eCollection 2021. 2021. Jpn J Radiol. Orthop. 2022 May 21;16:15-20. doi: 10.1016/j.artd.2022.04.002. Careers. World J Clin Cases. A 60-year-old female patient with sarcoidosis who had been treated with steroids for years. Objective: Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. North Am. . 2016 Nov;85(11):2096-2103. doi: 10.1016/j.ejrad.2016.08.016. Clin. Epub 2018 Aug 17. Although low bone density may be present concurrently, it is not the. The https:// ensures that you are connecting to the The key to the diagnosis is seeing a linear low signal line adjacent to and paralleling the cortex without any cortical defect or break in the acute phase. -, Lee S, Saifuddin A. 18. A diagnosis of AS involving the symphysis pubis was established, and she was started on tumor necrosis factor alpha blocker Adalimumab 0.8 ml subcutaneous injection every 2 weeks. Recently, the MRI has become more popular and is an important diagnostic tool in differentiating femoral stress fractures, particularly distal shaft fractures, from other hip- and knee-related pain.1,2,13 An MRI is often ordered either in conjunction with a bone scan13 or separately20,21 due to its ability to precisely pinpoint the location of . Methods Subchondral insufficiency fractures of the knee is also known as spontaneous osteonecrosis of the knee (SONK). Subchondral impaction fractures were noted in 5 athletes (1 woman and 4 men) by an experienced musculoskeletal radiologist. Knee MRI checklist [Knee_01] MRI check list, meniscus, anatomy, root, horizontal tear, vertical tear, meniscus tear [Knee_02] Meniscus tear, radial tear, root tear . Would you like email updates of new search results? In more advanced cases, subchondroplasty (where a bone substitute is injected) may be considered. Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome. Spontaneous osteonecrosis of the knee: tibial plateaus. FOIA Radiographics. Epub 2021 Nov 29. In the later stages features seen include: complicating subchondral fracture with periosteal reaction, On radiographs the Koshino classificiation is sometimes used which is as 18, stage II: radiolucency in subchondral weight-bearing area, stage III: expanded lucent area surrounded by sclerosis, subchondral bone collapse, stage IV: osteophytes and osteosclerosis on affected condyle. It is almost always unilateral, usually affects the medial femoral condyle (but can occasionally involve the tibial plateau 9) and is often associated with a meniscal tear. Alternate treatment approach to subchondral insufficiency fracture of the knee utilizing genicular nerve cooled radiofrequency ablation and adjunctive bisphosphonate supplementation: A case report. Technique for Treatment of Subchondral Compression Fracture of the Lateral Femoral Condyle Associated With ACL Tear Abstract Excessive knee pivoting that causes a complete anterior cruciate ligament (ACL) tear may result in a subchondral compression fracture on the lateral femoral condyle after impacting the lateral tibial condyle. Subchondral insufficiency fractures of the knee: review of imaging findings. The typical findings of subchondral insufficiency fracture of the knee on magnetic resonance imaging (MRI) include cortical thickening associated with high-intensity signal of the adjacent cancellous bone, which is known as "bone edema". 2014 Apr;22(4):540-6. doi: 10.1016/j.joca.2014.01.006. The classical and extended classical types both account for 75% of OCD. Would you like email updates of new search results? Epub 2014 Jun 11. Mears SC, McCarthy EF, Jones LC et-al. Epidemiology Subchondral insufficiency fractures are more common in elderly women 1,4,6. We present a case of a 53-year-old woman with subchondral insufficiency fracture (SIF) of the femoral head without history of severe osteoporosis or overexertion. Pathology They tend to occur when normal physiological forces are repeatedly applied to an area of bone. 1. Although plain radiographs may reveal an intra-articular fracture, generally MRI or computed tomography (CT) is needed to delineate the full extent of the injury. FOIA sharing sensitive information, make sure youre on a federal In recent literature, subchondral insufficiency fracture of the knee (SIFK) has been proposed as a new terminology to better reflect the underlying pathophysiology. Careers. Allam E, Boychev G, Aiyedipe S, Morrison W, Roedl JB, Singer AD, Gonzalez FM. (2019) Skeletal radiology. 5. Epub 2014 Feb 6. van der Heijden L, van de Sande MA, Heineken AC, Fiocco M, Nelissen RG, Dijkstra PD. 2010;29: 38-42. Subchondral fractures due to trauma can occur at any age. 2021 Aug 10;26:15-20. doi: 10.1016/j.asmart.2021.07.005. and transmitted securely. Differentiating subchondral insufficiency fracture from osteonecrosis may help avoid unnecessary total hip arthroplasty Effects of Gastrocnemius Recession on Ankle Motion, Strength, and Functional . Improvement of BME on follow-up was highly predictive of low-grade disease. -. 