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Semin Musculoskelet Radiol 2019; 23(05): 534-546
DOI: 10.1055/s-0039-1693978
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Perspective on Idiopathic Subchondral, Osteochondral, and Chondral Lesions with Emphasis on the Knee

Wolfgang Fischer 
1   Hessingpark-Clinic, MRI Department, Germany
› Author Affiliations
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Publication History

Publication Date:
25 September 2019 (online)

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Abstract

Subchondral, osteochondral, and chondral lesions of unknown cause are often encountered, especially in the knee joint. These are mainly idiopathic bone marrow edema syndrome, osteochondrosis dissecans, and cartilage delaminations. The literature on these diseases is sparse and often confusing and inconsistent. Because there is little evidence, this article was written as a perspective on these conditions. It offers an overview of the literature with personal comments and opinions based on observations from many years of clinical practice. The main goal is to highlight clinically important features and provide a practical guide for dealing with various magnetic resonance imaging findings in everyday work. The article also discusses several terms commonly used in relation to these diseases and their differential diagnoses.

Keywords

bone marrow edema syndrome - osteochondrosis dissecans - cartilage delamination - bone marrow lesion
 

  • References

  • 1 Plenk Jr H, Hofmann S, Eschberger J. , et al. Histomorphology and bone morphometry of the bone marrow edema syndrome of the hip. Clin Orthop Relat Res 1997; (334) 73-84
    PubMedGoogle Scholar
  • 2 Yamamoto T, Kubo T, Hirasawa Y, Noguchi Y, Iwamoto Y, Sueishi K. A clinicopathologic study of transient osteoporosis of the hip. Skeletal Radiol 1999; 28 (11) 621-627
    CrossrefPubMedGoogle Scholar
  • 3 Kim YM, Oh HC, Kim HJ. The pattern of bone marrow oedema on MRI in osteonecrosis of the femoral head. J Bone Joint Surg Br 2000; 82 (06) 837-841
    CrossrefPubMedGoogle Scholar
  • 4 Yamamoto T, Schneider R, Bullough PG. Insufficiency subchondral fracture of the femoral head. Am J Surg Pathol 2000; 24 (03) 464-468
    CrossrefPubMedGoogle Scholar
  • 5 Miyanishi K, Yamamoto T, Nakashima Y. , et al. Subchondral changes in transient osteoporosis of the hip. Skeletal Radiol 2001; 30 (05) 255-261
    CrossrefPubMedGoogle Scholar
  • 6 Wilson AJ, Murphy WA, Hardy DC, Totty WG. Transient osteoporosis: transient bone marrow edema?. Radiology 1988; 167 (03) 757-760
    CrossrefPubMedGoogle Scholar
  • 7 Kon E, Ronga M, Filardo G. , et al. Bone marrow lesions and subchondral bone pathology of the knee. Knee Surg Sports Traumatol Arthrosc 2016; 24 (06) 1797-1814
    CrossrefPubMedGoogle Scholar
  • 8 Thiryayi WA, Thiryayi SA, Freemont AJ. Histopathological perspective on bone marrow oedema, reactive bone change and haemorrhage. Eur J Radiol 2008; 67 (01) 62-67
    CrossrefPubMedGoogle Scholar
  • 9 Roemer FW, Frobell R, Hunter DJ. , et al. MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis. Osteoarthritis Cartilage 2009; 17 (09) 1115-1131
    CrossrefPubMedGoogle Scholar
  • 10 Klontzas ME, Vassalou EE, Zibis AH, Bintoudi AS, Karantanas AH. MR imaging of transient osteoporosis of the hip: an update on 155 hip joints. Eur J Radiol 2015; 84 (03) 431-436
    CrossrefPubMedGoogle Scholar
  • 11 Milonas N, Touzopoulos P, Zafeiris CP, Papantoniou N, Koutsoubeli E, Chatzigiannakis A. Bilateral transient osteoporosis of the knees during pregnancy. A case report and review of the literature. JRPMS 2018; 2: 18-21
    CrossrefPubMedGoogle Scholar
  • 12 Ververidis AN, Drosos GI, Kazakos KJ, Xarchas KC, Verettas DA. Bilateral transient bone marrow edema or transient osteoporosis of the knee in pregnancy. Knee Surg Sports Traumatol Arthrosc 2009; 17 (09) 1061-1064
