Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original articleTransient Bone Marrow Edema Syndrome of the Knee: Clinical and Magnetic Resonance Imaging Results at 5 Years After Core Decompression
Section snippets
Methods
From March 1997 to April 1999, 18 consecutive patients (13 men and 5 women; 24 knees; mean age, 53.7 ± 5.4 years; range, 35 to 64 years) with bone marrow edema syndrome of the knee were treated with core decompression. (Average time between onset of symptoms and referral to our department was 4 weeks.) All patients presented with pain during mechanical loading and, to a variable degree, during the night. Characteristically, pain was present in the affected condyle when it was tapped. None of
Results
In total, the medial and lateral femoral condyles were affected in 15 and 7 knees, respectively, whereas intra-articular migrating bone marrow edema was present in 2 knees (Fig 1). Six patients presented with bilateral involvement of the knees (migrating transient bone marrow edema syndrome). Two of these patients had affections of the medial and lateral compartments within the same knee at different times, consistent with intra-articular regional bone marrow edema syndrome. All patients
Discussion
To date, significant confusion exists concerning the pathophysiology and nomenclature of bone marrow edema syndrome.2, 11 Although the disorder was initially described as transient osteoporosis—osteopenia is a late finding on plain radiographs—the term bone marrow edema syndrome was suggested as more appropriate, on the basis of early MRI findings and histologic features.2, 12 Furthermore, the relationship of bone marrow edema syndrome and avascular necrosis remains open to controversial debate.
Conclusions
Our results suggest that core decompression is a safe and effective procedure in the treatment of patients with bone marrow edema syndrome of the knee. At 5 years after surgery, signal alterations consistent with bone marrow edema were not present in any case on MRI, and patients were free of symptoms without recurrence of bone marrow edema syndrome or progression to avascular necrosis. The high incidence of migrating bone marrow edema, the diffuse pattern on MRI, and the lack of osteonecrotic
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Osteonecrosis
2016, Kelley and Firestein's Textbook of Rheumatology: Volumes 1-2, Tenth EditionOsteonecrosis
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The authors report no conflict of interest.