The relationship between bone marrow edema size and knee pain

Unay, Koray; Poyanlı, Oğuz; Akan, Kaya; Güven, Melih; Demircay, Can

doi:10.1007/s00167-009-0842-9

Cited by 14 publications

(14 citation statements)

References 19 publications

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“…Although the BME area on MRI scans had not disappeared in all cases, the functional results were all good or excellent. It has been reported that the BME area is not necessarily correlated to pain [ 22 ], and that MRI abnormalities may take up to 16 months before resolving [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Shock Wave Therapy Is Effective in the Treatment of Bone Marrow Edema of the Medial Compartment of the Knee: A Comparative Study

2016

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Objective: To test the hypothesis that shock wave therapy can produce a statistically significant improvement in symptoms and imaging features of the knee bone marrow edema syndrome (BMES) within 6 months of treatment. Subjects and Methods: Eighty-six consecutive patients suffering from BMES of the medial compartment of the knee were prescribed a course of high-energy extracorporeal shock wave therapy (ESWT) and clinically followed up at 3 and 6 months and finally from 14 to approximately 18 months after treatment. Thirty-one patients were unable to undergo ESWT but returned for the 6-month and final follow-up; these were referred to as the conservative (control) group, while the other 55 patients constituted the ESWT group. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Visual Analog Scale (VAS) score of each patient were calculated at every follow-up. The BME area was assessed using magnetic resonance imaging before treatment and at the 6-month follow-up. Results: Statistically significant improvements were observed in clinical scores and in the BME area for both the ESWT and the control group (p < 0.05). The improvements in the ESWT group were statistically better in all parameters compared with the control group: the ESWT group had a reduction in the BME area of 86% versus 41% in the control group, the VAS pain score improved by 88% in the ESWT group versus 42% in the control group, and the WOMAC score improved by 65% in the ESWT group versus 22% in the control group. Clinical scores were significantly better for patients with medial tibial lesions in the ESWT group. Conclusion: In this study, ESWT reduced pain and the BME area in the knee, with significant clinical improvement noticed 3 months after treatment.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Shock Wave Therapy Is Effective in the Treatment of Bone Marrow Edema of the Medial Compartment of the Knee: A Comparative Study

2016

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“…Thus, the type 1 (oedema type) group tended to have a larger effect. More bone marrow oedema may be associated with worse pain and disability [22][23][24] and might indicate more severe disease with a larger potential for improvement. Therefore, we hypothesised a larger effect of amoxicillin in subgroups with more versus less MC-related oedema.…”

Section: Introductionmentioning

confidence: 99%

Oedema on STIR modified the effect of amoxicillin as treatment for chronic low back pain with Modic changes—subgroup analysis of a randomized trial

et al. 2020

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Objective To evaluate potential MRI-defined effect modifiers of amoxicillin treatment in patients with chronic low back pain and type 1 or 2 Modic changes (MCs) at the level of a previous lumbar disc herniation (index level). Methods In a prospective trial (AIM), 180 patients (25–64 years; mean age 45; 105 women) were randomised to receive amoxicillin or placebo for 3 months. Primary outcome was the Roland-Morris Disability Questionnaire (RMDQ) score (0–24 scale) at 1 year. Mean RMDQ score difference between the groups at 1 year defined the treatment effect; 4 RMDQ points defined the minimal clinically important effect. Predefined baseline MRI features of MCs at the index level(s) were investigated as potential effect modifiers. The predefined primary hypothesis was a better effect of amoxicillin when short tau inversion recovery (STIR) shows more MC-related high signal. To evaluate this hypothesis, we pre-constructed a composite variable with three categories (STIR1/2/3). STIR3 implied MC-related STIR signal increases with volume ≥ 25% and height > 50% of vertebral body and maximum intensity increase ≥ 25% and presence on both sides of the disc. As pre-planned, interaction with treatment was analysed using ANCOVA in the per protocol population (n = 155). Results The STIR3 composite group (n = 41) and STIR signal volume ≥ 25% alone (n = 45) modified the treatment effect of amoxicillin. As hypothesised, STIR3 patients reported the largest effect (− 5.1 RMDQ points; 95% CI − 8.2 to − 1.9; p for interaction = 0.008). Conclusions Predefined subgroups with abundant MC-related index-level oedema on STIR modified the effect of amoxicillin. This finding needs replication and further support. Key Points • In the primary analysis of the AIM trial, the effect of amoxicillin in patients with chronic low back pain and type 1 or 2 MCs did not reach the predefined cut-off for clinical importance. • In the present MRI subgroup analysis of AIM, predefined subgroups with abundant MC-related oedema on STIR reported an effect of amoxicillin. • This finding requires replication and further support.

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“…30,31 For BME size and knee pain, Unay et al found a weak but significant correlation for the Stanmore Functional Rating Scale (SFRS) (r = 0.313, P = .025) but no correlation for the VAS (r = 0.203, P = .153). 31 Tonbul et al reported on idiopathic BME of the talus, showing a poor correlation to the AOFAS scores (r = 0.313, P = .025) and no correlation to the VAS (r = 0.203, P = .153). 30 These consistent findings raise the question on where the residual pain originates from.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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The relationship between bone marrow edema size and knee pain

Cited by 14 publications

References 19 publications

Extracorporeal Shock Wave Therapy Is Effective in the Treatment of Bone Marrow Edema of the Medial Compartment of the Knee: A Comparative Study

Extracorporeal Shock Wave Therapy Is Effective in the Treatment of Bone Marrow Edema of the Medial Compartment of the Knee: A Comparative Study

Oedema on STIR modified the effect of amoxicillin as treatment for chronic low back pain with Modic changes—subgroup analysis of a randomized trial

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

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