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Villari E, Digennaro V, Panciera A, Ferri R, Benvenuti L, Cesare F. Bone marrow edema of the knee: a narrative review. Arch Orthop Trauma Surg 2024; 144:2305-2316. [PMID: 38642163 PMCID: PMC11093815 DOI: 10.1007/s00402-024-05332-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
Bone marrow edema (BME) is a frequent MRI finding in patients with knee pain. According to the etiology, BME of the knee can be classified into three main categories: ischemic, mechanic, and reactive. The diagnosis may be difficult, because of the specificity of symptoms and the poor radiographic findings. MRI is the gold standard, showing an area of altered signal of the bone with an high signal intensity on fat-suppressed, T2 weighted images, usually in combination with an intermediate or low signal intensity on T1 weighted images. Bone marrow edema tends to be self-limiting and, in most cases, resolves without any consequences in a varying amount of time. However, since it may evolve to complete joint destruction, early diagnosis and correct treatment are crucial to prevent the articular degeneration. Conservative therapy is the first step, with no weight-bearing for 3 to 6 weeks on the affected side, in combination with the administration of anti-inflammatory drugs or painkillers to manage symptoms. In non-responding forms and more advanced stages, minimally invasive preservative surgery can provide significant results, with subchondroplasty and core decompression being the two main procedures available. Knee arthroplasty, both total (TKA) or unicompartmental (UKA), is the only effective option when the degradation of cartilage is diffuse and in patients with subchondral bone collapse.
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Affiliation(s)
- Eleonora Villari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, Bologna, 40136, Italy.
| | - Vitoantonio Digennaro
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, Bologna, 40136, Italy
| | - Alessandro Panciera
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, Bologna, 40136, Italy
| | - Riccardo Ferri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, Bologna, 40136, Italy
| | - Lorenzo Benvenuti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, Bologna, 40136, Italy
| | - Faldini Cesare
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, Bologna, 40136, Italy
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Konarski W, Poboży T, Konarska K, Śliwczyński A, Kotela I, Krakowiak J. A Comparative Analysis of Osteochondritis Dissecans and Avascular Necrosis: A Comprehensive Review. J Clin Med 2024; 13:287. [PMID: 38202294 PMCID: PMC10780049 DOI: 10.3390/jcm13010287] [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: 11/17/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
Musculoskeletal disorders, standing as the fifth leading cause of disability-adjusted life years globally, present significant challenges in orthopedics. Osteochondritis dissecans (OCD) and avascular necrosis (AVN) are distinct but closely related conditions within this spectrum, impacting patients' quality of life with pain, limited mobility, and dysfunction. OCD, involving cartilage and bone detachment in joints, predominantly affects young athletes, but its exact etiology and optimal management remain subjects of ongoing research. Conversely, AVN, marked by bone tissue death due to compromised blood supply, is linked to systemic factors like corticosteroid use and traumatic injuries. Diagnosis for both conditions relies on radiography and magnetic resonance imaging. Conservative treatment for AVN includes the use of a cane or crutches, pharmacological therapy, or physical therapy. On the other hand, in OCD, the primary approach is activity/sports restriction. Surgical treatment options for AVN patients encompass core decompression, bone grafting, or, in the most advanced cases, total hip arthroplasty. OCD may be surgically treated through subchondral drilling or fixation of unstable lesions. Advanced cases of OCD involve cartilage salvage with resurfacing techniques. The presentation of differences between these conditions enhances our understanding, facilitating improved diagnosis and management strategies.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
| | - Tomasz Poboży
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
| | - Klaudia Konarska
- Medical Rehabilitation Center, Sobieskiego 47D, 05-120 Legionowo, Poland;
| | - Andrzej Śliwczyński
- Social Medicine Institute, Department of Social and Preventive Medicine, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
| | - Ireneusz Kotela
- Department of Orthopedic Surgery and Traumatology, Central Research Hospital of Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland;
| | - Jan Krakowiak
- Social Medicine Institute, Department of Social and Preventive Medicine, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
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Moretti L, Bizzoca D, Geronimo A, Abbaticchio AM, Moretti FL, Carlet A, Fischetti F, Moretti B. Targeting Adenosine Signalling in Knee Chondropathy: The Combined Action of Polydeoxyribonucleotide and Pulsed Electromagnetic Fields: A Current Concept Review. Int J Mol Sci 2023; 24:10090. [PMID: 37373237 PMCID: PMC10298276 DOI: 10.3390/ijms241210090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Chondropathy of the knee is one of the most frequent degenerative cartilage pathologies with advancing age. Scientific research has, in recent years, advanced new therapies that target adenosine A2 receptors, which play a significant role in human health against many disease states by activating different protective effects against cell sufferance and damage. Among these, it has been observed that intra-articular injections of polydeoxyribonucleotides (PDRN) and Pulsed Electromagnetic Fields (PEMF) can stimulate the adenosine signal, with significant regenerative and healing effects. This review aims to depict the role and therapeutic modulation of A2A receptors in knee chondropathy. Sixty articles aimed at providing data for our study were included in this review. The present paper highlights how intra-articular injections of PDRN create beneficial effects by reducing pain and improving functional clinical scores, thanks to their anti-inflammatory action and the important healing and regenerating power of the stimulation of cell growth, production of collagen, and the extracellular matrix. PEMF therapy is a valid option in the conservative treatment of different articular pathologies, including early OA, patellofemoral pain syndrome, spontaneous osteonecrosis of the knee (SONK), and in athletes. PEMF could also be used as a supporting therapy after an arthroscopic knee procedure total knee arthroplasty to reduce the post-operative inflammatory state. The proposal of new therapeutic approaches capable of targeting the adenosine signal, such as the intra-articular injection of PDRN and the use of PEMF, has shown excellent beneficial results compared to conventional treatments. These are presented as an extra weapon in the fight against knee chondropathy.