2009;114 (3): 437-47. Coronal (A) and sagittal (B) T2-weighted, fat-suppressed MRI of the right knee 58days after injury. The pain typically gets worse with weight bearing and at night. Federal government websites often end in .gov or .mil. 4. An official website of the United States government. It was first systematically described by Ahlbck in 1968 2. Conclusion: A subchondral T2 hypointense line of the affected condyle with extended bone marrow edema-like signal intensity are characteristic findings on MRI. Wilmot AS, Ruutiainen AT, Bakhru PT, Schweitzer ME, Shabshin N. Eur J Radiol. Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. North Am. What is claimed is: 1.A method for treating joint pain comprising: identifying a subchondral defect in a subchondral region of a bone of the joint; selecting a subchondral access path to a location near the subchondral defect; and treating the subchondral defect, via the subchondral access, in a manner that restores normal force distribution and joint function while preserving the articular . Reply to the letter to the editor: rapid progression of joint deformity after subchondral insufficiency fracture of the knee with medial meniscal root tear. Careers. Epub 2019 Jan 31. Jpn J Radiol. 2 A case series of 32 patients (mean age 70 years, 5 patients osteoporotic) with knee insufficiency fractures concluded that osteop. Takeda M, Higuchi H, Kimura M et-al. American journal of roentgenology. Sclerosis of the medial tibial plate with reduction of the joint space of the same side. subchondral stress/fatigue fracture: overuse injuries in patients without associated risk factors 17. government site. Spontaneous insufficiency fracture of the knee is a potentially devastating yet poorly understood disease entity that can lead to secondary osteoarthritis. Federal government websites often end in .gov or .mil. This site needs JavaScript to work properly. Abstract Objective: To assess the relationship between low- and high-grade subchondral insufficiency fracture of the knee (SIFK) and meniscal tear/type/location, severity of meniscal extrusion, grade of chondrosis, and extent of surrounding edema-like marrow signal intensity. Bookshelf -, Osteoarthritis Cartilage. It usually affects the inside of the knee or the medial compartment which bears more stress and may involve the medial condyle of the femur. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Subchondral insufficiency fracture refers to a type of stress fracture that occurs below the chondral surface on a weight-bearing surface of a bone due to mechanic failure of subchondral cancellous bone. The subchondral bone is key to cartilage and joint health. Bethesda, MD 20894, Web Policies government site. 3. Breer S, Oheim R, Krause M et-al. The majority of SIFK lesions were low-grade (LG; 78%) and most of them (70%) were observed in the medial femoral condyle. Bone marrow edema; Chondrosis; Insufficiency fracture of the knee; Meniscus; Spontaneous osteonecrosis of the knee. Fotiadou A, Karantanas A. 11. Osteonecrosis of the knee represents a condition caused by reduced blood flow to bone secondary to a variety of risk factors such as sickle cell disease, steroid use, alcoholism, autoimmune disorders, and hypercoagulable states. Treatment can either be operative or non-operative, with initial treatment often conservative and consisting of analgesia and protected weight bearing. Crema MD, Cibere J, Sayre EC, Roemer FW, Wong H, Thorne A, Singer J, Esdaile JM, Marra MD, Kopec JA, Nicolaou S, Guermazi A. Osteoarthritis Cartilage. The 80 experts for the knee in Germany, FOCUS Nr: 46 11/2006. Epub 2020 Aug 19. 2007;14 (2): 112-6. PMC Most common forms are osteoarthritis (OA) and rheumatoid arthritis (RA). Subchondral insufficiency fracture of the femoral head. Spontaneous Osteonecrosis/Subchondral Insufficiency Fractures of the Knee: High Rates of Conversion to Surgical Treatment and Arthroplasty. Iowa Orthop J. Results: Epub 2018 Aug 17. eCollection 2021 Oct. Asia Pac J Sports Med Arthrosc Rehabil Technol. MRCS Revision. Following magnetic resonance imaging, the diagnosis of subchondral insufficiency fracture of the knee (SIFK) was made. The following criteria apply to lesions without overlying cartilage abnormalities: in the weight-bearing area of the involved condyle, subtle flattening or a focal depressive deformity, an irregular, discontinuous hypointense line in the subarticular marrow, representing callus and granulation tissue, there may be a fluid-filled cleft within the subchondral bone plate (poor prognostic factor) 13, excavated defect of the articular surface (advanced cases), focal subchondral area of low