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Nashi N, Chan CX, Choo SX, Sia SYD, Lim CT, Satkunanantham K. Does the osteonecrotic volume/other factors predict progression to total knee arthroplasty in spontaneous osteonecrosis of the knee? An MRI study. J Clin Orthop Trauma 2024; 53:102442. [PMID: 38975294 PMCID: PMC11227023 DOI: 10.1016/j.jcot.2024.102442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/12/2023] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Background The aim of this study is to determine whether the volume of the osteonecrotic lesion in spontaneous osteonecrosis of the knee (SONK) or other prognostic factors predict progression to total knee arthroplasty (TKA). The secondary aim is to analyse co-relation of volume of osteonecrotic lesion versus other prognostic factors The authors hypothesize that a greater osteonecrotic volume predicts progression to TKA. Materials and methods A retrospective study was conducted at a single tertiary hospital. All patients under the care of a single surgeon with magnetic resonance imaging (MRI)-proven SONK were included from the period of January 2011 to January 2018. Survival analysis was conducted to evaluate for progression to TKA based on volume and location of osteonecrotic lesion. Univariate and multivariate analyses were performed to identify potential risk factors for TKA. Results 42 patients with MRI-proven SONK were evaluated. 9 patients (21.4 %) required TKA. There was no significant association between progression to TKA with volume of the osteonecrotic lesion. Other factors such as age, gender, body mass index, degree of bony edema and cartilage damage, presence of meniscal tear and subchondral fractures and location of osteonecrotic lesion were also not significant. Conclusion The volume of the osteonecrotic lesion and other evaluated prognostic factors were not predictive of the progression to TKA for patients with SONK.
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Affiliation(s)
- Nazrul Nashi
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster National University Hospital Singapore, 1E Kent Ridge Road, 119228, Singapore
| | - Chloe Xiaoyun Chan
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster National University Hospital Singapore, 1E Kent Ridge Road, 119228, Singapore
| | - Selena Xueli Choo
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster National University Hospital Singapore, 1E Kent Ridge Road, 119228, Singapore
| | - Soon Yiew David Sia
- Department of Diagnostic Imaging National University Hospital Singapore, 1E Kent Ridge Road, 119228, Singapore
| | - Chin Tat Lim
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster National University Hospital Singapore, 1E Kent Ridge Road, 119228, Singapore
| | - Kandiah Satkunanantham
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster National University Hospital Singapore, 1E Kent Ridge Road, 119228, Singapore
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Yokota S, Ishizu H, Miyazaki T, Takahashi D, Iwasaki N, Shimizu T. Osteoporosis, Osteoarthritis, and Subchondral Insufficiency Fracture: Recent Insights. Biomedicines 2024; 12:843. [PMID: 38672197 PMCID: PMC11048726 DOI: 10.3390/biomedicines12040843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/31/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
The increased incidence of osteoarthritis (OA), particularly knee and hip OA, and osteoporosis (OP), owing to population aging, have escalated the medical expense burden. Osteoarthritis is more prevalent in older women, and the involvement of subchondral bone fragility spotlights its association with OP. Notably, subchondral insufficiency fracture (SIF) may represent a more pronounced condition of OA pathophysiology. This review summarizes the relationship between OA and OP, incorporating recent insights into SIF. Progressive SIF leads to joint collapse and secondary OA and is associated with OP. Furthermore, the thinning and fragility of subchondral bone in early-stage OA suggest that SIF may be a subtype of OA (osteoporosis-related OA, OPOA) characterized by significant subchondral bone damage. The high bone mineral density observed in OA may be overestimated due to osteophytes and sclerosis and can potentially contribute to OPOA. The incidence of OPOA is expected to increase along with population aging. Therefore, prioritizing OP screening, early interventions for patients with early-stage OA, and fracture prevention measures such as rehabilitation, fracture liaison services, nutritional management, and medication guidance are essential.
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Affiliation(s)
| | | | | | | | | | - Tomohiro Shimizu
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (S.Y.); (H.I.); (T.M.); (D.T.); (N.I.)
