Subchondral Insufficiency Fractures of the Knee

Musbahi, Omar; Waddell, Lily; Shah, Nehal; Smith, Stacy E.; Chen, Antonia F.; Bisson, Leslie; Katz, Jeffrey N.

doi:10.2106/jbjs.rvw.23.00084

Cited by 5 publications

(1 citation statement)

References 84 publications

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“…Conservative management is the primary treatment approach for SIFK, particularly in the early stages and in the absence of accompanying meniscal injuries [147]. Current non-operative management strategies for SIFK include observation, nonsteroidal antiinflammatory drugs, non-weight-bearing practices, and the use of wedge insoles [138,148].…”

Section: Treatmentmentioning

confidence: 99%

Osteoporosis, Osteoarthritis, and Subchondral Insufficiency Fracture: Recent Insights

Yokota,

Ishizu,

Miyazaki

et al. 2024

Biomedicines

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The increased incidence of osteoarthritis (OA), particularly knee and hip OA, and osteoporosis (OP), owing to population aging, have escalated the medical expense burden. Osteoarthritis is more prevalent in older women, and the involvement of subchondral bone fragility spotlights its association with OP. Notably, subchondral insufficiency fracture (SIF) may represent a more pronounced condition of OA pathophysiology. This review summarizes the relationship between OA and OP, incorporating recent insights into SIF. Progressive SIF leads to joint collapse and secondary OA and is associated with OP. Furthermore, the thinning and fragility of subchondral bone in early-stage OA suggest that SIF may be a subtype of OA (osteoporosis-related OA, OPOA) characterized by significant subchondral bone damage. The high bone mineral density observed in OA may be overestimated due to osteophytes and sclerosis and can potentially contribute to OPOA. The incidence of OPOA is expected to increase along with population aging. Therefore, prioritizing OP screening, early interventions for patients with early-stage OA, and fracture prevention measures such as rehabilitation, fracture liaison services, nutritional management, and medication guidance are essential.

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Section: Treatmentmentioning

confidence: 99%

Osteoporosis, Osteoarthritis, and Subchondral Insufficiency Fracture: Recent Insights

Yokota,

Ishizu,

Miyazaki

et al. 2024

Biomedicines

View full text Add to dashboard Cite

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Prevalence of Clinically Relevant Findings on Magnetic Resonance Imaging in Middle‐Aged Adults With Knee Pain and Suspected Meniscal Tear: A Follow‐Up

Waddell,

Opare‐Addo,

Shah

et al. 2024

Arthritis Care & Research

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ObjectiveRadiographs are frequently obtained in patients with knee osteoarthritis (KOA), with magnetic resonance imaging (MRI) reserved for complex cases. There is little data on how often subsequent MRI reveals clinically actionable but unanticipated findings. The purpose of this study is to estimate the prevalence of these findings on MRI in patients managed nonoperatively for suspected meniscal tears.MethodsThe TeMPO study enrolled subjects aged 45‐85 years with knee pain, osteoarthritis (Kellgren‐Lawrence (KL) grade 0‐3), and suspected meniscal tear. We reviewed baseline MRI images and recorded notable findings, including subchondral insufficiency fractures of the knee (SIFK), avascular necrosis (AVN), tumors, and non‐subchondral fractures. Other baseline data included demographic characteristics, Knee Injury and Osteoarthritis Outcome Score (KOOS) pain scores, duration of knee symptoms, and KL grade.ResultsStudy‐ordered MRIs were performed on 760 subjects with 61 concerning findings identified (8.03%, 95% CI: 6.09%, 9.96%). Twenty‐five were SIFK, 10 were non‐subchondral fractures, 4 were AVN, 8 were benign tumors, and 14 were other clinically relevant findings.ConclusionsWe estimated the prevalence of clinically relevant incidental findings on MRI to be 8.03% in middle‐aged adults with mild to moderate KOA and suspected meniscal tear. These data may prompt clinicians to be more aware of the range of findings that can underlie knee symptoms, some of which could change management but may require different modalities of imaging to detect. Future research is needed to pinpoint factors associated with these concerning findings so that at‐risk patients can be identified and referred for advanced imaging.

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High incidence of medial meniscus root/radial tears and extrusion in 253 patients with subchondral insufficiency fractures of the knee

Clark,

Pareek,

Hevesi

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe demographic and radiological risk factors of subchondral insufficiency fractures of the knee (SIFK) continue to be a subject of debate. The purpose of this study was to associate patient‐specific factors with SIFK in a large cohort of patients.MethodsInclusion criteria consisted of patients with SIFK as verified on magnetic resonance imaging (MRI). All radiographs and MRIs were reviewed to assess characteristics such as meniscus tear presence and type, subchondral oedema presence and location, location of SIFK, mechanical limb alignment, osteoarthritis as assessed by Kellgren–Lawrence grade and ligamentous injury. A total of 253 patients (253 knees) were included, with 171 being female. The average body mass index (BMI) was 32.1 ± 7.0 kg/m2.ResultsSIFK was more common in patients with medial meniscus tears (77.1%, 195/253) rather than tears of the lateral meniscus (14.6%, 37/253) (p < 0.001). Medial meniscus root and radial tears of the posterior horn were present in 71.1% (180/253) of patients. Ninety‐one percent (164/180) of medial meniscus posterior root and radial tears had an extrusion ≥3.0 mm. Eighty‐one percent (119/147) of patients with SIFK on the medial femoral condyle and 86.8% (105/121) of patients with SIFK on the medial tibial plateau had a medial meniscus tear. Varus knees had a significantly increased rate of SIFK on the medial femoral condyle in comparison to valgus knees (p = 0.016).ConclusionIn this large cohort of patients with SIFK, there was a high association with medial meniscus root and radial tears of the posterior horn, meniscus extrusion ≥3.0 mm as well as higher age, female gender and higher BMI. Additionally, there was a particularly strong association of medial compartment SIFK with medial meniscus tears. As SIFK is frequently undiagnosed, identifying patient‐specific demographic and radiological risk factors will help achieve a prompt diagnosis.Level of EvidenceLevel IV.

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Subchondral Insufficiency Fractures of the Knee

Cited by 5 publications

References 84 publications

Osteoporosis, Osteoarthritis, and Subchondral Insufficiency Fracture: Recent Insights

Osteoporosis, Osteoarthritis, and Subchondral Insufficiency Fracture: Recent Insights

Prevalence of Clinically Relevant Findings on Magnetic Resonance Imaging in Middle‐Aged Adults With Knee Pain and Suspected Meniscal Tear: A Follow‐Up

High incidence of medial meniscus root/radial tears and extrusion in 253 patients with subchondral insufficiency fractures of the knee

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