signal intensity subjacent to the subchondral bone plate representing local ischemia (considered most important in early lesions and a specific MRI finding12), this area shows no enhancement on post-contrast; if it is thicker than 4 mm or longer than 14 mm, the lesion may be irreversible and may evolve into irreparable epiphyseal collapse and articular destruction, appears as a thickened subchondral bone plate, which represents a fracture with callus and granulation tissue and secondary osteonecrosis in the subarticular region 13, ill-defined bone marrow edemaand a lack of peripheral low signal intensity rim as seen in osteonecrosisand bone infarcts. Coronal and sagittal FS-PDWI of a 79-year-old female patient who complained of a sudden worsening of knee pain during follow-up for osteoarthritis of the right knee. xray *Phalen test (60secs) - positive if pain/paresthesias in at least 1 fig. 1990;154 (2): 331-6. Narvez JA, Narvez J, De Lama E et-al. Prevalence of Undiagnosed Subchondral Insufficiency Fractures of the Knee in Middle Age Adults with Knee Pain and Suspected Meniscal Tear. Osteoarthr. The method comprises: identifying a subchondral defect in a subchondral region of a bone of the joint; selecting a subchondral access path to a location near the subchondral defect; and treating the subchondral defect, via the subchondral access, in a manner that restores normal force distribution and joint function while preserving the . The 66 best doctors and clinical institutes in Germany, Fit For Fun 4/2003. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Subchondral Fracture, Knee Most cases involve the medial femoral condyle, and the lateral femoral condyle is rarely affected. Khaled M. Sarraf, BSc (Hons), MBBS, MRCS Specialist Registrar in Trauma and Orthopaedic Surgery, North West Thames Rotation - London Deanery, Chelsea and Westminster Hospital NHS Foundation Trust . Case study, Radiopaedia.org (Accessed on 05 Dec 2022) https://doi.org/10.53347/rID-88093 See this image and copyright information in PMC. 12. However, bone marrow edema-like signal intensity and osteochondral collapse alone are not specific to SIFK, and other osteochondral lesions, including avascular necrosis, osteochondral dissecans, and osteoarthritis should be considered. Subchondral insufficiency fracture of the knee (SIF/SIFK) are stress fracturesin the femoral condyles or tibial plateau that occur in the absence of acute trauma, typically affecting older adults. Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. subchondral bone, under arthroscopic control, with good results in pain reduction and a small risk of complica-tions [33, 34]. Orthop. Significance of Lateral Pillar in Osteonecrosis of Femoral Head: A Finite Element Analysis. Accessibility Knee. Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Accessibility 16. You can use Radiopaedia cases in a variety of ways to help you learn and teach. - Of these, OA is by far the more common, affecting approximately 27 million Americans, whereas an . Bookshelf Magnetic resonance imaging of subchondral insufficiency fractures of the lower limb. 2000;82 (6): 858-66. 2022 May;40 (5):443-457. doi: 10.1007/s11604-021-01224-3. Images. Yates PJ, Calder JD, Stranks GJ et-al. Osteoporosis is the most common cause of insufficiency fractures, although there are many causes 7-9: disrupted bone mineral homeostasis: hyperparathyroidism, diabetes mellitus, osteomalacia. and insufficiency or stress fractures. The patients are usually over 50 and have a sudden, non traumatic onset of severe knee pain that How do you best treat a small subchondral fracture involving the medial rim of the medial femoral condyle with extensive Medical Ask an Expert Medical Questions How do you best treat a small subchondral fracture involving Dr Brims, U.S. OCD rarely occurs in the anterior part of the femur (2%), MRI of a 16-year-old boy with unstable OCD in the medial femoral condyle in the right knee. Magnetic resonance imaging reveals extensive bone marrow edema and subchondral bone collapse on the medial compartment of the femoral and tibial surface where grade 4 chondral loss is present. Epub 2016 Aug 26. Figure 2 A and B. 2004;35 (3): 293-303, viii. In fractures with a vertical fracture line, a buttress plate is necessary to counteract the vertical shear forces. The patient successfully recovered and returned to full athletic function, having recently returned to competitive marathon running. Hussain ZB, Chahla J, Mandelbaum BR, Gomoll AH, LaPrade RF. Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. J Bone Joint Surg Am . medications: glucocorticoids, chemotherapy. 