Abstract
Acute nontraumatic pain in the adult knee can be seen in many settings, such as transient bone marrow oedema syndrome (TBMOS), regional migratory osteoporosis (RMO), spontaneous osteonecrosis (SONK) and insufficiency fractures. Early differentiation among them is crucial to avoid unnecessary treatment. TBMOS and RMO are considered to be self-limiting conditions without longterm sequelae. On the other hand, the clinical course of SONK is thought to be dependent on the size of osteonecrosis. Recent data suggest the term SONK is misleading one and should be replaced. Insufficiency fractures may demonstrate a similar clinical syndrome without a history of a single traumatic injury. The imaging pathway for knee pain has evolved considerably with the advent of magnetic resonance (MR) imaging, which is very sensitive in the early depiction of bone marrow oedema. Therefore, in patients with acute nontraumatic knee pain whose radiographs are negative or inconclusive, MR imaging is the method of choice for further evaluation. This article discusses the potential aetiologies and reviews MR imaging findings of the most common disorders afflicting the subchondral knee-joint area.
Abstract
Il dolore acuto non traumatico del ginocchio nell’adulto può essere presente in molte situazioni, come la sindrome dell’edema transitorio del midollo osseo (TBMOS), l’osteoporosi migrante regionale (RMO), l’osteonecrosi spontanea (SONK) e le fratture da stress. La diagnosi differenziale precoce è importante per evitare un trattamento inutile. La TBMOS e l’osteoporosi migrante regionale sono considerate condizioni autolimitantesi prive di sequele a lungo termine. D’altra parte, si ritiene che il decorso clinico dell’osteonecrosi spontanea dipenda dall’entità dell’osteonecrosi. Dati recenti suggeriscono che il termine osteonecrosi spontanea potrebbe indurre ad errore, per cui andrebbe modificato. Le fratture da stress possono presentarsi con un’analoga sindrome clinica senza una storia di lesione traumatica. La diagnostica per immagini nel dolore del ginocchio si è notevolmente evoluta con l’avvento della risonanza magnetica (RM), che ha un’elevata sensibilità nella identificazione precoce dell’edema midollare. Quindi, in pazienti con dolore acuto non traumatico del ginocchio i cui radiogrammi sono negativi o dubbi, l’RM è il metodo di scelta per ulteriori indagini. Questo articolo discute la potenziale eziologia e riesamina i reperti RM delle patologie più comuni dell’area sub-condrale dell’articolazione del ginocchio.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References/Bibliografia
Hofmann S, Kramer J, Vakil-Adli A et al (2004) Painful bone marrow edema of the knee: differential diagnosis and therapeutic concepts. Orthop Clin N Am 35:321–333
Beltran J, Shankman S (1994) Magnetic resonance imaging of bone marrow disorders of the knee. Magn Reson Imaging Clin N Am 2:463–473
Hofmann S, Kramer J, Breitenseher M et al (2006) Bone marrow edema in the knee. Differential diagnosis and therapeutic possibilities. Orthopade 35:463–475
Wilson AJ, Murphy WA, Hardy DC, Totty WG (1988) Transient osteoporosis: transient bone marrow edema? Radiology 167:757–760
Malizos KN, Zibis AH, Dailiana Z et al (2004) MR imaging findings in transient osteoporosis of the hip. Eur J Radiol 50:238–244
Karantanas AH (2007) Acute bone marrow edema of the hip: role of MR imaging. Eur Radiol 17:2225–2236
Eustace S, Keogh C, Blake M et al (2001) MR imaging of bone oedema: mechanisms and interpretation. Clin Radiol 56:4–12
Lakhanpal S, Ginsburg WW, Luthra HS, Hunder GG (1987) Transient regional osteoporosis. A study of 56 cases and review of the literature. Ann Intern Med 106:444–450
Berger CE, Kroner AH, Kristen KH et al (2006) Transient bone marrow edema syndrome of the knee: clinical and magnetic resonance imaging results at 5 years after core decompression arthroscopy. J Arthroscopy Relat Surg 22:866–871
Karantanas AH, Drakonaki E, Karachalios T et al (2008) acute non traumatic marrow edema syndrome in the knee: MRI findings at presentation, correlation with spinal DEXA and outcome. Eur J Radiol doi:10.1016/j.ejrad.2008.01.053
Curtiss PH Jr, Kincaid WE (1959) Transitory demineralization of the hip in pregnancy. A report of three cases. J Bone Joint Surg Am 41:1327–1333
Schweitzer ME, White LM (1996) Does altered biomechanics cause marrow edema? Radiology 198:851–853