    CrossrefPubMedGoogle Scholar
  • 13 Lloyd JM, Lewis M, Jones A. Transient osteoporosis of the knee in pregnancy. J Knee Surg 2006; 19 (02) 121-123
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Stamp L, McLean L, Stewart N, Birdsall M. Bilateral transient osteoporosis of the knee in pregnancy. Ann Rheum Dis 2001; 60 (07) 721-722
    CrossrefPubMedGoogle Scholar
  • 15 Patel V, Temkin S, O'Loughlin M. Transient osteoporosis of pregnancy in a 34-year-old female. Radiol Case Rep 2015; 7 (02) 646
    PubMedGoogle Scholar
  • 16 Willis-Owen CA, Daurka JS, Chen A, Lewis A. Bilateral femoral neck fractures due to transient osteoporosis of pregnancy: a case report. Cases J 2008; 1 (01) 120
    CrossrefPubMedGoogle Scholar
  • 17 Horas K, Fraissler L, Maier G. , et al. High prevalence of vitamin deficiency in patients with bone marrow edema syndrome of the foot and ankle. Foot Ankle Int 2017; 38 (07) 760-766
    CrossrefPubMedGoogle Scholar
  • 18 Sprinchorn AE, O'Sullivan R, Beischer AD. Transient bone marrow edema of the foot and ankle and its association with reduced systemic bone mineral density. Foot Ankle Int 2011; 32 (05) S508-S512
    CrossrefPubMedGoogle Scholar
  • 19 Trevisan C, Klumpp R, Compagnoni R. Risk factors in transient osteoporosis: a retrospective study on 23 cases. Clin Rheumatol 2016; 35 (10) 2517-2522
    CrossrefPubMedGoogle Scholar
  • 20 Alsaed O, Hammoudeh M. Recurrent migratory transient bone marrow edema of the knees associated with low vitamin D and systemic low bone mineral density: a case report and literature review. Case Rep Rheumatol 2018; 2018: 7657982
    PubMedGoogle Scholar
  • 21 Nelson FR, Craig J, Francois H, Azuh O, Oyetakin-White P, King B. Subchondral insufficiency fractures and spontaneous osteonecrosis of the knee may not be related to osteoporosis. Arch Osteoporos 2014; 9: 194
    CrossrefPubMedGoogle Scholar
  • 22 Geith T, Niethammer T, Milz S, Dietrich O, Reiser M, Baur-Melnyk A. Transient bone marrow edema syndrome versus osteonecrosis: perfusion patterns at dynamic contrast-enhanced MR imaging with high temporal resolution can allow differentiation. Radiology 2017; 283 (02) 478-485
    CrossrefPubMedGoogle Scholar
  • 23 Starr AM, Wessely MA, Albastaki U, Pierre-Jerome C, Kettner NW. Bone marrow edema: pathophysiology, differential diagnosis, and imaging. Acta Radiol 2008; 49 (07) 771-786
    CrossrefPubMedGoogle Scholar
  • 24 Lecouvet FE, van de Berg BC, Maldague BE. , et al. Early irreversible osteonecrosis versus transient lesions of the femoral condyles: prognostic value of subchondral bone and marrow changes on MR imaging. AJR Am J Roentgenol 1998; 170 (01) 71-77
    CrossrefPubMedGoogle Scholar
  • 25 Asadipooya K, Graves L, Greene LW. Transient osteoporosis of the hip: review of the literature. Osteoporos Int 2017; 28 (06) 1805-1816
    CrossrefPubMedGoogle Scholar
  • 26 Felson DT, Chaisson CE, Hill CL. , et al. The association of bone marrow lesions with pain in knee osteoarthritis. Ann Intern Med 2001; 134 (07) 541-549
    CrossrefPubMedGoogle Scholar
  • 27 Felson DT, Niu J, Guermazi A. , et al. Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging. Arthritis Rheum 2007; 56 (09) 2986-2992
    CrossrefPubMedGoogle Scholar
  • 28 Zhang Y, Nevitt M, Niu J. , et al. Fluctuation of knee pain and changes in bone marrow lesions, effusions, and synovitis on magnetic resonance imaging. Arthritis Rheum 2011; 63 (03) 691-699
    CrossrefPubMedGoogle Scholar
  • 29 Yusuf E, Kortekaas MC, Watt I, Huizinga TW, Kloppenburg M. Do knee abnormalities visualised on MRI explain knee pain in knee osteoarthritis? A systematic review. Ann Rheum Dis 2011; 70 (01) 60-67
    CrossrefPubMedGoogle Scholar
  • 30 Hayes CW, Jamadar DA, Welch GW. , et al. Osteoarthritis of the knee: comparison of MR imaging findings with radiographic severity measurements and pain in middle-aged women. Radiology 2005; 237 (03) 998-1007