6. -, Clin Imaging. The Infona portal uses cookies, i.e. Epub 2022 Feb 19. Ochi J, Nozaki T, Nimura A, Yamaguchi T, Kitamura N. Subchondral Insufficiency Fracture of the Knee: Review of Current Concepts and Radiological Differential Diagnoses. Saucerized defect (arrow) of, MRI of a 50-year-old man with a complaint of sudden left knee pain., MRI of a 73-year-old female patient with SIFK in the medial femoral condyle, Coronal FS-PDWI of a 71-year-old female patient with SIFK in the medial femoral, Coronal and sagittal FS-PDWI of a 79-year-old female patient who complained of a, Coronal FS-PDWI and T1WI of a 40-year-old female patient in the postpartum period, A 60-year-old female patient with sarcoidosis who had been treated with steroids for, A 60-year-old male patient with AVN. this study, subchondral insufficiency fracture has been increasingly studied, including the identification of risk factors and associated lesions (3). Chin Med J (Engl) 2017; 130:2569. Describe its MRI appearance. J Bone Joint Surg Am. Before There Read More Recognizing that spontaneous osteonecrosis of the knee was a misnomer and actually represents a subchondral insufficiency fracture that progressed to subchondral collapse with secondary osteonecrosis,the Society of Skeletal Radiology Subchondral Bone Nomenclature Committee recommended that "subchondral insufficiency fracture" be the preferred term 17. 10. 14. The .gov means its official. SIFK is a type of stress fracture that occurs when repetitive and excessive stress is applied to the subchondral bone. The relationship between subchondral sclerosis detected with MRI and cartilage loss in a cohort of subjects with knee pain: the knee osteoarthritis progression (KOAP) study. The knee is the area that is most often affected by this disease, although it is also common in other joints and bone areas. To propose an magnetic resonance imaging (MRI) grading system for subchondral insufficiency fracture of the knee (SIFK) to predict outcome and assess risk factors. Davies M, Cassar-Pullicino VN, Darby AJ. Subchondral insufficiency fracture of the knee: review of current concepts and radiological differential diagnoses Jpn J Radiol. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture. 2000 Oct;35(10):581-8 Coronal FS-PDWI of a 71-year-old female patient with SIFK in the medial femoral condyle of the left knee. Subchondral insufficiency fractures are slowly healing fractures of the bone situated immediately below the cartilage of a joint. HHS Vulnerability Disclosure, Help 2021 May 19;3(3):100183. doi: 10.1016/j.ocarto.2021.100183. Surrogate markers of high-grade lesions include medial meniscus posterior root tears with associated moderate to severe extrusion, high-grade chondrosis, larger lesion sizes (anteroposterior/transverse), and articular surface collapse. 8. ADVERTISEMENT: Supporters see fewer/no ads. Diagnosis is radiographic for advanced disease but requires MRI for detection of early or . J Bone Joint Surg Am. . Subchondral insufficiency fracture of the knee. MRI was performed on the 12th day post-cesarean section for the complaint of severe right hip pain. 2021 Sep 3;2021:6622445. doi: 10.1155/2021/6622445. doi: 10.2106/JBJS.M.00066. Disclaimer, National Library of Medicine Authors Junko Ochi 1 , Taiki Nozaki 2 , Akimoto Nimura 3 , Takehiko Yamaguchi 4 , Nobuto Kitamura 5 Affiliations 2012;4:173180. Bethesda, MD 20894, Web Policies Lesion location 3D dimensions, extent of bone marrow edema (BME), location of meniscal tears and associated extrusion, degree of chondrosis and among other parameters were stratified according to lesion grade and compared with follow-up examinations. J Bone Joint Surg Am. The areas colored in black correspond to OCD lesions. Yeh WL, Su CY, Chang CW, Chen CH, Fu TS, Chen LH, Lin TY. SIFK is a type of stress fracture that occurs when repetitive and excessive stress is applied to the subchondral bone. Spontaneous osteonecrosis of the knee: value of MR imaging in determining prognosis. 17. . Subchondral insufficiency fractures are typically found in older female patients with increased bone fragility. Wen PF, Guo WS, Zhang QD, et al. Clinically, it presents as a sudden onset of severe knee pain without trauma or in association with only minor trauma. Radiol Med. Epub 2016 Aug 26. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Nicoletti D, Subchondral insufficiency fracture - knee. 42 10/2003. To assess the relationship between low- and high-grade subchondral insufficiency fracture of the knee (SIFK) and meniscal tear/type/location, severity of meniscal extrusion, grade of chondrosis, and extent of surrounding edema-like marrow signal intensity. Epub 2022 Jan 30. 