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3
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Sun H, Wang W, He F, Wang D, Liu X, Xu S, Zhao B, Li Q, Wang X, Jiang Q, Zhang R, Liu S, Xiao Y. An AI-Based Image Quality Control Framework for Knee Radiographs. J Digit Imaging 2023; 36:2278-2289. [PMID: 37268840 PMCID: PMC10501977 DOI: 10.1007/s10278-023-00853-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 06/04/2023] Open
Abstract
Image quality control (QC) is crucial for the accurate diagnosis of knee diseases using radiographs. However, the manual QC process is subjective, labor intensive, and time-consuming. In this study, we aimed to develop an artificial intelligence (AI) model to automate the QC procedure typically performed by clinicians. We proposed an AI-based fully automatic QC model for knee radiographs using high-resolution net (HR-Net) to identify predefined key points in images. We then performed geometric calculations to transform the identified key points into three QC criteria, namely, anteroposterior (AP)/lateral (LAT) overlap ratios and LAT flexion angle. The proposed model was trained and validated using 2212 knee plain radiographs from 1208 patients and an additional 1572 knee radiographs from 753 patients collected from six external centers for further external validation. For the internal validation cohort, the proposed AI model and clinicians showed high intraclass consistency coefficients (ICCs) for AP/LAT fibular head overlap and LAT knee flexion angle of 0.952, 0.895, and 0.993, respectively. For the external validation cohort, the ICCs were also high, with values of 0.934, 0.856, and 0.991, respectively. There were no significant differences between the AI model and clinicians in any of the three QC criteria, and the AI model required significantly less measurement time than clinicians. The experimental results demonstrated that the AI model performed comparably to clinicians and required less time. Therefore, the proposed AI-based model has great potential as a convenient tool for clinical practice by automating the QC procedure for knee radiographs.
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Affiliation(s)
- Hongbiao Sun
- Department of Radiology, Shanghai Changzheng Hospital, Naval Medical University, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Wenwen Wang
- Department of Radiology, Shanghai Changzheng Hospital, Naval Medical University, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Fujin He
- Deepwise Artificial Intelligence Laboratory, Beijing, 100089, China
| | - Duanrui Wang
- Deepwise Artificial Intelligence Laboratory, Beijing, 100089, China
| | - Xiaoqing Liu
- Deepwise Artificial Intelligence Laboratory, Beijing, 100089, China
| | - Shaochun Xu
- Department of Radiology, Shanghai Changzheng Hospital, Naval Medical University, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Baolian Zhao
- Department of Radiology, Shanghai Changzheng Hospital, Naval Medical University, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Qingchu Li
- Department of Radiology, Shanghai Changzheng Hospital, Naval Medical University, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Xiang Wang
- Department of Radiology, Shanghai Changzheng Hospital, Naval Medical University, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Qinling Jiang
- Department of Radiology, Shanghai Changzheng Hospital, Naval Medical University, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Rong Zhang
- Department of Radiology, Shanghai Changzheng Hospital, Naval Medical University, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Shiyuan Liu
- Department of Radiology, Shanghai Changzheng Hospital, Naval Medical University, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
| | - Yi Xiao
- Department of Radiology, Shanghai Changzheng Hospital, Naval Medical University, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
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Baek J, Lee SC, Ryu S, Ahn HS, Nam CH. Early aseptic loosening of primary total knee arthroplasty in patients with osteonecrosis of the knee: A case series. Clin Case Rep 2022; 10:e6773. [PMID: 36545561 PMCID: PMC9761662 DOI: 10.1002/ccr3.6773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/19/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
The cause of early aseptic loosening in total knee arthroplasty (TKA) is uncertain, although several possibilities could be offered. We report that osteonecrosis of the knee should be considered as a possible cause or contributing etiologic factor for early aseptic loosening following primary TKA.
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Affiliation(s)
- Ji‐Hoon Baek
- Joint & Arthritis Research, Department of Orthopaedic SurgeryHimchan HospitalSeoulKorea
| | - Su Chan Lee
- Joint & Arthritis Research, Department of Orthopaedic SurgeryHimchan HospitalSeoulKorea
| | - Suengryol Ryu
- Department of Orthopaedic SurgeryHimnaera HospitalBusanKorea
| | - Hye Sun Ahn
- Joint & Arthritis Research, Department of Orthopaedic SurgeryHimchan HospitalSeoulKorea
| | - Chang Hyun Nam
- Joint & Arthritis Research, Department of Orthopaedic SurgeryHimchan HospitalSeoulKorea
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Yamaguchi J, Yasuda K, Kondo E, Kaibara T, Ueda D, Yabuuchi K, Onodera J, Iwasaki N, Saito M, Yagi T. Extrusion of the medial meniscus is a potential predisposing factor for post-arthroscopy osteonecrosis of the knee. BMC Musculoskelet Disord 2021; 22:852. [PMID: 34610805 PMCID: PMC8493670 DOI: 10.1186/s12891-021-04730-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Post-arthroscopic osteonecrosis of the knee (PAONK) is a rare condition. No studies have analyzed the relationship between the meniscus extrusion and PAONK. The purpose of this retrospective study is to test a hypothesis that the degree of the medial meniscus (MM) extrusion might be significantly greater in the knees with PAONK than in the matched control knees both before and after the meniscectomy. Methods Ten knees with PAONK were detected out of a total of 876 knees which had undergone arthroscopic partial meniscectomy of the MM. Ten matched control knees were randomly selected out of the remaining 866 knees without PAONK. The clinical data of these 20 patients were retrospectively collected from the medical records. To evaluate the location of the menisci on the joint line, Extrusion width and Inner width were defined on a coronal section of magnetic resonance imaging (MRI). The intra- and inter-rater reliability was evaluated by calculating the intra- and inter-class coefficients. Statistical comparisons between the 2 groups were made using the 3 non-parametric tests. Results Before the meniscectomy, the Extrusion width of the MM (mean 4.7 ± 1.4 mm) was significantly greater than that (3.0 ± 1.3 mm) in the Control group (P = 0.0195). In the MRI taken in a range from 3 to 50 weeks after the meniscectomy, the Extrusion width of the MM (5.9 ± 1.1 mm) in the PAONK group was significantly greater than that (3.4 ± 1.4 mm) in the Control group (P = 0.0009), and the Inner width of the MM (0.6 ± 1.7 mm) in the PAONK group was significantly less than that (3.9 ± 1.0 mm) in the Control group (P = 0.0001). Conclusion A significant relationship was found between the degree of the MM extrusion and the onset of PAONK. This study suggested that the extrusion of the MM is a potential predisposing factor for PAONK.