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Affiliation(s)
- Lorenzo Moretti
- Orthopaedics Unit—UOSD Vertebral Surgery, AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Davide Bizzoca
- Orthopaedics Unit—UOSD Vertebral Surgery, AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy;
- Ph.D. Course in Public Health, Clinical Medicine and Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Alessandro Geronimo
- Orthopaedics Unit, DiBraiN, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | | | - Francesco Luca Moretti
- National Centre for Chemicals, Cosmetic Products and Consumer Protection, National Institute of Health, 00161 Rome, Italy
| | - Arianna Carlet
- Orthopaedics Unit, DiBraiN, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Francesco Fischetti
- Departement DiBraiN, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Biagio Moretti
- Orthopaedics Unit, DiBraiN, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Serrano DV, Saseendar S, Shanmugasundaram S, Bidwai R, Gómez D, D’Ambrosi R. Spontaneous Osteonecrosis of the Knee: State of the Art. J Clin Med 2022; 11:jcm11236943. [PMID: 36498517 PMCID: PMC9737125 DOI: 10.3390/jcm11236943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
Osteonecrosis is a terrible condition that can cause advanced arthritis in a number of joints, including the knee. The three types of osteonecrosis that can affect the knee are secondary, post-arthroscopic, and spontaneous osteonecrosis of the knee (SPONK). Regardless of osteonecrosis classification, treatment for this condition seeks to prevent further development or postpone the onset of knee end-stage arthritis. Joint arthroplasty is the best course of action whenever there is significant joint surface collapse or there are signs of degenerative arthritis. The non-operative options for treatment at the moment include observation, nonsteroidal anti-inflammatory medications (NSAIDs), protective weight bearing, and analgesia if needed. Depending on the severity and type of the condition, operational procedures may include unilateral knee arthroplasty (UKA), total knee arthroplasty (TKA), or joint preservation surgery. Joint preservation techniques, such as arthroscopy, core decompression, osteochondral autograft, and bone grafting, are frequently used in precollapse and some postcollapse lesions, when the articular cartilage is typically unaffected and only the underlying subchondral bone is affected. In contrast, operations that try to save the joint following significant subchondral collapse are rarely successful and joint replacement is required to ease discomfort. This article's goal is to summarise the most recent research on evaluations, clinical examinations, imaging and various therapeutic strategies for osteonecrosis of the knee, including lesion surveillance, medicines, joint preservation methods, and total joint arthroplasty.
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Affiliation(s)
| | | | | | - Rohan Bidwai
- Senior Clinical Fellow, York Teaching Hospital NHS Foundation Trust, York YO31 8HE, UK
| | - Diego Gómez
- Hospital Britanico of Buenos Aires, Buenos Aires C1280 AEB, Argentina
| | - Riccardo D’Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milan, Italy
- Correspondence:
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De Berardinis L, Qordja F, Farinelli L, Faragalli A, Gesuita R, Gigante AP. Is Primary Bone Marrow Edema of the Knee Associated with Thyroid Disorders? A Retrospective Clinical Study. J Clin Med 2022; 11:jcm11195973. [PMID: 36233839 PMCID: PMC9570638 DOI: 10.3390/jcm11195973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 11/29/2022] Open
Abstract
Primary bone marrow edema (BME) of the knee is still an elusive condition. This retrospective study was undertaken to gain insight into its characteristic features. The records of 48 patients with primary BME of the knee diagnosed by magnetic resonance imaging were reviewed. Demographic data, medical history, current medications, pain type, smoking and drinking habits, allergies, occupation, sports practiced, environmental factors, and life events predating symptom onset were examined. Data analysis demonstrated that 56.3% of patients had experienced a stressful event before BME pain onset and that 50% suffered from thyroid disorders. Standard conservative treatment resulted in pain resolution irrespective of the use of anti-inflammatories. However, most patients reported new persistent symptoms: dysesthesia/hypoesthesia on palpation in the skin area overlying the previous edema and a reduced ipsilateral patellar reflex. To our knowledge, this is the first study characterizing a substantial cohort of patients with BME. We found that middle-aged, sedentary, and slightly overweight women smokers are the typical patients with primary BME of the knee. The appearance and persistence of cutaneous dysesthesia/hypoesthesia at the site of the earlier lesion and ipsilateral patellar hyporeflexia implicate an autonomous nervous system dysfunction in BME pathogenesis and warrant further investigation.
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Affiliation(s)
- Luca De Berardinis
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy
| | - Fjorela Qordja
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy
| | - Andrea Faragalli
- Centre of Epidemiology, Biostatistics and Medical Information Technology, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy
| | - Rosaria Gesuita
- Centre of Epidemiology, Biostatistics and Medical Information Technology, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy
| | - Antonio Pompilio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-071-596-3080
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Zmerly H, Moscato M, Akkawi I, Galletti R, Di Gregori V. Treatment options for secondary osteonecrosis of the knee. Orthop Rev (Pavia) 2022; 14:33639. [PMID: 35775038 PMCID: PMC9239350 DOI: 10.52965/001c.33639] [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: 08/23/2021] [Accepted: 02/20/2022] [Indexed: 08/30/2023] Open
Abstract
Knee osteonecrosis is a debilitating progressive degenerative disease characterized by subchondral bone ischemia. It can lead to localized necrosis, tissue death, and progressive joint destruction. For this reason, it is essential to diagnose and treat this disease early to avoid subchondral collapse, chondral damage, and end-stage osteoarthritis, where the only solution is total knee arthroplasty. Three types of knee osteonecrosis have been documented in the literature: spontaneous or primitive, secondary, and post arthroscopy. Spontaneous osteonecrosis is the most common type studied in the literature. Secondary osteonecrosis of the knee is a rare disease and, unlike the spontaneous one, involves patients younger than 50 years. It presents a particular set of pathological, clinical, imaging, and progression features. The management of secondary osteonecrosis is determined by the stage of the disorder, the clinical manifestation, the size and location of the lesions, whether the involvement is unilateral or bilateral, the patient's age, level of activity, general health, and life expectancy. This review aims to present the recent evidence on treatment options for secondary osteonecrosis of the knee, including conservative treatment, joint preserving surgery, and knee replacement.