9. Clin. A 72-year-old female patient with knee OA. The site is secure. Subchondral insufficiency fracture - knee. Predictor variables found to be significantly different between controls and patients were meniscal tear (p = 0.024), location of the medial meniscal tear (p < 0.0001), degree of extrusion (p < 0.0001), chondrosis (p < 0.0001), joint effusion (p < 0.0001), Baker's cyst (p < 0.0001), knee lock (p = 0.03) and buckle (p = 0.01), and history of trauma (p = 0.01). Associated devices and instruments for treatment of the subchondral bone are also disclosed. . Online ahead of print. collagen formation: Marfan syndrome, fibrous dysplasia. The large lesion size and the presence of osteochondral collapse on imaging are associated with an increased risk of osteoarthritis. Close. Surgical outcome of atypical subtrochanteric and femoral fracture related to bisphosphonates use in osteoporotic patients with or without teriparatide treatment. The site is secure. The areas colored in black correspond to OCD lesions., MRI of a 16-year-old boy with unstable OCD in the medial femoral condyle, A 72-year-old female patient with knee OA. Clipboard, Search History, and several other advanced features are temporarily unavailable. Plain radiographs showed acetabular overcoverage with excessive lateralization of the acetabular rim. Subchondral insufficiency fractures of the hip have been identified as a cause of accelerated osteoarthritis . Pareek A, Parkes CW, Bernard C, Camp CL, Saris DBF, Stuart MJ, Krych AJ. Epub 2020 May 26. Please enable it to take advantage of the complete set of features! official website and that any information you provide is encrypted strings of text saved by a browser on the user's device. 2009;40 (2): 193-211. 8600 Rockville Pike 1 The prognosis may range from full recovery to rapidly escalating joint destruction. These are typically located in the medial femoral condyle or medial tibial plateau. Kidwai AS, Hemphill SD, Griffiths HJ: Spontaneous osteonecrosis of the knee reclassified as insufficiency fracture. The entity subsumes that previously known as spontaneous osteonecrosis of the knee (SONK/SPONK) or Ahlbck disease. Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. 2004;33 (10): 575-81. -, Plett SK, Hackney LA, Heilmeier U, Nardo L, Yu A, Zhang CA, et al. These mechanisms can cause this class offemur fracture. Clipboard, Search History, and several other advanced features are temporarily unavailable. Wilmot AS, Ruutiainen AT, Bakhru PT, Schweitzer ME, Shabshin N. Eur J Radiol. All injuries presented similar features and in each case, the following diagnostic criteria were fulfilled: The typical region of trauma concerned the postero-superior, non-weight-bearing aspect of the medial femoral condyle. eCollection 2022 Aug. Nissan N, Bauer E, Moss Massasa EE, Sklair-Levy M. Insights Imaging. Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. There is diffuse marrow oedema throughout the lateral femoral condyle and a minimal lateral femoral condylar depression (arrow) consistent with a subchondral insufficiency fracture. 2003 Oct 13;163(18):2165-72 Check for errors and try again. 2003;13 (8): 1843-8. Hiranaka T, Furumatsu T, Okazaki Y, Tanaka T, Ozawa M, Masuda K, Seno N, Xue H, Ozaki T. Asia Pac J Sports Med Arthrosc Rehabil Technol. Ochi J, Nozaki T, Nimura A, Yamaguchi T, Kitamura N. Jpn J Radiol. Subchondral insufficiency fractures of the femoral head. A subchondral fracture refers to a fracture subjacent to the cortex and the subchondral bone plate, without cortical contour abnormality or disruption. Chondral lesions and meniscal abnormalities, including posterior root tears, are also found in many patients with SIFK, and they are considered to be related to the development of SIFK. The patient complained of knee pain lasting for more than a year. Subchondral insufficiency fracture of the knee (SIFK) is a common cause of knee joint pain in older adults. Unable to load your collection due to an error, Unable to load your delegates due to an error. Historically, prominent marrow edema in the femoral condyle without significant injury was termed "spontaneous osteonecrosis of the knee" or SPONK (or SONK). Subchondral insufficiency fracture of the knee (SIF/SIFK) are stress fractures in the femoral condyles or tibial plateau that occur in the absence of acute trauma, typically affecting older adults. Activity/Rest & Sleep: Rheumatoid Arthritis vs. Osteoarthritis & Gout NUR112 - Nursing Care of Clients with Uncomplicated Health Care Needs SUMMER 2013 Arthritis A medical term that literally means joint inflammation. official website and that any information you provide is encrypted Radiol Case Rep. 2020 Apr 5;15(6):691-696. doi: 10.1016/j.radcr.2020.02.034. Subchondral insufficiency fracture of the knee typically affects individuals that are 55 or older and presents with sudden non traumatic unilateral knee pain. 2017 Dec 13;18(1):527. doi: 10.1186/s12891-017-1878-5. 2022 Apr;76(2):121-127. doi: 10.18926/AMO/63405. 