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Affiliation(s)
- Jun Yamaguchi
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, 3-Jo 5-Chome, Nishino, Nishi-ku, Sapporo, 063-0033, Japan.,Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazunori Yasuda
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, 3-Jo 5-Chome, Nishino, Nishi-ku, Sapporo, 063-0033, Japan.
| | - Eiji Kondo
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Takuma Kaibara
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, 3-Jo 5-Chome, Nishino, Nishi-ku, Sapporo, 063-0033, Japan.,Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Daisuke Ueda
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, 3-Jo 5-Chome, Nishino, Nishi-ku, Sapporo, 063-0033, Japan
| | - Koji Yabuuchi
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, 3-Jo 5-Chome, Nishino, Nishi-ku, Sapporo, 063-0033, Japan
| | - Jun Onodera
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, 3-Jo 5-Chome, Nishino, Nishi-ku, Sapporo, 063-0033, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomonori Yagi
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, 3-Jo 5-Chome, Nishino, Nishi-ku, Sapporo, 063-0033, Japan
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Hashimoto S, Terauchi M, Hatayama K, Ohsawa T, Omodaka T, Chikuda H. Medial meniscus extrusion as a predictor for a poor prognosis in patients with spontaneous osteonecrosis of the knee. Knee 2021; 31:164-171. [PMID: 34214956 DOI: 10.1016/j.knee.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/26/2021] [Accepted: 06/07/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Risk factors for the progression of spontaneous osteonecrosis of the knee (SONK) remain unclear. The purpose of this study was to investigate the association between magnetic resonance imaging (MRI) findings of the meniscus and the prognosis of SONK. METHODS A total of 78 consecutive patients (female 85%; mean age 75.6 ± 7.2 years old) diagnosed with SONK were included. Of these, 30 patients did not receive surgery within 1 year from the onset of SONK (conservative group), while the remaining 48 patients underwent unicompartmental knee arthroplasty due to worsening of symptoms (UKA group). Using MRI findings obtained within 3 months of the onset, we compared the types of meniscus tear and medial meniscus extrusion between the conservative group and UKA group. We performed a receiver operating characteristics (ROC) analysis to estimate the cut-off value. RESULTS Patients in the UKA group showed greater medial meniscus extrusion (absolute value, 4.2 mm ± 1.9 vs. 2.8 mm ± 1.2, P = 0.001; relative percentage of extrusion (RPE), 45.7% ± 21.5 vs. 30.7% ± 12.9, P = 0.001) and a higher prevalence of radial tear (P = 0.021) than those in the conservative group. In the multivariate analysis, RPE remained a relevant independent factor (P = 0.035) for future UKA. An ROC analysis found that the cut-off point of RPE was 33% (sensitivity, 81.2%; specificity, 63.3%). CONCLUSION RPE was a predictor of the prognosis of patients who underwent UKA within 1 year after the onset of SONK. Our results suggest that patients with RPE ≥ 33% are at high risk for progression.
