specific in diagnosing spontaneous osteonecrosis. Role of bone scan was variable in different studies.…”

Osteonecrosis of the knee

“…However, in a study performed between January, 2005, and February, 2008, Jung et al 20 found that of 11,093 knees after total knee arthroplasty (TKA), three had SPONK in both the medial femoral condyle and the medial tibial plateau. Those three patients (mean age, 59 years; range, 55-63 years) had distinctive radiographic findings, including longitudinal subchondral collapse.…”