48 (12): 1961-1974. Skelet Radiol. Osteonecrosis of the knee is a potentially devastating condition and has been obse. Keywords: The leading cause of insufficiency fractures is osteoporosis a condition that commonly develops after age 50 that . [11] MRI findings usually include bone marrow edema localized to the medial femoral condyle, with extension into the inter-condylar notch. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Weerakkody Y, Bickle I, et al. Subchondral hypointense fracture lines tend to resolve with conservative therapy. 213 (5): 963-982. Meniscal root tear; Spontaneous osteonecrosis of the knee; Subchondral insufficiency fracture; Subchondral plate. Gorbachova T, Amber I, Beckmann NM, Bennett DL, Chang EY, Davis L, Gonzalez FM, Hansford BG, Howe BM, Lenchik L, Winalski CS, Bredella MA. Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Imaging of early stages of osteonecrosis of the knee. ( a) Plain radiographs taken 2 weeks after the onset of both left and right hip pain show linear increased density lesion in both femoral heads and collapse of the right femoral head. PMC Huizinga JL, Shah N, Smith SE, Notino A, Kluczynski MA, Jordan K, Bisson LJ, Chen AF, Selzer F, Losina E, Katz JN. Subchondral insufficiency fracture of the knee (SIFK) is a common cause of knee joint pain in older adults. The leg opposite the examiner is flexed at the knee and hip and adducted toward the examiner until the pelvis begins to follow. The 63 best specialists for joints in Germany, FOCUS No. a A sagittal T2WI shows necrotic areas, Frequent sites of OCD. Abstract. A subchondral insufficiency fracture is a type of stress fracture that occurs when bone underlying the cartilage in a joint is unable to bear stresses normally subjected to the joint. Osteochondral fractures involve both articular cartilage and the subchondral bone plate and appear as a fracture line that violates the joint surface, subchondral bone plate depression, articular surface disruption and fragmentation, or a combination of these features ( Fig 4) ( 9, 10 ). Development and Analysis of Mouse Medial Meniscus Posterior Root Tear Model. J Bone Joint Surg Br. and transmitted securely. Postoperative clinical outcomes of unicompartmental knee arthroplasty in patients with isolated medial compartmental osteoarthritis following medial meniscus posterior root tear. physiologic limits of normal bone. For example, using T2-weighted MRI images, bone marrow lesions or edemas can be identified, and using T1-weighted MRI images, associated regions of sclerotic bone adjacent to the bone marrow lesion can be identified. A total of 50 SIFK patients were retrospectively reviewed utilizing two MRI examinations approximately a year apart and compared them with 51 control subjects. An insufficiency fracture is a type of stress fracture that can occur due to minor pressure in a bone that is weakened. 29.1 A 27-year-old man with bilateral fatigue-type subchondral stress fracture of the femoral head. If the fracture does not heal, the lesion develops into osteonecrosis and results in osteochondral collapse, requiring surgical management. . summary. This type of injury can happen anywhere in the body, and it most often affects the spine and pelvic bones. Orthop. doi: 10.1177/0363546517743734. Subchondral insufficiency fracture of the knee: unicompartmental correlation to meniscal pathology and degree of chondrosis by MRI. A reformatted CT coronal image shows multiple lesions with a serpiginous sclerotic border (arrows), which corresponds to lesions of AVN/bone infarction, Frequent sites of OCD. 1996;63:859861. MRI of a 73-year-old female patient with SIFK in the medial femoral condyle of the right knee. Acute nontraumatic adult knee pain: the role of MR imaging. 2021;40(5):443-57. Unable to process the form. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. Moderate degenerative changes of bilateral sacroiliac joints, with no sacroiliac joint effusion or ankyloses were reported . 2009;17 (9): 1115-31. This article presents a 51-year-old postmenopausal woman, a physician, who had subchondral insufficiency fractures of the knee associated with prolonged standing during clinical work. These similarities often lead to missed or delayed diagnosis which can often delay or change management. 1991 Feb;62(1):19-23 Jpn J Radiol. Bookshelf Subchondral Stress Fracture of the Femoral Head Fig. (2019) AJR. -. Change in MRI-detected subchondral bone marrow lesions is associated with cartilage loss: The MOST study. OCD tends to occur slightly lateral to the weight bearing area of the medial femoral condyle. Results: Forty-one patients were included in the study (21 males, 20 females). Kabra U, Subchondral insufficiency fracture of the knee. The authors declare that they have no conflict of interest. Osteoarthritis of the knee would likely have changes present on the radiograph and no sclerotic lesion would be present. 