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Affiliation(s)
- Shogo Hashimoto
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan.
| | - Masanori Terauchi
- Department of Orthopaedic Surgery, Gunma Central Hospital, Maebashi, Gunma, Japan
| | - Kazuhisa Hatayama
- Department of Orthopaedic Surgery, Gunma Central Hospital, Maebashi, Gunma, Japan
| | - Takashi Ohsawa
- Department of Orthopaedic Surgery, Kiryu Orthopedic Hospital, Kiryu, Gunma, Japan
| | - Takuya Omodaka
- Department of Orthopaedic Surgery, Zensyukai Hospital, Maebashi, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
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7
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Barras LA, Pareek A, Parkes CW, Song BM, Camp CL, Saris DBF, Stuart MJ, Krych AJ. Post-arthroscopic Subchondral Insufficiency Fractures of the Knee Yield High Rate of Conversion to Arthroplasty. Arthroscopy 2021; 37:2545-2553. [PMID: 33774060 DOI: 10.1016/j.arthro.2021.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate both the potential causes and resultant outcomes in patients in whom subchondral insufficiency fracture of the knee (SIFK) develops after arthroscopy. METHODS We performed a retrospective review of all patients with a magnetic resonance imaging diagnosis of SIFK after arthroscopic meniscectomy and chondroplasty over a 12-year period. RESULTS A total of 28 patients were included, with a mean age of 61 years and mean follow-up period of 5.7 years. SIFK showed a predilection for the medial compartment (n = 25, 89%), specifically the medial femoral condyle (n = 21, 75%). In 7 patients (25%), SIFK developed in both the femoral condyle and tibial plateau in the ipsilateral compartment. Fifteen patients (54%) went on to conversion to arthroplasty at a mean of 0.72 years. The rate of survival free of conversion to arthroplasty was 57%, 45%, and 40% at 1 year, 2 years, and 5 years, respectively. Furthermore, 63% of patients with a meniscal tear and SIFK in the same compartment went on to arthroplasty (P = .04). There was an increased risk of conversion to arthroplasty if SIFK was present in both the femur and tibia in the same compartment (P = .04). A higher Kellgren-Lawrence grade at the time of the SIFK diagnosis increased the likelihood of eventual arthroplasty (P = .03). The presence of SIFK in both the femur and tibia in the ipsilateral compartment, an increased Kellgren-Lawrence grade, and a meniscal tear or prior meniscectomy in the same compartment as SIFK were associated with an increased risk of eventual arthroplasty. CONCLUSIONS Post-arthroscopic SIFK most commonly occurs in the medial compartment, particularly in patients who underwent a prior meniscectomy. The presence of meniscal root and radial tears in these patients is notable (75%). Ultimately, there is a high rate of progression of arthrosis (33%) and eventual conversion to arthroplasty. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Laurel A Barras
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Ayoosh Pareek
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Chad W Parkes
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Bryant M Song
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Michael J Stuart
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A..
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Choi HG, Kim JS, Yoo HJ, Jung YS, Lee YS. The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures. Am J Sports Med 2021; 49:1551-1560. [PMID: 33793351 DOI: 10.1177/03635465211002160] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Subchondral insufficiency fracture of the knee (SIFK) is characterized by a subchondral lesion that may lead to end-stage osteoarthritis (OA). In patients who have SIFK in a precollapse state with varus malalignment, a joint-preserving technique such as open wedge high tibial osteotomy (OWHTO) should be considered. PURPOSE To evaluate the efficacy of OWHTO in primary OA and SIFK-dominant OA by clinical and radiological evaluations including magnetic resonance imaging (MRI). STUDY DESIGN Cohort study; Level of evidence 3. METHODS A total of 33 SIFK-dominant OA knees and 66 with primary OA that underwent biplanar OWHTO between March 2014 and February 2016 were included after 1:2 propensity score matching. The MRI Osteoarthritis Knee Score was used to assess bone marrow lesions (BMLs) preoperatively and at follow-up. The weightbearing line ratio, the hip-knee-ankle angle, and the joint line convergence angle were measured. The clinical outcomes assessed were range of motion, the American Knee Society Score, and the Western Ontario and McMaster University (WOMAC) score. RESULTS The mean follow-up period was 41.2 ± 12.6 months. The distribution of preoperative BML grade in the SIFK-dominant OA group was significantly higher in both the femur and tibia (P < .001 and <.001, respectively) than that in the primary OA group. However, the difference was not significant postoperatively (femur, P = .425; tibia, P = .462). In both groups, postoperative BMLs showed significant improvement compared with preoperative BMLs (primary OA [femur, P < .001; tibia, P = .001] and SIFK-dominant OA [femur, P < .001; tibia, P < .001]). The WOMAC pain score was higher in the SIFK-dominant OA group preoperatively (primary OA, 7.0 ± 3.73; SIFK-dominant OA, 9.17 ± 2.6; P = .032) even though it was not different at the final follow-up (primary OA, 2.11 ± 1.7; SIFK-dominant OA, 1.79 ± 1.32; P = .179). CONCLUSION OWHTO is an effective procedure not only for primary OA but also for SIFK-dominant OA. OWHTO can improve BMLs, which represent the main pathological feature of SIFK. Therefore, in patients who have SIFK with varus malalignment, OWHTO can be an attractive treatment option for preserving the joint and enhancing subchondral bone healing.