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Affiliation(s)
- Hassan Zmerly
- San Pier Damiano Hospital, GVM, Faenza (RA), Italy; Villa Erbosa Hospital, Bologna, Italy
| | | | | | | | - Valentina Di Gregori
- Medical direction, San Pier Damiano Hospiatl, GVM care and research, Faenza (RA), Italy
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Moretti L, Bizzoca D, Giancaspro GA, Cassano GD, Moretti F, Setti S, Moretti B. Biophysical Stimulation in Athletes' Joint Degeneration: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111206. [PMID: 34833424 PMCID: PMC8619315 DOI: 10.3390/medicina57111206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/18/2022]
Abstract
Osteoarthritis (OA) is the most prevalent degenerative joint disease and the main cause of pain and disability in elderly people. OA currently represents a significant social health problem, since it affects 250 million individuals worldwide, mainly adults aged over 65. Although OA is a multifactorial disease, depending on both genetic and environmental factors, it is reported that joint degeneration has a higher prevalence in former athletes. Repetitive impact and loading, joint overuse and recurrent injuries followed by a rapid return to the sport might explain athletes' predisposition to joint articular degeneration. In recent years, however, big efforts have been made to improve the prevention and management of sports injuries and to speed up the athletes' return-to-sport. Biophysics is the study of biological processes and systems using physics-based methods or based on physical principles. Clinical biophysics has recently evolved as a medical branch that investigates the relationship between the human body and non-ionizing physical energy. A physical stimulus triggers a biological response by regulating specific intracellular pathways, thus acting as a drug. Preclinical and clinical trials have shown positive effects of biophysical stimulation on articular cartilage, subchondral bone and synovia. This review aims to assess the role of pulsed electromagnetic fields (PEMFs) and extracorporeal shockwave therapy (ESWT) in the prevention and treatment of joint degeneration in athletes.
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Affiliation(s)
- Lorenzo Moretti
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy; (L.M.); (G.A.G.); (G.D.C.); (B.M.)
| | - Davide Bizzoca
- PhD. Course in Public Health, Clinical Medicine and Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence:
| | - Giovanni Angelo Giancaspro
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy; (L.M.); (G.A.G.); (G.D.C.); (B.M.)
| | - Giuseppe Danilo Cassano
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy; (L.M.); (G.A.G.); (G.D.C.); (B.M.)
| | - Francesco Moretti
- National Center for Chemicals, Cosmetic Products and Consumer Protection, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy;
| | - Stefania Setti
- IGEA Spa-Clinical Biophysics, via Parmenide, 10/A, 41012 Carpi (Mo), Italy;
| | - Biagio Moretti
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy; (L.M.); (G.A.G.); (G.D.C.); (B.M.)
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Pasqualotto S, Sgroi AV, Causero A, Di Benedetto P, Zorzi C. Subchondroplasty in the Treatment of Bone Marrow Lesions of the Knee: Preliminary Experience on First 15 Patients. JOINTS 2021; 7:174-181. [PMID: 34235382 PMCID: PMC8253614 DOI: 10.1055/s-0041-1730984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/19/2021] [Indexed: 12/19/2022]
Abstract
Purpose The aim of this prospective study was to assess the effectiveness in terms of pain relief and functional improvement of the Subchondroplasty procedure in the treatment of osteoarthritis-related bone marrow lesions (BMLs) of the knee. Methods The study included first 15 consecutive patients undergone to Subchondroplasty procedure for the treatment of chronic degenerative BMLs in which previous conservative treatment have failed. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Knee Injury and Osteoarthritis Outcome Scores (KOOS), and visual analog scale (VAS) pain scores were obtained preoperatively and at 1, 6, and 12 months of follow-up. Results WOMAC scores significantly improved from 39.7 ± 20.2 before surgery to 26.8 ± 16.1 at the 1-month follow-up ( p = 0.045). A further significant improvement to 15.5 ± 12.7 ( p = 0.02) and to 8.6 ± 3.1 ( p < 0.01) was obtained both at 6-month and at 1-year follow-up. KOOS scores improved significantly from 47.5 ± 16.6 before surgery to 65.4 ± 14.9 at 1 month ( p = 0.013) and to 80.4 ± 15.1 at 6-month follow-up ( p = 0.01). A further improvement to 85.6 ± 15.1 was recorded 1 year postoperatively, although nonsignificant. VAS score showed a significant improvement from 55.8 ± 20.5 preoperatively to 36.2 ± 16.9 at 1 month ( p = 0.008) and to 18.2 ± 17.3 at 6-month follow-up ( p = 0.005). This further improved to 12.8 ± 17.9 at 1-year follow-up, although not significantly. Conclusion Subchondroplasty procedure represents a safe and valid surgical option in the treatment of osteoarthritis-related BMLs of the knee, providing an improvement in terms of pain relief and functional recovery. Longer studies are required to evaluate how long these improvements may last. Level of Evidence Therapeutic case-series, Level IV study.
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Affiliation(s)
- Stefano Pasqualotto
- Divisione di Ortopedia e Traumatologia, IRCCS Ospedale Classificato Equiparato Sacro Cuore - Don Calabria, Negrar (Verona), Italy
| | - Andrea Vincenzo Sgroi
- Divisione di Ortopedia e Traumatologia, IRCCS Ospedale Classificato Equiparato Sacro Cuore - Don Calabria, Negrar (Verona), Italy
| | - Araldo Causero
- DAME Università degli studi di Udine, Clinica Ortopedica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Paolo Di Benedetto
- DAME Università degli studi di Udine, Clinica Ortopedica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Claudio Zorzi
- Divisione di Ortopedia e Traumatologia, IRCCS Ospedale Classificato Equiparato Sacro Cuore - Don Calabria, Negrar (Verona), Italy
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Hu H, Yang W, Zeng Q, Chen W, Zhu Y, Liu W, Wang S, Wang B, Shao Z, Zhang Y. Promising application of Pulsed Electromagnetic Fields (PEMFs) in musculoskeletal disorders. Biomed Pharmacother 2020; 131:110767. [PMID: 33152929 DOI: 10.1016/j.biopha.2020.110767] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/06/2020] [Accepted: 09/17/2020] [Indexed: 12/13/2022] Open
Abstract
Increasing evidence suggests that an exogenous electromagnetic field might be involved in many biologic processes which are of great importance for therapeutic interventions. Pulsed electromagnetic fields (PEMFs) are known to be a noninvasive, safe and effective therapy agent without apparent side effects. Numerous studies have shown that PEMFs possess the potential to become a stand-alone or adjunctive treatment modality for treating musculoskeletal disorders. However, several issues remain unresolved. Prior to their widely clinical application, further researches from well-designed, high-quality studies are still required to standardize the treatment parameters and derive the optimal protocol for health-care decision making. In this review, we aim to provide current evidence on the mechanism of action, clinical applications, and controversies of PEMFs in musculoskeletal disorders.