7. Nomenclature of Subchondral Nonneoplastic Bone Lesions. Takai H, Kitajima M, Takai S, Takahashi T, Katsura KI, Tokunaga M, Watanabe S. Case Rep Orthop. An official website of the United States government. A new method using MRI. 2020 Dec;2(4):100089. doi: 10.1016/j.ocarto.2020.100089. government site. 2015 Jul-Aug;39(4):659-61 (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1478-1495. Subchondral insufficiency fracture of the knee (SIF/SIFK) are stress fractures in the femoral condyles or tibial plateau that occur in the absence of acute trauma, typically affecting older adults. Risk factors osteoporosis 4 osteoarthritis 4 . Subchondral fractures were defined as T1-T2 hypointense signal intensity changes, usually in the form of a line paralleling the articular surface. -, Acta Orthop Scand. It usually involves the weight-bearing surfaces and most commonly occurs in the central weight-bearing surface of the medial femoral condyle. Rapid Destructive Arthropathy of the Knee in Parkinson's Disease with Pisa Syndrome: A Case of Knee-Spine Syndrome. 2013;21 (2): 340-5. Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Eur Radiol 2004; 14:201. Subchondral insufficiency fracture of the knee is characterized by sudden onset of pain in the absence of trauma. Rapid progression of joint deformity after subchondral insufficiency fracture of the knee with medial meniscal root tear. Radiologists should be familiar with these imaging features and clinical presentations for appropriate management. Would you like email updates of new search results? Please enable it to take advantage of the complete set of features! Am J Sports Med. Subchondral insufficiency fracture of the knee (SIFK) is a common cause of knee joint pain that mainly afflicts the elderly. Osteoarthr Cartil Open. Subchondral bone marrow edema in patients with osteoarthritis of the knee joint has been associated with knee pain and the progression of . A subchondral fracture is a fracture of the trabecular cancellous bone just beneath the subchondral bone plate without disruption of the articular surface 1. See this image and copyright information in PMC. Insufficiency fracture s are a type of stress fracture, which are the result of normal stresses on abnormal bone [1] . By definition,secondary osteonecrosis of the knee occurs secondary to an insult. Licensed Physician 9,617 Satisfied Customers MD Dr Brims is online now Related Medical Questions Abstract Objective: To propose an magnetic resonance imaging (MRI) grading system for subchondral insufficiency fracture of the knee (SIFK) to predict outcome and assess risk factors. Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. 2022 Oct 15. doi: 10.1007/s00223-022-01028-1. The https:// ensures that you are connecting to the A diagnosis of SIF was made by typical MRI findings of SIF. Anteroposterior radiograph of both knees (A) and a lateral radiograph of the right knee (B) show minimal osteophytosis, but are otherwise normal. Prognosis varies from complete recovery to total joint collapse 2. Unable to process the form. Okazaki Y, Furumatsu T, Hiranaka T, Kamatsuki Y, Nakata E, Tetsunaga T, Yamane K, Ozaki T. Acta Med Okayama. Subchondral insufficiency fracture of the knee: unicompartmental correlation to meniscal pathology and degree of chondrosis by MRI. This site needs JavaScript to work properly. Subtle bone marrow edema-like signal intensity can be observed around the cyst (asterisk). ), or their login data. Dgx X-ray to r/o fracture Hx & Ph. Radiographics. Characterization and pathological characteristics of spontaneous osteonecrosis of the knee. Coronal FS-PDWI and T1WI of a 40-year-old female patient in the postpartum period with transient BMES in the right hip. ADVERTISEMENT: Supporters see fewer/no ads. Until now, how a sudden insufficiency fracture of subchondral bone affects the transcriptomic profiles of cartilage in SIFK and OA patients are largely unknown. Acta Radiol. The diagnosis of subchondral insufficiency fracture (SIF) was confirmed in a consensus review by one fellowship trained musculoskeletal (MSK) radiologist and one radiology fellow. Conclusion: Since this study, subchondral insufficiency fracture has been increasingly studied, including the identification of risk factors and associated lesions . She was treated with partial weight bearing on crutches until 14 months after the injury, viscosupplementation at 4 months to treat osteoarthritis and teriparatide treatment to improve bone healing at 7 months. MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis. It is important to note that in cases in which insufficiency fractures lead to bone structural col-lapse, subchondral support techniques are inadequate, and thus, the treatment of choice should be bone Predictor variables comparing low-grade and high-grade SIFK lesions included meniscal tear (p = 0.01), degree of extrusion (p < 0.003), chondrosis (p = 0.01), medial chondrosis grade (p = 0.001), medial femoral condyle (p = 0.01), surface collapse (p < 0.0001), marrow edema improvement (p < 0.0001), first MRI anteroposterior dimension (p = 0.001), transverse dimension (p < 0.001), and ellipsoid volume (p = 0.02). 