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Affiliation(s)
- Han Gyeol Choi
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seoul, Republic of Korea
| | - Joo Sung Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seoul, Republic of Korea
| | - Hyun Jin Yoo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seoul, Republic of Korea
| | - You Sun Jung
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seoul, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seoul, Republic of Korea
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9
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Tsukamoto H, Saito H, Saito K, Yoshikawa T, Oba M, Sasaki K, Sato C, Akagawa M, Takahashi Y, Miyakoshi N, Shimada Y. Radiographic deformities of the lower extremity in patients with spontaneous osteonecrosis of the knee. Knee 2020; 27:838-845. [PMID: 32331828 DOI: 10.1016/j.knee.2020.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Spontaneous osteonecrosis of the knee (SONK) is one of the acute knee pain disorders arising in elderly patients. The presence of knee varus alignment and the size of necrotic area have been reported as the negative prognostic factors in prior studies. However, no previous study has yet clarified the radiological analysis of the lower extremity in SONK compared with that in osteoarthritis. The purpose of this study was therefore to identify the radiographic findings of the lower extremity in SONK. METHODS Sixty-three knees of Kellgren-Lawrence classification grade 1 or 2 without any trauma treated between April 2012 and March 2014 were enrolled in this study. These knees were divided into two groups according to their magnetic resonance imaging (MRI) findings: SONK group (31 knees) and OA group (32 knees). Using a long leg standing X-ray, femorotibial angle (FTA), mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA) and joint line convergent angle (JLCA) were compared between groups. Correlation between each parameter and the width ratio (WR) of the necrotic lesion were analyzed. RESULTS FTA, MAD, MPTA and JLCA showed significant differences between the SONK and OA groups. In the SONK group, FTA was positively correlated with WR, and, MAD and MPTA was negatively correlated with WR. CONCLUSIONS Compared with OA, SONK is associated with a significantly larger varus deformity at the proximal tibia, and larger joint play in the coronal plane.
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Affiliation(s)
- Hiroaki Tsukamoto
- Department of Orthopedic Surgery, Omori Municipal Hospital, Akita, Japan; Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan; Department of Internal Medicine, Tazawako Municipal Hospital, Akita, Japan; Akita Sports Arthroscopy Knee Group (ASAK), Akita, Japan.
| | - Hidetomo Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan; Akita Sports Arthroscopy Knee Group (ASAK), Akita, Japan
| | - Kimio Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan; Akita Sports Arthroscopy Knee Group (ASAK), Akita, Japan
| | - Takayuki Yoshikawa
- Department of Orthopedic Surgery, Omori Municipal Hospital, Akita, Japan; Akita Sports Arthroscopy Knee Group (ASAK), Akita, Japan
| | - Masashi Oba
- Department of Orthopedic Surgery, Omori Municipal Hospital, Akita, Japan
| | - Kana Sasaki
- Akita Sports Arthroscopy Knee Group (ASAK), Akita, Japan
| | - Chie Sato
- Akita Sports Arthroscopy Knee Group (ASAK), Akita, Japan
| | - Manabu Akagawa
- Akita Sports Arthroscopy Knee Group (ASAK), Akita, Japan
| | | | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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10
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Spontaneous osteonecrosis of the knee: what do we know so far? A literature review. INTERNATIONAL ORTHOPAEDICS 2020; 44:1063-1069. [PMID: 32249354 DOI: 10.1007/s00264-020-04536-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/13/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Spontaneous osteonecrosis of the knee (SONK) is said to be a relatively common disease which may lead to an end-stage osteoarthritis of the knee. The aim of this paper was to review the literature on this field published until now, discuss the results of both conservative and surgical treatment options, as well as to introduce new methods of treatment, which may be applicable in SONK treatment. METHODS We searched the PubMed and Cochrane databases until November 2019 and presented the most recent findings in this work. RESULTS The exact aetiology of SONK still remains unclear; however, recent studies suggested that early stage of SONK is rather a result of the subchondral fracture than primary osteonecrosis. So far described conservative treatment includes non-weight bearing or protected weight bearing with a knee brace, nonsteroidal anti-inflammatory drugs, analgesics, and bisphosphonates. Surgical management includes arthroscopic debridement, core decompression, osteochondral autograft, high tibial osteotomy, and unicompartmental knee arthroplasty or total knee arthroplasty. CONCLUSIONS Although the aetiology of SONK remains unknown, there are many treatment options, and the choice of the most suitable one is challenging. We think that subchondroplasty may be one of the effective methods.