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Affiliation(s)
- Hongzhi Hu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
| | - Wenbo Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Qianwen Zeng
- Department of Pediatrics, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - YanBin Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Weijian Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shangyu Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Baichuan Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Yingze Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
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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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Tsintzas D, Mahesh S, Vithoulkas G. Individualized Treatment of Bone Marrow Edema of the Knee With the Aid of Classical Homeopathy: A Report of 2 Cases. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2020; 13:1179547620904896. [PMID: 32110129 PMCID: PMC7016301 DOI: 10.1177/1179547620904896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 12/05/2022]
Abstract
BACKGROUND Bone marrow edema lesions around the knee are a common magnetic resonance image finding. They constitute a central component of a wide variety of inflammatory and noninflammatory conditions affecting the knee joint. Those lesions are not only a significant source of pain, but are also connected to many musculoskeletal pathologies. CASE REPORT We describe 2 cases of bone marrow edema of the knee joint treated with the aid of Classical Homeopathy. In both of the cases, Arnica montana was the chosen homeopathic remedy. CONCLUSIONS The results of the treatment are promising, encouraging for more research on this area.
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Affiliation(s)
- Dionysis Tsintzas
- Amfilochia Rehabilitation Center, General Hospital of Aitoloakarnania, Agrinion, Greece
| | - Seema Mahesh
- Centre for Classical Homeopathy, Bangalore, India
| | - George Vithoulkas
- University of the Aegean, Lesbos, Greece
- International Academy of Classical Homeopathy Alonissos, Northern Sporades, Greece
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Konchugova TV, Kulchitskaya DB, Ivanov AV. [Efficiency of magnetic therapy techniques in the treatment and rehabilitation of patients with joint diseases from the standpoint of evidence-based medicine]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2019; 96:63-68. [PMID: 31513170 DOI: 10.17116/kurort20199604163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article provides information on currently proven effective treatment methods for patients with joint diseases, by using magnetic fields with various physical characteristics. A wide range of biotropic parameters allows obtaining various primary physicochemical changes in biological tissues, which was a rationale for including magnetic therapy (MT) in the combination treatment of degenerative-dystrophic and inflammatory diseases. Analysis of scientific publications suggests that there are a large number of randomized, placebo-controlled studies providing evidence for reduced pain, improved joint functional activity and quality of life in patients with knee osteoarthritis under magnetic fields with varying inductions, frequencies, and exposures. There are few randomized clinical trials identifying the efficiency of MT for a number of other joint diseases and after arthroplasty. Despite the fact that there are differences in methodological approaches, it is possible to draw a general conclusion on the scientific validity of using MT in the complex treatment and rehabilitation programs for patients with joint diseases and on the prospects of further developments in this area.
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Affiliation(s)
- T V Konchugova
- National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - D B Kulchitskaya
- National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia, Moscow, Russia
| | - A V Ivanov
- AO Elatma Instrumental-Making Plant, Elatma, Kasimov District, Ryazan Region, Russia
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Abstract
OBJECTIVE. The purpose of this article is to summarize the nomenclature of nonneoplastic conditions affecting subchondral bone through a review of the medical literature and expert opinion of the Society of Skeletal Radiology Subchondral Bone Nomenclature Committee. CONCLUSION. This consensus statement summarizes current understanding of the pathophysiologic characteristics and imaging findings of subchondral nonneoplastic bone lesions and proposes nomenclature to improve effective communication across clinical specialties and help avoid diagnostic errors that could affect patient care.
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Yang WM, Zhao CQ, Lu ZY, Yang WY, Lin DK, Cao XW. Clinical Characteristics and Treatment of Spontaneous Osteonecrosis of Medial Tibial Plateau: A Retrospective Case Study. Chin Med J (Engl) 2019; 131:2544-2550. [PMID: 30381587 PMCID: PMC6213846 DOI: 10.4103/0366-6999.244113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: In a small proportion of cases, spontaneous osteonecrosis of the knee (SONK) involves the medial tibial plateau (MT). Here, we introduced the clinical characteristics of spontaneous osteonecrosis of the MT and unicompartmental knee arthroplasty (UKA) as the favorable treatment for this situation based on a retrospective case study. Methods: Patients with spontaneous osteonecrosis of the MT, confirmed by magnetic resonance imaging (MRI) at Guangdong Provincial Hospital of Chinese Medicine (China) from March 2015 to June 2016, were included as a case serial and analyzed retrospectively. All patients underwent Oxford Medial UKA. The characteristics of their lesions, corresponding treatment, and results of follow-up were presented. The lesion scores and grade were determined according to the criteria of Ficat and Arlet. Results: In total, 22 patients (5 men, 17 women; mean age, 64.1 years) with spontaneous osteonecrosis of the MT were analyzed. The lesion stages assessment showed that 3 (14%) were Stage II, 10 (45%) were Stage III, 7 (32%) were Stage IV, and 2 (9%) were Stage V. In the sagittal plane, 7 (32%) were in the anterior region (MTa) and 15 (68%) were central (MTc). The lesion volume averaged 2.24 ± 0.79 cm3 (range: 1.57–3.08 cm3). Seventeen patients (77%) had Level III posterior medial meniscus root tears (MMRTs). All the patients underwent UKA. Average follow-up was 30.0 ± 6.4 months with a range of 23.0–38.0 months. The visual analog scale score was 7.78 ± 0.67 before surgery while decreased to 2.22 ± 1.09 at the final follow-up (P < 0.001). The Hospital for Special Surgery scores of pre-/post-surgery were 65.67 ± 5.45 and 84.10 ± 4.20, respectively (P < 0.001). Conclusions: SONK often occurs in the anterior and central tibial plateau due to abnormal stresses. Most of the patients had Level III posterior medial meniscus root tears. MRI is recommended for suspected cases to identify SONK at an early stage. The use of the Oxford Medial UKA for SONK of the MT is reliable both immediately and at follow-up.