    CrossrefPubMedGoogle Scholar
  • 31 Ghasemi RA, Sadeghi S, Rahimee N, Tahmasebi M. Technologies in the treatment of bone marrow edema syndrome. Orthop Clin North Am 2019; 50 (01) 131-138
    CrossrefPubMedGoogle Scholar
  • 32 Mirghasemi SA, Trepman E, Sadeghi MS, Rahimi N, Rashidinia S. Bone marrow edema syndrome in the foot and ankle. Foot Ankle Int 2016; 37 (12) 1364-1373
    CrossrefPubMedGoogle Scholar
  • 33 Vitali M, Naim Rodriguez N, Pedretti A. , et al. Bone marrow edema syndrome of the medial femoral condyle treated with extracorporeal shock wave therapy: a clinical and MRI retrospective comparative study. Arch Phys Med Rehabil 2018; 99 (05) 873-879
    CrossrefPubMedGoogle Scholar
  • 34 Gao F, Sun W, Li Z. , et al. Extracorporeal shock wave therapy in the treatment of primary bone marrow edema syndrome of the knee: a prospective randomised controlled study. BMC Musculoskelet Disord 2015; 16: 379
    CrossrefPubMedGoogle Scholar
  • 35 Patel S. Primary bone marrow oedema syndromes. Rheumatology (Oxford) 2014; 53 (05) 785-792
    CrossrefPubMedGoogle Scholar
  • 36 Yamamoto T, Bullough PG. Subchondral insufficiency fracture of the femoral head and medial femoral condyle. Skeletal Radiol 2000; 29 (01) 40-44
    CrossrefPubMedGoogle Scholar
  • 37 Yamamoto T, Bullough PG. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Joint Surg Am 2000; 82 (06) 858-866
    CrossrefPubMedGoogle Scholar
  • 38 Kidwai AS, Hemphill SD, Griffiths HJ. Radiologic case study. Spontaneous osteonecrosis of the knee reclassified as insufficiency fracture. Orthopedics 2005; 28 (03) 236-336 ; 333–336
    CrossrefPubMedGoogle Scholar
  • 39 Yamamoto T. Subchondral insufficiency fractures of the femoral head. Clin Orthop Surg 2012; 4 (03) 173-180
    CrossrefPubMedGoogle Scholar
  • 40 Ramnath RR, Kattapuram SV. MR appearance of SONK-like subchondral abnormalities in the adult knee: SONK redefined. Skeletal Radiol 2004; 33 (10) 575-581
    PubMedGoogle Scholar
  • 41 Ikemura S, Yamamoto T, Motomura G, Nakashima Y, Mawatari T, Iwamoto Y. MRI evaluation of collapsed femoral heads in patients 60 years old or older: differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head. AJR Am J Roentgenol 2010; 195 (01) W63-8
    PubMedGoogle Scholar
  • 42 Marcacci M, Andriolo L, Kon E, Shabshin N, Filardo G. Aetiology and pathogenesis of bone marrow lesions and osteonecrosis of the knee. EFORT Open Rev 2017; 1 (05) 219-224
    PubMedGoogle Scholar
  • 43 Jose J, Pasquotti G, Smith MK, Gupta A, Lesniak BP, Kaplan LD. Subchondral insufficiency fractures of the knee: review of imaging findings. Acta Radiol 2015; 56 (06) 714-719
    CrossrefPubMedGoogle Scholar
  • 44 Hussain ZB, Chahla J, Mandelbaum BR, Gomoll AH, LaPrade RF. The role of meniscal tears in spontaneous osteonecrosis of the knee: a systematic review of suspected etiology and a call to revisit nomenclature. Am J Sports Med 2019; 47 (02) 501-507
    CrossrefPubMedGoogle Scholar
  • 45 Ahlbäck S, Bauer GC, Bohne WH. Spontaneous osteonecrosis of the knee. Arthritis Rheum 1968; 11 (06) 705-733
    CrossrefPubMedGoogle Scholar
  • 46 Wilmot AS, Ruutiainen AT, Bakhru PT, Schweitzer ME, Shabshin N. Subchondral insufficiency fracture of the knee: a recognizable associated soft tissue edema pattern and a similar distribution among men and women. Eur J Radiol 2016; 85 (11) 2096-2103
    CrossrefPubMedGoogle Scholar
  • 47 Kubo Y, Motomura G, Ikemura S. , et al. Osteoclast-related markers in the hip joint fluid with subchondral insufficiency fracture of the femoral head. J Orthop Res 2018; 36 (11) 2987-2995
    CrossrefPubMedGoogle Scholar
  • 48 Zhao G, Yamamoto T, Ikemura S. , et al. A histopathological evaluation of a concave-shaped low-intensity band on T1-weighted MR images in a subchondral insufficiency fracture of the femoral head. Skeletal Radiol 2010; 39 (02) 185-188