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Chalmers BP, Mehrotra KG, Sierra RJ, Pagnano MW, Taunton MJ, Abdel MP. Reliable outcomes and survivorship of primary total knee arthroplasty for osteonecrosis of the knee. Bone Joint J 2019; 101-B:1356-1361. [PMID: 31674235 DOI: 10.1302/0301-620x.101b11.bjj-2019-0576.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Knee osteonecrosis in advanced stages may lead to joint degeneration. Total knee arthroplasty (TKA) for osteonecrosis has traditionally been associated with suboptimal results. We analyzed outcomes of contemporary TKAs for osteonecrosis, with particular emphasis on: survivorship free from aseptic loosening, any revision, and any reoperation plus the clinical outcomes, complications, and radiological results. PATIENTS AND METHODS In total, 156 patients undergoing 167 primary TKAs performed for osteonecrosis between 2004 and 2014 at a single institution were reviewed. The mean age at index TKA was 61 years (14 to 93) and the mean body mass index (BMI) was 30 kg/m2 (18 to 51) The mean follow-up was six years (2 to 12). A total of 110 TKAs (66%) were performed for primary osteonecrosis and 57 TKAs (34%) for secondary osteonecrosis. Overall, 15 TKAs (9%) had tibial stems, while 12 TKAs (7%) had femoral stems. Posterior-stabilized designs were used in 147 TKAs (88%) of TKAs. Bivariate Cox regression analysis was conducted to identify risk factors for revision and reoperation. RESULTS Survivorship free from aseptic loosening, any revision, and any reoperation at ten years was 97% (95% confidence interval (CI) 93 to 100), 93% (95% CI 85 to 100), and 82% (95% CI 69 to 93), respectively. No factors, including age, sex, BMI, primary versus secondary osteonecrosis, stem utilization, and constraint, were identified as risk factors for reoperation. Four TKAs (2%) underwent revision, most commonly for tibial aseptic loosening (n = 2). Excluding revisions and reoperations, there was a total of 11 complications (7%), with the most common being a manipulation under anaesthesia (six TKAs, 4%). Mean Knee Society Scores (Knee component) significantly improved from 57 (32 to 87) preoperatively to 91 (49 to 100) postoperatively (p < 0.001). No unrevised TKAs had complete radiolucent lines or radiological evidence of loosening. CONCLUSION Contemporary cemented TKAs with selective stem utilization for osteonecrosis resulted in durable survivorship, a low complication rate, and reliable improvement in clinical outcomes. Cite this article: Bone Joint J 2019;101-B:1356-1361.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kapil G Mehrotra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Taunton
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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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; 47:501-507. [PMID: 29253348 DOI: 10.1177/0363546517743734] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The cause of spontaneous osteonecrosis of the knee (SONK) and postarthroscopic osteonecrosis of the knee is unknown, and the mechanisms involved have been poorly characterized. HYPOTHESIS/PURPOSE The purpose of this study was to perform a detailed systematic review of the literature to examine proposed etiological mechanisms for SONK in order to establish an improved understanding of the processes involved. We hypothesized that the etiology of SONK would be multifactorial. STUDY DESIGN Systematic review. METHODS A systematic review of the literature was performed by searching PubMed, Medline, Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. Inclusion criteria were all original research articles presented in the English language that reported on the suspected etiology of SONK. Reviews, case reports with fewer than 3 patients, cost-effectiveness studies, technical reports, editorial articles, surveys, special topics, letters to the editor, personal correspondence, and studies that only proposed factors for the progression of SONK were excluded. RESULTS After a comprehensive review of 255 articles, 26 articles were included for final analysis. Twenty-one (80.7%) of 26 articles implicated the role of the meniscus in the development of SONK, in an association with either meniscal tears or its development after meniscectomy. The medial meniscus and posterior meniscal root tears were implicated more frequently. All 4 studies incorporating histological findings supported the insufficiency fracture hypothesis as a pathological basis of SONK. CONCLUSION Physicians should be cognizant of the high prevalence of medial meniscus root tears in patients with SONK. Meniscectomy and meniscal tears, particularly of the medial meniscus posterior root, increase contact pressures and create an environment from which insufficiency fractures can emanate. We believe the term SONK is a misrepresentation of the etiology and pathogenesis of the condition and should be replaced with subchondral insufficiency fractures of the knee. Further elucidation of the etiology is required.