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Affiliation(s)
- Wei-Ming Yang
- Department of Orthopaedics, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Cai-Qiong Zhao
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Zhao-Yu Lu
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Wei-Yi Yang
- Department of Orthopaedics, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Ding-Kun Lin
- Department of Orthopaedics, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Xue-Wei Cao
- Department of Orthopaedics, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
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Massari L, Benazzo F, Falez F, Perugia D, Pietrogrande L, Setti S, Osti R, Vaienti E, Ruosi C, Cadossi R. Biophysical stimulation of bone and cartilage: state of the art and future perspectives. INTERNATIONAL ORTHOPAEDICS 2019; 43:539-551. [PMID: 30645684 PMCID: PMC6399199 DOI: 10.1007/s00264-018-4274-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/03/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Biophysical stimulation is a non-invasive therapy used in orthopaedic practice to increase and enhance reparative and anabolic activities of tissue. METHODS A sistematic web-based search for papers was conducted using the following titles: (1) pulsed electromagnetic field (PEMF), capacitively coupled electrical field (CCEF), low intensity pulsed ultrasound system (LIPUS) and biophysical stimulation; (2) bone cells, bone tissue, fracture, non-union, prosthesis and vertebral fracture; and (3) chondrocyte, synoviocytes, joint chondroprotection, arthroscopy and knee arthroplasty. RESULTS Pre-clinical studies have shown that the site of interaction of biophysical stimuli is the cell membrane. Its effect on bone tissue is to increase proliferation, synthesis and release of growth factors. On articular cells, it creates a strong A2A and A3 adenosine-agonist effect inducing an anti-inflammatory and chondroprotective result. In treated animals, it has been shown that the mineralisation rate of newly formed bone is almost doubled, the progression of the osteoarthritic cartilage degeneration is inhibited and quality of cartilage is preserved. Biophysical stimulation has been used in the clinical setting to promote the healing of fractures and non-unions. It has been successfully used on joint pathologies for its beneficial effect on improving function in early OA and after knee surgery to limit the inflammation of periarticular tissues. DISCUSSION The pooled result of the studies in this review revealed the efficacy of biophysical stimulation for bone healing and joint chondroprotection based on proven methodological quality. CONCLUSION The orthopaedic community has played a central role in the development and understanding of the importance of the physical stimuli. Biophysical stimulation requires care and precision in use if it is to ensure the success expected of it by physicians and patients.
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Affiliation(s)
- Leo Massari
- University of Ferrara, Via Vigne 4, 44121, Ferrara, Italy.
| | - Franco Benazzo
- IRCCS Foundation "San Matteo" Hospital, University of Pavia, 27100, Pavia, Italy
| | | | | | | | | | | | | | - Carlo Ruosi
- Federico II University Naples, 80100, Naples, Italy
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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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Di Caprio F, Meringolo R, Navarra MA, Mosca M, Ponziani L. Postarthroscopy Osteonecrosis of the Knee: Current Concepts. JOINTS 2017; 5:229-236. [PMID: 29270561 PMCID: PMC5738467 DOI: 10.1055/s-0037-1608666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Knee osteonecrosis is a severe disease rapidly leading to end-stage osteoarthritis, which was classified into three categories: spontaneous, secondary, and postarthroscopy. To understand postarthroscopy osteonecrosis of the knee, all the three types of knee osteonecrosis have to be deepened. This article reviewed spontaneous and secondary osteonecroses of the knee, with special focus upon postarthroscopy osteonecrosis, which is a rare form, affecting patients operated for arthroscopic knee surgery, most commonly for meniscectomy. Due to its rarity, patients and surgeons are often unprepared for this complication. A correct diagnosis is essential for appropriate treatment, and also to determine if a preexisting osteonecrosis was present, avoiding medicolegal sequelae, although many authors agree that osteonecrosis (both spontaneous and postarthroscopy) represent unpreventable and unpredictable conditions. In spontaneous osteonecrosis, the treatment is defined according to the size and the degree of the lesion, whereas in postarthroscopy osteonecrosis, the size of the lesion has no prognostic value, and therefore, the choice of the correct treatment is based more on the timing of the diagnosis. A diagnostic and therapeutic algorithm was outlined on the basis of the actual knowledge.
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Affiliation(s)
- Francesco Di Caprio
- Operating Unit of Orthopedics and Traumatology, AUSL of Romagna, Ceccarini Hospital, Riccione, Italy
| | - Renato Meringolo
- Operating Unit of Orthopedics and Traumatology, AUSL of Romagna, Ceccarini Hospital, Riccione, Italy
| | - Maria Adiletta Navarra
- Operating Unit of Orthopedics and Traumatology, AUSL of Romagna, Ceccarini Hospital, Riccione, Italy
| | - Massimiliano Mosca
- Second Orthopedics and Traumatology Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Lorenzo Ponziani
- Operating Unit of Orthopedics and Traumatology, AUSL of Romagna, Ceccarini Hospital, Riccione, Italy
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Predictive factors for the progression of spontaneous osteonecrosis of the knee. Knee Surg Sports Traumatol Arthrosc 2017; 25:477-484. [PMID: 26572631 DOI: 10.1007/s00167-015-3839-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess potentially predictive factors that were evaluated 1 year after the onset of symptoms in patients with spontaneous osteonecrosis of the knee (SONK) and to determine receiver operating characteristic (ROC) curve cut-off values. METHODS Within 1 year of symptom onset, patients with SONK-selected treatment options, mainly based on severity of pain, chose either conservative treatment (n = 27 knees) or operative treatment (n = 27 knees). Knee and whole-leg radiographs, knee MRIs and bone mineral density scans of the lumbar spine, femoral neck and femoral condyles were obtained. The parameters measured were: (1) anatomical angle on whole-leg radiograph and (2) lesion size and medial meniscus extrusion on MRI. RESULTS The anatomical angle and lesion size in the sagittal section (depth) on MRI were markedly larger in the operative treatment group than those in the conservative treatment group. The anatomical angle and depth on MRI of SONK at Stages 1-3 were significantly different between groups, with odds ratios (95 % confidence intervals) of 1.16 (1.18-2.34) and 1.11 (1.01-1.23). One year after symptom onset, ROC curve cut-off value for anatomical angle was 180° and depth on MRI was 20 mm. CONCLUSION An anatomical angle >180° and depth >20 mm on MRI were predictive factors for a poorer prognosis 1 year after symptom onset in patients with SONK. Our results on radiographs and MRI provided a predictive prognosis for patients with SONK at the initial visit to their orthopaedic surgeons. LEVEL OF EVIDENCE III.
