Subchondral insufficiency fractures of the knee: review of imaging findings

Jose, Jean; Pasquotti, Giulio; Smith, Moira; Gupta, Akhil Kumar; Lesniak, Bryson P.; Kaplan, Lee D.

doi:10.1177/0284185114535132

Cited by 23 publications

(16 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Diffuse infiltration of the bone marrow may be observed in several hematologic and oncologic diseases and although rare in general may be encountered in an OA sample as an incidental finding. Subchondral insufficiency fractures of the knee are difficult to detect and may have an unpredictable course due to delayed diagnosis and lack of standard treatment approaches 42,43 . Posterior root tears of the medial meniscus result in instability of the knee and are associated with more severe meniscal extrusion and more cases of osteonecrosis compared with horizontal tears 44 .…”

Section: Discussionmentioning

confidence: 99%

MRI-based screening for structural definition of eligibility in clinical DMOAD trials: Rapid OsteoArthritis MRI Eligibility Score (ROAMES)

Roemer

Collins

Kwoh

et al. 2020

Osteoarthritis and Cartilage

View full text Add to dashboard Cite

Purpose: Our aim was to introduce a simplified MRI instrument, Rapid OsteoArthritis MRI Eligibility Score (ROAMES), for defining structural eligibility of patients for inclusion in disease-modifying osteoarthritis drug trials using a tri-compartmental anatomic approach that enables stratification of knees into different structural phenotypes and includes diagnoses of exclusion. We also aimed to define overlap between phenotypes and determine reliability. Methods: 50 knees from the Foundation for National Institutes of Health Osteoarthritis Biomarkers study, a nested case-control study within the Osteoarthritis Initiative, were selected within pre-defined definitions of phenotypes as either inflammatory, subchondral bone, meniscus/cartilage, atrophic or hypertrophic. A focused scoring instrument was developed covering cartilage, meniscal damage, inflammation and osteophytes. Diagnoses of exclusion were meniscal root tears, osteonecrosis, subchondral insufficiency fracture, tumors, malignant marrow infiltration and acute traumatic changes. Reliability was determined using weighted kappa statistics. Descriptive statistics were used for determining concordance between the a priori phenotypic definition and ROAMES and overlap between phenotypes. Results: ROAMES identified 43 of 50 (86%) pre-defined phenotypes correctly. Of the 50 participants, 27 (54%) had no additional phenotypes other than the pre-defined phenotype. 18 (36%) had one and 5 (10%) had two additional phenotypes. None had three or four additional phenotypes. All features of ROAMES showed almost perfect agreement. One case with osteonecrosis and one with a tumor were detected. Conclusions: ROAMES is able to screen and stratify potentially eligible knees into different structural phenotypes and record relevant diagnoses of exclusion. Reliability of the instrument showed almost perfect agreement.

show abstract

Section: Discussionmentioning

confidence: 99%

MRI-based screening for structural definition of eligibility in clinical DMOAD trials: Rapid OsteoArthritis MRI Eligibility Score (ROAMES)

Roemer

Collins

Kwoh

et al. 2020

Osteoarthritis and Cartilage

View full text Add to dashboard Cite

show abstract

“…The patient's significant decrease in hip bone density and quadriceps atrophy were probably due to decreased ipsilateral weight bearing in the 5 months since the injury, in addition to normal bone density loss during the menopausal transition. Her low normal body weight might have been a protective factor because subchondral fractures are more severe in patients with high BMI 6. Although not approved by the US Food and Drug Administration for treatment of subchondral fractures, teriparatide has been studied as a chondroregenerative agent in animal models 11.…”

Section: Discussionmentioning

confidence: 99%

“…Instead, these fractures are typically precipitated by athletic or overuse injuries or trauma (including surgical interventions) to the knee, and they may occur on the non-weight bearing surface of the femur 4 5. The outcome of subchondral insufficiency fractures depends on several factors, including the initial fracture size, patient body mass index (BMI; positive association with obesity), degree of osteopenia, as well as early diagnosis and initial treatment 6. We present this case to encourage clinicians to consider subchondral fracture in the differential diagnosis when a patient with normal radiographic findings reports severe and worsening knee pain in the absence of overt traumatic injury.…”

Section: Introductionmentioning

confidence: 99%

Subchondral insufficiency fracture of the knee: a non-traumatic injury with prolonged recovery time

et al. 2015

View full text Add to dashboard Cite

Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. Patients with subchondral insufficiency fracture characteristically have unremarkable plain radiographs, while MRI examination may reveal extensive bone marrow oedema and subchondral bone collapse. This article presents a 51-year-old postmenopausal woman, a physician, who had subchondral insufficiency fractures of the knee associated with prolonged standing during clinical work. She was treated with partial weight bearing on crutches until 14 months after the injury, viscosupplementation at 4 months to treat osteoarthritis and teriparatide treatment to improve bone healing at 7 months. By 26 months after the injury, she tolerated independent walking with a fabric knee support but still experienced mild posterolateral knee pain and numbness on prolonged standing.

show abstract

“…The prognosis may range from full recovery to rapidly escalating joint destruction 58 . The outcome of SIFs depends on several factors, including the initial fracture size, patient body mass index, and degree of osteopenia, as well as early diagnosis and initial treatment 59 . Meniscal root tear is a subtype of radial tears that has recently gained much interest in the field of OA research.…”

Section: Why Mri May Offer Solutionsmentioning

confidence: 99%

The role of radiography and MRI for eligibility assessment in DMOAD trials of knee OA

et al. 2018

View full text Add to dashboard Cite

Currently no disease-modifying drugs for osteoarthritis have been approved. There are several reasons for failure of clinical trials in the past, including the commonly applied definition of structural eligibility based on radiographic assessment. In the context of precision medicine it will be of increasing relevance to find the appropriate patient for a specific treatment approach. Phenotypical stratification by imaging at eligibility will be paramount in the future and cannot be achieved using radiography alone. Furthermore, joints at high risk for faster progression need to be identified, as these may allow a more efficient DMOAD trial design. In addition, joints at high risk for collapse need to be excluded at screening. MRI may be able to offer solutions in this context, and commonly perceived hurdles in the application of MRI at eligibility assessment are being addressed as a result of technological advances and simplified image assessment.

show abstract

Subchondral insufficiency fractures of the knee: review of imaging findings

Cited by 23 publications

References 19 publications

MRI-based screening for structural definition of eligibility in clinical DMOAD trials: Rapid OsteoArthritis MRI Eligibility Score (ROAMES)

MRI-based screening for structural definition of eligibility in clinical DMOAD trials: Rapid OsteoArthritis MRI Eligibility Score (ROAMES)

Subchondral insufficiency fracture of the knee: a non-traumatic injury with prolonged recovery time

The role of radiography and MRI for eligibility assessment in DMOAD trials of knee OA

Contact Info

Product

Resources

About