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Affiliation(s)
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Andreas H Gomoll
- Cartilage Repair Center and Center for Regenerative Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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Chalmers BP, Mehrotra KG, Sierra RJ, Pagnano MW, Taunton MJ, Abdel MP. Reliable outcomes and survivorship of unicompartmental knee arthroplasty for isolated compartment osteonecrosis. Bone Joint J 2018; 100-B:450-454. [PMID: 29629588 DOI: 10.1302/0301-620x.100b4.bjj-2017-1041.r2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Primary (or spontaneous) and secondary osteonecrosis of the knee can lead to severe joint degeneration, for which either total or unicompartmental arthroplasty may be considered. However, there are limited studies analyzing outcomes of unicompartmental knee arthroplasties (UKAs) for osteonecrosis involving an isolated compartment of the knee. The aims of this study were to analyze outcomes of UKAs for osteonecrosis with specific focus on 1) survivorship free of any revision or reoperation, 2) risk factors for failure, 3) clinical outcomes, and 4) complications. Patients and Methods A total of 45 patients underwent 46 UKAs for knee osteonecrosis between 2002 and 2014 at our institution (The Mayo Clinic, Rochester, Minnesota). Twenty patients (44%) were female; the mean age of the patients was 66 years, and mean body mass index (BMI) was 31 kg/m2. Of the 46 UKAs, 44 (96%) were medial UKAs, and 35 (76%) were fixed-bearing design. Mean mechanical axis postoperatively was 1.5° varus (0° to 5° varus); 41 UKAs (89%) were performed for primary osteonecrosis. Mean follow-up was five years (2 to 12). Results Survivorship free of any revision in the cohort was 89% (95% CI 77 to 99) and 76% (95% CI 53 to 99) at five and ten years, respectively. In patients undergoing UKA for primary osteonecrosis survivorship free of any revision was 93% (95% CI 83 to 100)at both five and ten years. Secondary osteonecrosis was a significant risk factor for poorer survivorship free of any revision or reoperation (hazard ratio 7.7, p = 0.03). Three medial UKAs (6.5%) were converted to total knee arthroplasties (TKAs): two for lateral compartment degeneration and one for development of lateral osteonecrosis. No implants were revised for loosening, fracture, or wear. Knee Society scores improved from a mean of 60 (44 to 72) preoperatively to a mean of 94 postoperatively (82 to 100) (p < 0.001). There were no surgical complications. Conclusion When done for primary osteonecrosis of the knee, UKA resulted in reliable clinical improvement, minimal complications, and durable estimated implant survivorship free of revision at ten years. UKA done for secondary osteonecrosis was substantially less durable at mid-term follow-up. Progression of knee degeneration, rather than implant failure or loosening, was most common indication for conversion to TKA. Cite this article: Bone Joint J 2018;100-B:450-4.
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Affiliation(s)
- B P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - K G Mehrotra
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - R J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - M W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - M J Taunton
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - M P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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Bhatnagar N, Sharma S, Gautam VK, Kumar A, Tiwari A. Characteristics, management, and outcomes of spontaneous osteonecrosis of the knee in Indian population. INTERNATIONAL ORTHOPAEDICS 2018; 42:1499-1508. [PMID: 29552689 DOI: 10.1007/s00264-018-3878-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Spontaneous osteonecrosis of the knee affects the medial femoral condyle in patients above 55 years of age. Many reports and studies are available from western countries. But there is a gross paucity of literature on spontaneous osteonecrosis of the knee (SPONK) in the Indian subcontinent, either it is under-reported or detected at a later stage. The aim of our study was to detect SPONK in Indian population and describe its characteristics, treatment, and outcome. MATERIAL AND METHOD A prospective study was conducted over a period of three years. All patients above 18 years with knee pain at rest and medial condyle tenderness without joint laxity were evaluated with plain radiographs and MRI. Further tests were done if radiological signs of osteonecrosis were present. Various parameters were recoded like Visual Analog Scale (VAS), Knee Society Score (KSS), and MRI Osteoarthritis Knee Score. Conservative treatment consisted of a combination of NSAIDs and bisphosphonates. Decompression with bone grafting was done if there was no improvement or deterioration at three month follow-up. RESULTS Ten patients were diagnosed with SPONK. The mean age was 50 years with male predominance (60%) with the involvement of medial femoral condyle (80%) or left knee (70%). Most cases were in Koshino stage 1. Mean VAS was 6.5 and mean KSS was 59. All clinical parameters showed improvement at one year. DISCUSSION A study with a bigger sample size and longer follow-up is needed to fill the lacunae of literature on this topic from the Indian subcontinent. In spite of the limitations, we did observe that in our population, males were more commonly affected than females, which is contrary to most studies on the subject. Also, the disease had an early age of onset (50 years) in Indian population as compared to Western and East Asian populations. CONCLUSION Combined therapy of NSAIDs and bisphosphonates shows excellent results over a period of one year. Joint-preserving surgeries are effective even in Koshino stage 3 SPONK.
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Affiliation(s)
- Nishit Bhatnagar
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, 2, Near Delhi Gate, Jawaharlal Nehru Marg, New Delhi, 110002, India
| | - Siddharth Sharma
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, 2, Near Delhi Gate, Jawaharlal Nehru Marg, New Delhi, 110002, India.