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Berruto M, Ferrua P, Uboldi F, Pasqualotto S, Ferrara F, Carimati G, Usellini E, Delcogliano M. Can a biomimetic osteochondral scaffold be a reliable alternative to prosthetic surgery in treating late-stage SPONK? Knee 2016; 23:936-941. [PMID: 27592357 DOI: 10.1016/j.knee.2016.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to assess the reliability of the Maioregen® biomimetic osteochondral scaffold (Finceramica Faenza SpA, Faenza, Italy) as a salvage and joint-preserving procedure in the treatment of late-stage osteonecrosis of the knee. METHODS Eleven active patients aged under 65years and presenting with clinical and radiological signs of SPONK were treated with Maioregen®. All were clinically evaluated pre-operatively and yearly thereafter for a minimum of two years. Subjective IKDC and Lysholm Knee Scale scores were used to assess clinical outcome. A VAS scale served to quantify pre-operative pain and post-operative pain. Activity levels were evaluated pre-operatively and at follow-up using the Tegner Activity Scale. RESULTS Subjective IKDC (40±15.0 to 65.7±14.8 (mean±SD)) and Lysholm Knee Scale (49.7±17.9 to 86.6±12.7 (mean±SD)) scores improved significantly from pre-operative evaluation (p<.01). VAS scores decreased from a pre-operative mean (±SD) of 6.3±2.5 to 1.6±2.7 at two years. The Tegner Activity Scale showed no significant differences between pre-injury and two-year follow-up. Two out of the 11 patients were symptomatic at 18months post implant and progressed to condylar collapse. These patients required total knee arthroplasty. CONCLUSIONS Use of a biomimetic scaffold can be a valid option in the surgical treatment of SPONK in relatively young active patients. Indeed, this surgical technique, originally developed for osteochondritis dissecans, has been found to give good clinical results at medium-term follow-up of late-stage osteonecrosis treatment and could postpone or even avoid the need for joint replacement procedures.
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Affiliation(s)
- M Berruto
- SSD Chirurgia Articolare del Ginocchio Istituto Ortopedico Gaetano Pini, Milan, Italy.
| | - P Ferrua
- SSD Chirurgia Articolare del Ginocchio Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - F Uboldi
- SSD Chirurgia Articolare del Ginocchio Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - S Pasqualotto
- SSD Chirurgia Articolare del Ginocchio Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - F Ferrara
- SSD Chirurgia Articolare del Ginocchio Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - G Carimati
- SSD Chirurgia Articolare del Ginocchio Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - E Usellini
- SSD Chirurgia Articolare del Ginocchio Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - M Delcogliano
- Ospedale Regionale di Lugano, Civico e Italiano, Reparto di Ortopedia e Traumatologia, Lugano, Switzerland
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Martinelli N, Bianchi A, Sartorelli E, Dondi A, Bonifacini C, Malerba F. Treatment of bone marrow edema of the talus with pulsed electromagnetic fields: outcomes in six patients. J Am Podiatr Med Assoc 2016; 105:27-32. [PMID: 25675223 DOI: 10.7547/8750-7315-105.1.27] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Bone marrow edema (BME) of the talus is a rare, mostly self-limiting cause of foot and ankle pain. We sought to investigate in patients with idiopathic BME of the talus the effectiveness of pulsed electromagnetic fields and to determine the effect of this therapy on magnetic resonance imaging findings. METHODS Six patients with BME of the talus confirmed by magnetic resonance imaging were enrolled. Pain was quantified with a visual analog scale from 0 (no pain) to 10 (the worst pain imaginable). The clinical outcome was assessed using the American Orthopaedic Foot and Ankle Society scoring system. Treatment consisted of pulsed electromagnetic field stimulation 8 h/d for 30 days. The device used generated pulses 1.3 milliseconds in duration, with a frequency of 75 Hz and a mean ± SD induced electric field of 3.5 ± 0.5 mV. RESULTS The mean American Orthopaedic Foot and Ankle Society score improved from 59.4 (range, 40-66) before treatment to 94 (range, 80-100) at the last follow-up. The visual analog scale score decreased significantly from 5.6 (range, 4-7) before treatment to 1 (range, 0-2) at the last follow-up. Magnetic resonance imaging showed that BME improved after 1 month of treatment and resolved completely within 3 months in 5 patients, with normal signal intensity and no signs of progression to avascular necrosis. CONCLUSIONS A significant reduction in BME area was associated with a significant decrease in pain within 3 months of beginning treatment.
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Affiliation(s)
- Nicolò Martinelli
- Department of Ankle and Foot Surgery, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Galeazzi, Milan, Italy
| | - Alberto Bianchi
- Department of Ankle and Foot Surgery, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Galeazzi, Milan, Italy
| | - Elena Sartorelli
- Department of Ankle and Foot Surgery, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Galeazzi, Milan, Italy
| | - Alessandra Dondi
- Department of Ankle and Foot Surgery, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Galeazzi, Milan, Italy
| | - Carlo Bonifacini
- Department of Ankle and Foot Surgery, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Galeazzi, Milan, Italy
| | - Francesco Malerba
- Department of Ankle and Foot Surgery, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Galeazzi, Milan, Italy
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Kon E, Ronga M, Filardo G, Farr J, Madry H, Milano G, Andriolo L, Shabshin N. Bone marrow lesions and subchondral bone pathology of the knee. Knee Surg Sports Traumatol Arthrosc 2016; 24:1797-814. [PMID: 27075892 DOI: 10.1007/s00167-016-4113-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/25/2016] [Indexed: 01/03/2023]
Abstract
Bone marrow lesions (BMLs) around the knee are a common magnetic resonance imaging (MRI) finding. However, despite the growing interest on BMLs in multiple pathological conditions, they remain controversial not only for the still unknown role in the etiopathological processes, but also in terms of clinical impact and treatment. The differential diagnosis includes a wide range of conditions: traumatic contusion and fractures, cyst formation and erosions, hematopoietic and infiltrated marrow, developmental chondroses, disuse and overuse, transient bone marrow oedema syndrome and, lastly, subchondral insufficiency fractures and true osteonecrosis. Regardless the heterogeneous spectrum of these pathologies, a key factor for patient management is the distinction between reversible and irreversible conditions. To this regard, MRI plays a major role, leading to the correct diagnosis based on recognizable typical patterns that have to be considered together with coexistent abnormalities, age, and clinical history. Several treatment options have been proposed, from conservative to surgical approaches. In this manuscript the main lesion patterns and their management have been analysed to provide the most updated evidence for the differential diagnosis and the most effective treatment.