Parker RK, Ross GJ, Urso JA (1997) Transient osteoporosis of the knee. Skeletal Radiol 26:306–309
Noorda RJ, van der Aa JP, Wuisman PI et al (1997) Transient osteoporosis and osteogenesis imperfecta. A case report. Clin Orthop Relat Res 337:249–255
Papadopoulos EC, Papagelopoulos PJ, Boscainos PJ et al (2001) Bone marrow edema syndrome. Orthopedics 24:69–73
Gil HC, Levine SM, Zoga AC (2006) MRI findings in the subchondral bone marrow: a discussion of conditions including transient osteoporosis, transient bone marrow edema syndrome, SONK, and shifting bone marrow edema of the knee. Semin Musculoskelet Radiol 10:177–186
Lecouvet FE, Vande Berg BC, Maldague B et al (1998) Early irreversible osteonecrosis versus transient lesions of the femoral condyles: prognostic value of subchondral and marrow changes on MR imaging. AJR Am J Roentgenol 170:71–77
Korompilias AV, Karantanas AH, Lykissas MG, Beris AE (2008) Transient osteoporosis. J Am Acad Orthop Surg 16:480–489
Duncan H, Frame B, Frost H, Arnstein AR (1969) Regional migratory osteoporosis. South Med J 62:41–44
Trevisan C, Ortolani S (2002) Bone loss and recovery in regional migratory osteoporosis. Osteoporos Int 13:901–906
Toms AP, Marshall TJ, Becker E et al (2005) Regional migratory osteoporosis: a review illustrated by five cases. Clin Radiol 60:425–438
Horiuchi K, Shiraga N, Fujita N et al (2004) Regional migratory osteoporosis: a case report. J Ortop Sci 9:178–181
Fazekas JE, Losada R, Fruauff AA et al (2002) Migratory transient osteoporosis of the hip occurring before and during pregnancy. J Wom Imaging 4:80–85
Karantanas AH, Nikolakopoulos I, Korompilias AV et al (2008) Regional migratory osteoporosis in the knee: MRI findings in 22 patients and review of the literature. Eur J Radiol 67:34–41
Fertakos RJ, Swayne LC, Colston WC (1995) Three-phase bone imaging in bone marrow edema of the knee. Clin Nucl Med 20:587–590
Massara A, Orzincolo C, Prandini N, Trotta F (2005) Transient regional osteoporosis. Reumatismo 57:5–15
Hogan CJ, Hurwitz SR (2002) Treatment of complex regional pain syndrome of the lower extremity. J Am Acad Orthop Surg 10:281–289
Ahlback S, Bauer GCH, Bohne WH (1968) Spontaneous osteonecrosis of the knee. Arthritis Rheum 11:705–733
Pape D, Seil R, Fritsch E et al (2002) Prevalence of spontaneous osteonecrosis of the medial femoral condyle in elderly patients. Knee Surg Sport Traum Arthr 10:233–240
Karachalios T, Zibis A, Papanagiotou P et al (2004) MR imaging findings in early osteoarthritis of the knee. Eur J Radiol 50:225–230
Narvaez JA, Narvaez J, De Lama E, Sanchez A (2003) Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture. Eur Radiol 13:1843–1848
Zanetti M, Bruder E, Romero J, Hodler J (2000) Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. Radiology 215:835–840
Satku K, Kumar VP, Chong SM, Thambyah A (2003) The natural history of spontaneous osteoncecrosis of the medial tibial plateau. J Bone Joint Surg Br 85-B:983–988
Mont MA, Baumgarten KM, Rifai A et al (2000) Atraumatic osteonecrosis of the knee. J Bone Joint Surg Am 82:1279–1290
Mont MA, Tomek IM, Hungerford DS (1997) Core decompression for avascular necrosis of the distal femur: long term follow up. Clin Orthop 334:124–130
Yamamoto T, Bullough PG (2000) Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Joint Surg Am 82:858–866
Marmor L, Goldberg RT (1992) Failure of magnetic resonance imaging in evaluating osteonecrosis of the knee. Am J Knee Surg 5:195–220
Kattapuram TM, Kattapuram SV (2008) Spontaneous osteonecrosis of the knee. Eur J Radiol 67:42–48
Satku K, Kumar VP, Chacha PB (1990) Stress fractures around the knee in elderly patients: a cause of acute pain in the knee. J Bone Joint Surg Am 1990 72:918–922
Alonso-Bartolome P, Manuel Martinez-Taboada V, Blanco R, Rodriguez-Valverde V (1999) Insufficiency fractures of the tibia and fibula. Semin Arthritis Rheum 28:413–420
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fotiadou, A., Karantanas, A. Acute nontraumatic adult knee pain: the role of MR imaging. Radiol med 114, 437–447 (2009). https://doi.org/10.1007/s11547-009-0380-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11547-009-0380-z
Keywords
- Knee joint/adults
- Bone marrow oedema
- MR imaging/diagnosis
- Insufficiency fracture
- Spontaneous osteonecrosis
- Transient osteoporosis