- , Ghaziabad, India.
| | - Virender Kumar Gautam
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, 2, Near Delhi Gate, Jawaharlal Nehru Marg, New Delhi, 110002, India
| | - Ajeet Kumar
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, 2, Near Delhi Gate, Jawaharlal Nehru Marg, New Delhi, 110002, India
| | - Anurag Tiwari
- Department of Orthopedics, All India Institute of Medical Sciences, Saket Nagar, Habib Ganj, Bhopal, Madhya Pradesh, 462026, India
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Tírico LEP, Early SA, McCauley JC, Bugbee WD. Fresh Osteochondral Allograft Transplantation for Spontaneous Osteonecrosis of the Knee: A Case Series. Orthop J Sports Med 2017; 5:2325967117730540. [PMID: 29051901 PMCID: PMC5637976 DOI: 10.1177/2325967117730540] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Spontaneous osteonecrosis of the knee (SONK) is a clinical entity identified by acute knee pain usually associated with joint effusion, with radiographic findings of a radiolucent defect on the weightbearing area of the femoral condyle. Conservative treatment is initially undertaken; however, surgical procedures are often necessary. Historically, surgical options have included core decompression, cartilage repair, high tibial osteotomy, or joint arthroplasty. Few studies in the literature have reported the use of fresh osteochondral allograft (OCA) for the treatment of SONK lesions. Hypothesis: OCA transplantation is an effective treatment for SONK lesions on the medial femoral condyle. Study Design: Case series; Level of evidence, 4. Methods: A case series was analyzed of 7 patients treated with OCA for large SONK lesions of the medial femoral condyle with a minimum 4-year follow-up. All patients experienced failure of at least 6 months of conservative treatment and declined arthroplasty as the form of definitive treatment for medial femoral condyle lesion. All patients underwent OCA of the medial femoral condyle. Mean lesion size was 4.6 cm2 (range, 3.24-6.25 cm2), with a mean condylar width of 41.7 mm (range, 35.4-48.6 mm), resulting in a median proportion (lesion size/condylar width) of 56.8% (range, 32.7%-62.6%). The median surface allograft area was 5.1 cm2 (range, 3.2-6.3 cm2). Results: The median follow-up was 7.1 years (range, 4.5-14.1 years). No patient had additional surgery following OCA transplant; the allograft failure rate was 0%. Subjective outcome scores from the International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, and modified Merle d’Aubigné-Postel scale improved from preoperative assessment to the latest follow-up. All patients were extremely satisfied with the results of the OCA transplant. Conclusion: Fresh OCA transplantation demonstrated excellent efficacy, durability, and satisfaction in this group of patients with isolated stage 2 and 3 SONK lesions who had experienced failure of conservative treatment. Fresh osteochondral allografts are an attractive method for surgical management of selected patients with spontaneous osteonecrosis of the knee.
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Affiliation(s)
- Luís E P Tírico
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - Samuel A Early
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA.,University of California San Diego Medical School, La Jolla, California, USA
| | - Julie C McCauley
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - William D Bugbee
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
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Jordan RW, Aparajit P, Docker C, Udeshi U, El-Shazly M. The importance of early diagnosis in spontaneous osteonecrosis of the knee - A case series with six year follow-up. Knee 2016; 23:702-7. [PMID: 27198760 DOI: 10.1016/j.knee.2016.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 03/17/2016] [Accepted: 04/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Spontaneous osteonecrosis of the knee has an unknown aetiology. Management options include conservative, surgical and pharmacological interventions. The aim of this study was to report the experience of the authors in conservative management of SONK using non-operative measures by analysing the functional outcome and need for surgical intervention. MATERIALS AND METHODS All patients treated for SONK between 1st August 2001 and 1st April 2014 were retrospectively reviewed. Treatment consisted of touch-down weight bearing for around six weeks. MR imaging was evaluated for size of lesion, the condyles involved and the time taken for resolution. Tegner Activity Scale, VAS pain, Lysholm, WOMAC and IKDC scores were recorded at presentation and final follow-up (mean six years, range six months to 13years). RESULTS Forty cases were included; the mean age of the group was 55.3years and 67.5% were male. The medial femoral condyle was the most commonly affected (52.5%). A statistically significant improvement was reported in all functional outcome measures (p<0.001). Only one patient required arthroscopic surgical intervention and no patients required arthroplasty during the follow-up period. CONCLUSION Early stage spontaneous osteonecrosis of the knee can be managed successfully without surgery if diagnosed early. Thus early investigation of acute knee pain with MRI scanning is recommended.
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Affiliation(s)
- Robert W Jordan
- University Hospitals Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Prasad Aparajit
- Aparajit Orthopaedic and Maternity Nursing Home, 22, Near State Bank Of India, West High Court Road, Surendranagar, Nagpur 440015, India.
| | - Charles Docker
- Worcester Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, United Kingdom.
| | - Umesh Udeshi
- Worcester Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, United Kingdom.
| | - Mohi El-Shazly
- Droitwich Knee Clinic, 27 New Road, Bromsgrove, Worcestershire B60 2JL, United Kingdom.
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