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Affiliation(s)
- Elizaveta Kon
- Biomechanics and Technology Innovation Laboratory, II Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy. .,Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - Mario Ronga
- Orthopaedics and Traumatology - Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Giuseppe Filardo
- Biomechanics and Technology Innovation Laboratory, II Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Jack Farr
- OrthoIndy Cartilage Restoration Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Henning Madry
- Department of Orthopaedic Surgery, Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Giuseppe Milano
- Department of Orthopaedics, Catholic University, A. Gemelli University Hospital, Rome, Italy
| | - Luca Andriolo
- Biomechanics and Technology Innovation Laboratory, II Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Nogah Shabshin
- Department of Radiology, Hospital of University of Pennsylvania, Philadelphia, PA, USA.,Department of Radiology, HaEmek University Medical Center, Afula, Israel
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de Girolamo L, Viganò M, Galliera E, Stanco D, Setti S, Marazzi MG, Thiebat G, Corsi Romanelli MM, Sansone V. In vitro functional response of human tendon cells to different dosages of low-frequency pulsed electromagnetic field. Knee Surg Sports Traumatol Arthrosc 2015; 23:3443-53. [PMID: 24957914 DOI: 10.1007/s00167-014-3143-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 06/12/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Chronic tendinopathy is a degenerative process causing pain and disability. Current treatments include biophysical therapies, such as pulsed electromagnetic fields (PEMF). The aim of this study was to compare, for the first time, the functional in vitro response of human tendon cells to different dosages of PEMF, varying in field intensity and duration and number of exposures. METHODS Tendon cells, isolated from human semitendinosus and gracilis tendons (hTCs; n = 6), were exposed to different PEMF treatments (1.5 or 3 mT for 8 or 12 h, single or repeated treatments). Scleraxis (SCX), COL1A1, COL3A1 and vascular endothelial growth factor-A (VEGF-A) expression and cytokine production were assessed. RESULTS None of the different dosages provoked apoptotic events. Proliferation of hTCs was enhanced by all treatments, whereas only 3 mT-PEMF treatment increased cell viability. However, the single 1.5 mT-PEMF treatment elicited the highest up-regulation of SCX, VEGF-A and COL1A1 expression, and it significantly reduced COL3A1 expression with respect to untreated cells. The treated hTCs showed a significantly higher release of IL-1β, IL-6, IL-10 and TGF-β. Interestingly, the repeated 1.5 mT-PEMF significantly further increased IL-10 production. CONCLUSIONS 1.5 mT-PEMF treatment was able to give the best results in in vitro healthy human tendon cell culture. Although the clinical relevance is not direct, this investigation should be considered an attempt to clarify the effect of different PEMF protocols on tendon cells, in particular focusing on the potential applicability of this cell source for regenerative medicine purpose, both in surgical and in conservative treatment for tendon disorders.
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Affiliation(s)
- L de Girolamo
- Orthopaedic Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi, 4, 20161, Milan, Italy.
| | - M Viganò
- Orthopaedic Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi, 4, 20161, Milan, Italy
| | - E Galliera
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - D Stanco
- Orthopaedic Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi, 4, 20161, Milan, Italy
| | - S Setti
- IGEA SpA, Clinical Biophysics, Carpi, Italy
| | - M G Marazzi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - G Thiebat
- Sport Traumatology Unit, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - M M Corsi Romanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.,IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - V Sansone
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.,Orthopaedic Department, Istituto Ortopedico Galeazzi, Milan, Italy
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23
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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; 56:714-9. [PMID: 24919465 DOI: 10.1177/0284185114535132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/17/2014] [Indexed: 11/15/2022]
Abstract
Subchondral insufficiency fracture of the knee (SIFK) is a potentially devastating disorder that may progress rapidly to osteoarthritis with articular surface collapse. It should be suspected in the appropriate clinical setting, as in early stages it is usually indistinct on initial plain radiographs and magnetic resonance imaging is required for a definitive diagnosis. Outcome of SIFK depends on several factors, including the initial subchondral fracture size, patient BMI, degree of osteopenia, as well as early diagnosis and initial treatment. The purpose of this paper is to review the clinical presentation, pathophysiology, image findings, complications and outcome of SIFK.
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Affiliation(s)
- Jean Jose
- University of Miami Miller School of Medicine, Jackson Memorial Hospital, Department of Radiology, Miami, FL, USA
| | | | - Marvin K Smith
- University of Miami Miller School of Medicine, Jackson Memorial Hospital, Department of Radiology, Miami, FL, USA
| | - Akhil Gupta
- University of Miami Miller School of Medicine, Jackson Memorial Hospital, Department of Radiology, Miami, FL, USA
| | - Bryson P Lesniak
- University of Miami Miller School of Medicine, Jackson Memorial Hospital, Department of Orthopedics, Miami, FL, USA
| | - Lee D Kaplan
- University of Miami Miller School of Medicine, Jackson Memorial Hospital, Department of Orthopedics, Miami, FL, USA
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24
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Karim AR, Cherian JJ, Jauregui JJ, Pierce T, Mont MA. Osteonecrosis of the knee: review. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:6. [PMID: 25705638 DOI: 10.3978/j.issn.2305-5839.2014.11.13] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/22/2014] [Indexed: 12/11/2022]
Abstract
Osteonecrosis is a devastating disease that can lead to end-stage arthritis of various joint including the knee. There are three categories of osteonecrosis that affect the knee: spontaneous osteonecrosis of the knee (SONK), secondary, and post-arthroscopic. Regardless of osteonecrosis categories, the treatment of this disease aims to halt further progression or delay the onset of end-stage arthritis of the knee. However, once substantial joint surface collapse has occurred or there are sign of degenerative arthritis, joint arthroplasty is the most appropriate treatment option. Currently, the non-operative treatment options consist of observation, non-steroidal anti-inflammatory drugs (NSAIDs), protected weight bearing, and analgesia as needed. Operative interventions include joint preserving surgery, unilateral knee arthroplasty (UKA), or total knee arthroplasty (TKA) depending on the extent and type of disease. Joint preserving procedures (i.e., arthroscopy, core decompression, osteochondral autograft, and bone grafting) are usually attempted in pre-collapse and some post-collapse lesions, when the articular cartilage is generally intact with only the underlying subchondral bone being affected. Conversely, after severe subchondral collapse has occurred, procedures that attempt to salvage the joint are rarely successful and joint arthroplasty are necessary to relieve pain. The purpose of this article is to highlight the recent evidence concerning the treatment options across the spectrum of management of osteonecrosis of the knee including lesion observation, medications, joint preserving techniques, and total joint arthroplasties.