    CrossrefPubMedGoogle Scholar
  • 49 Ikemura S, Mawatari T, Matsui G, Iguchi T, Mitsuyasu H. The depth of the low-intensity band on the T1-weighted MR image is useful for distinguishing subchondral insufficiency fracture from osteonecrosis of the collapsed femoral head. Arch Orthop Trauma Surg 2018; 138 (08) 1053-1058
    CrossrefPubMedGoogle Scholar
  • 50 Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. Osteochondral lesions of the knee: differentiating the most common entities at MRI. Radiographics 2018; 38 (05) 1478-1495
    CrossrefPubMedGoogle Scholar
  • 51 Bullough PG. Orthopaedic Pathology. 5th ed. Maryland Heights, MO: Mosby Elsevier; 2010: 347
    Google Scholar
  • 52 Iida S, Harada Y, Shimizu K. , et al. Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis. AJR Am J Roentgenol 2000; 174 (03) 735-743
    CrossrefPubMedGoogle Scholar
  • 53 Meier R, Kraus TM, Schaeffeler C. , et al. Bone marrow oedema on MR imaging indicates ARCO stage 3 disease in patients with AVN of the femoral head. Eur Radiol 2014; 24 (09) 2271-2278
    CrossrefPubMedGoogle Scholar
  • 54 Curtiss Jr PH, Kincaid WE. Transitory demineralization of the hip in pregnancy. A report of three cases. J Bone Joint Surg Am 1959; 41-A: 1327-1333
    PubMedGoogle Scholar
  • 55 Hayes CW, Conway WF, Daniel WW. MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics 1993; 13 (05) 1001-1011 ; discussion 1012
    CrossrefPubMedGoogle Scholar
  • 56 Berman N, Brent H, Chang G, Honig S. Transient osteoporosis: not just the hip to worry about. Bone Rep 2016; 5: 308-311
    PubMedGoogle Scholar
  • 57 Hefti F, Beguiristain J, Krauspe R. , et al. Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop B 1999; 8 (04) 231-245
    PubMedGoogle Scholar
  • 58 Roßbach BP, Paulus AC, Niethammer TR. , et al. Discrepancy between morphological findings in juvenile osteochondritis dissecans (OCD): a comparison of magnetic resonance imaging (MRI) and arthroscopy. Knee Surg Sports Traumatol Arthrosc 2016; 24 (04) 1259-1264
    CrossrefPubMedGoogle Scholar
  • 59 Ellermann JM, Donald B, Rohr S. , et al. Magnetic resonance imaging of osteochondritis dissecans: validation study for the ICRS classification system. Acad Radiol 2016; 23 (06) 724-729
    CrossrefPubMedGoogle Scholar
  • 60 Chen CH, Liu YS, Chou PH, Hsieh CC, Wang CK. MR grading system of osteochondritis dissecans lesions: comparison with arthroscopy. Eur J Radiol 2013; 82 (03) 518-525
    CrossrefPubMedGoogle Scholar
  • 61 Kijowski R, Blankenbaker DG, Shinki K, Fine JP, Graf BK, De Smet AA. Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Radiology 2008; 248 (02) 571-578
    CrossrefPubMedGoogle Scholar
  • 62 De Smet AA, Fisher DR, Graf BK, Lange RH. Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects. AJR Am J Roentgenol 1990; 155 (03) 549-553
    CrossrefPubMedGoogle Scholar
  • 63 De Smet AA, Ilahi OA, Graf BK. Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skeletal Radiol 1996; 25 (02) 159-163
    CrossrefPubMedGoogle Scholar
  • 64 Levy AS, Lohnes J, Sculley S, LeCroy M, Garrett W. Chondral delamination of the knee in soccer players. Am J Sports Med 1996; 24 (05) 634-639
    CrossrefPubMedGoogle Scholar
  • 65 White CL, Chauvin NA, Waryasz GR, March BT, Francavilla ML. MRI of native knee cartilage delamination injuries. AJR Am J Roentgenol 2017; 209 (05) W317-W321
    CrossrefPubMedGoogle Scholar
  • 66 Jannelli E, Parafioriti A, Acerbi A, Ivone A, Fioruzzi A, Fontana A. Acetabular delamination: epidemiology, histological features, and treatment. Cartilage 2019; 10 (03) 314-320
    CrossrefPubMedGoogle Scholar
  • 67 Rubin DA, Harner CD, Costello JM. Treatable chondral injuries in the knee: frequency of associated focal subchondral edema. AJR Am J Roentgenol 2000; 174 (04) 1099-1106
    CrossrefPubMedGoogle Scholar