Original article
Transient Bone Marrow Edema Syndrome of the Knee: Clinical and Magnetic Resonance Imaging Results at 5 Years After Core Decompression

https://doi.org/10.1016/j.arthro.2006.04.095Get rights and content

Purpose: We report on 24 cases of transient bone marrow edema syndrome in 18 patients who underwent core decompression of the knee. Methods: Diagnosis was made with the use of radiographs, magnetic resonance imaging (MRI), and core biopsy testing. Arthroscopic surgery and core decompression were carried out in all patients, and MRI was performed again, 5 years after surgery was performed. Results: Medial and lateral femoral condyles were affected in 15 and 7 knees, respectively. In all, 6 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. Core biopsy specimens showed areas of bone marrow edema and vital trabeculae covered by osteoblasts and osteoid seams. Resolution of symptoms and normalization of MRI findings occurred in all patients within 12 weeks after surgery. Conclusions: Migrating bone marrow edema was found in a high percentage (33%) of patients at 5-year follow-up; however, all patients were clinically asymptomatic, and signal alterations on MRI had resolved completely. The high incidence of migrating bone marrow edema, the lack of osteonecrotic regions in our specimens, and the fact that none of these cases progressed to spontaneous osteonecrosis seem to further support the contention that bone marrow edema syndrome of the knee is a distinct entity. Level of Evidence: Level II, diagnostic study; development of diagnostic criteria on the basis of consecutive patients and with universally applied reference gold standard.

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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