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Affiliation(s)
- Ammar R Karim
- 1 Rowan University, School of Osteopathic Medicine, Stratford, NJ, USA ; 2 Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Jeffrey J Cherian
- 1 Rowan University, School of Osteopathic Medicine, Stratford, NJ, USA ; 2 Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Julio J Jauregui
- 1 Rowan University, School of Osteopathic Medicine, Stratford, NJ, USA ; 2 Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Todd Pierce
- 1 Rowan University, School of Osteopathic Medicine, Stratford, NJ, USA ; 2 Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Michael A Mont
- 1 Rowan University, School of Osteopathic Medicine, Stratford, NJ, USA ; 2 Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, MD, USA
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25
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Saliev T, Mustapova Z, Kulsharova G, Bulanin D, Mikhalovsky S. Therapeutic potential of electromagnetic fields for tissue engineering and wound healing. Cell Prolif 2014; 47:485-93. [PMID: 25319486 DOI: 10.1111/cpr.12142] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/01/2014] [Indexed: 01/07/2023] Open
Abstract
Ability of electromagnetic fields (EMF) to stimulate cell proliferation and differentiation has attracted the attention of many laboratories specialized in regenerative medicine over the past number of decades. Recent studies have shed light on bio-effects induced by the EMF and how they might be harnessed to help control tissue regeneration and wound healing. Number of recent reports suggests that EMF has a positive impact at different stages of healing. Processes impacted by EMF include, but are not limited to, cell migration and proliferation, expression of growth factors, nitric oxide signalling, cytokine modulation, and more. These effects have been detected even during application of low frequencies (range: 30-300 kHz) and extremely low frequencies (range: 3-30 Hz). In this regard, special emphasis of this review is the applications of extremely low-frequency EMFs due to their bio-safety and therapeutic efficacy. The article also discusses combinatorial effect of EMF and mesenchymal stem cells for treatment of neurodegenerative diseases and bone tissue engineering. In addition, we discuss future perspectives of application of EMF for tissue engineering and use of metal nanoparticles activated by EMF for drug delivery and wound dressing.
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Affiliation(s)
- T Saliev
- Department of Regenerative Medicine and Artificial Organs, Centre for Life Sciences, Nazarbayev University, Astana, 010000, Kazakhstan; Institute for Medical Sciences and Technology, University of Dundee, Dundee, DD2 1FD, UK
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26
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Veronesi F, Torricelli P, Giavaresi G, Sartori M, Cavani F, Setti S, Cadossi M, Ongaro A, Fini M. In vivo effect of two different pulsed electromagnetic field frequencies on osteoarthritis. J Orthop Res 2014; 32:677-85. [PMID: 24501089 DOI: 10.1002/jor.22584] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 01/06/2014] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is a joint pathology characterized by fibrillation, reduced cartilage thickness and subchondral bone sclerosis. There is evidence that pulsed electromagnetic fields (PEMFs) counteract OA progression, but the effect of two different PEMF frequencies has not yet been shown. The aim of this study was to test the effectiveness of PEMFs at two different frequencies (37 and 75 Hz) in a late OA stage in 21-month-old Guinea pigs. After 3 months of 6 h/day PEMF stimulation, histological and histomorphometric analyses of the knees were performed. At both frequencies, PEMFs significantly reduced histological cartilage score, fibrillation index (FI), subchondral bone thickness (SBT) and trabecular number (Tb.N) and increased trabecular thickness (Tb.Th) and separation (Tb.Sp) in comparison to the not treated SHAM group. However, PEMFs at 75 Hz produced significantly more beneficial effects on the histological score and FI than 37 Hz PEMFs. At 75 Hz, PEMFs counteracted cartilage thinning as demonstrated by a significantly higher cartilage thickness values than either those of the SHAM or 37 Hz PEMF-treated groups. Although in severe OA both PEMF frequencies were able to limit its progression, 75 Hz PEMF stimulation achieved the better results.
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Affiliation(s)
- F Veronesi
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute-IOR, via Di Barbiano 1/10, 40136, Bologna, Italy
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27
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Santo VE, Rodrigues MT, Gomes ME. Contributions and future perspectives on the use of magnetic nanoparticles as diagnostic and therapeutic tools in the field of regenerative medicine. Expert Rev Mol Diagn 2014; 13:553-66. [DOI: 10.1586/14737159.2013.819169] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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28
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Shigemura T, Nakamura J, Shimizu K, Iida S, Oinuma K, Kishida S, Ohtori S, Takahashi K. Articular collapse and surgical frequency in corticosteroid-associated osteonecrosis of the femoral head and the knee: an MRI-based prospective study. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s12570-013-0216-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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29
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Juréus J, Lindstrand A, Geijer M, Robertsson O, Tägil M. The natural course of spontaneous osteonecrosis of the knee (SPONK): a 1- to 27-year follow-up of 40 patients. Acta Orthop 2013; 84:410-4. [PMID: 23799344 PMCID: PMC3768043 DOI: 10.3109/17453674.2013.810521] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Spontaneous osteonecrosis of the knee (SPONK) is a painful lesion in the elderly, frequently leading to osteoarthritis and subsequent knee surgery. We evaluated the natural course and long-term consequences of SPONK in terms of need for major knee surgery. METHODS Between 1982 and 1988, 40 consecutive patients were diagnosed with SPONK. The short-term outcome has been reported previously (1991). After 1-7 years, 10 patients had a good radiographic outcome and 30 were considered failures, developing osteoarthritis. In 2012, all 40 of the patients were matched with the Swedish Knee Arthroplasty Register (SKAR) and their medical records were reviewed to evaluate the long-term need for major knee surgery. RESULTS At the 2012 review, 33 of the 40 patients had died. The mean follow-up time from diagnosis to surgery, death, or end of study was 9 (1-27) years. 17 of 40 patients had had major knee surgery with either arthroplasty (15) or osteotomy (2). All operated patients but 1 were in the radiographic failure group and had developed osteoarthritis in the study from 1991. 6 of 7 patients with large lesions (> 40% of the AP radiographic view of the condyle) at the time of the diagnosis were operated. None of the 10 patients with a lesion of less than 20% were ever operated. INTERPRETATION It appears that the size of the osteonecrotic lesion can be used to predict the outcome. Patients showing early signs of osteoarthritis or with a large osteonecrosis have a high risk of later major knee surgery.
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Affiliation(s)
- Jan Juréus
- Department of Orthopedics, Clinical Sciences
| | | | - Mats Geijer
- Center for Medical Imaging and Physiology, Lund University and Skåne University Hospital, Lund, Sweden.
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30
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Low Frequency Pulsed Electromagnetic Field Affects Proliferation, Tissue-Specific Gene Expression, and Cytokines Release of Human Tendon Cells. Cell Biochem Biophys 2013; 66:697-708. [DOI: 10.1007/s12013-013-9514-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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