2021 Nov;50(11):2185-2194. doi: 10.1007/s00256-021-03777-w. Epub 2021 Apr 17. Next, the examiner grasps the knee of the adducted leg and palpates the sacroiliac joint with the other hand while exerting resilient axial pressure on the knee. Disclaimer, National Library of Medicine A sagittal FS-PDWI shows a rim of fluid signal intensity surrounding the OCD lesion (arrow). AJR Am J Roentgenol. R01 AG046294/AG/NIA NIH HHS/United States. BMC Musculoskelet Disord. Bethesda, MD 20894, Web Policies HHS Vulnerability Disclosure, Help Bullough PG: Spontaneous osteonecrosis of the knee: The result of subchondral insufficiency fracture. Skeletal Radiol. Keywords: An access path is mapped to a location in the subchondral region where the . The https:// ensures that you are connecting to the Patients often recall an acute onset of severe pain without significant trauma. The term insufficiency fracture is often applied to subchondral bone changes seen on knee magnetic resonance images (MRIs) (Figure 1). 8600 Rockville Pike The presence of metaphyseal burst sign was evaluated in the cohort. Subchondral insufficiency fracture of the knee is not thought to be caused by bone death but instead by osteoporosis and insufficiency fractures, with histopathologically proven origins in weakened trabeculae and applied microtraumatic forces 6,13. The .gov means its official. Fibular head or neck fracture A direct blow to the proximal fibula resulting in a bony contusion or fracture can cause lateral knee pain that presents with or without swelling . There is also cyst formation in the parent bone (arrowhead). Steps required to perform operative fixation of an insufficiency fracture within the knee using calcium phosphate bone substitute. Siu RWH, Liu JHP, Man GCW, Ong MTY, Yung PSH. Subchondral insufficiency fracture of the knee: A recognizable associated soft tissue edema pattern and a similar distribution among men and women. MeSH Magnetic resonance imaging of subchondral insufficiency fractures of the lower limb. Bjrkengren AG, Alrowaih A, Lindstrand A et-al. Before Patients with subchondral insufficiency fracture characteristically have unremarkable plain radiographs, while MRI examination may reveal extensive bone marrow oedema and subchondral bone collapse. . Admission to the Primo Medico medical network, 2017 official website and that any information you provide is encrypted Jose J, Pasquotti G, Smith MK, Gupta A, Lesniak BP, Kaplan LD. doi: 10.4055/cios.2012.4.3.173. 2020 Oct;39(10):3105-3113. doi: 10.1007/s10067-020-05181-6. MRI plays a significant role in the early diagnosis of SIFK. Osteonecrosis of the knee: a review of three disorders. sharing sensitive information, make sure youre on a federal Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Mid-term outcome after curettage with polymethylmethacrylate for giant cell tumor around the knee: higher risk of radiographic osteoarthritis? 2021 Sep 6;9(25):7445-7452. doi: 10.12998/wjcc.v9.i25.7445. Associated features that may predict prognosis include: associated meniscal tear and degree of extrusion. This occurs in early knee osteoarthritis and indicates the potential for cartilage loss and misalignment of a knee compartment. Disclaimer, National Library of Medicine The other leg remains extended. J Bone Joint Surg Am. SONK is now categorized as an advanced SIFK lesion in the spectrum of this disease, and some authors believe the term "SONK" is a misnomer. Arthroplast Today. Plain radiograph of SIFK in a 75-year-old female patient. The portal can access those files and use them to remember the user's data, such as their chosen settings (screen view, interface language, etc. Left knee demonstraste a SMALL subchondral insufficiency left knee demonstraste a SMALL subchondral insufficiency fracture over the left medial margin of the medial femoral condyle in read more Dr. P. Jyoti Consultant MD MD 13,131 satisfied customers Dear Dr. of Oncology I am confused on what some things mean 2022 Jul;40(7):751-753. doi: 10.1007/s11604-022-01254-5. Spontaneous osteonecrosis of the knee (SONK). They should not be confused with fatigue fractures which are due to abnormal stresses on normal bone, or with pathological fractures, the result of diseased, weakened bone due to focal pathology such as tumours . Objective To propose an magnetic resonance imaging (MRI) grading system for subchondral insufficiency fracture of the knee (SIFK) to predict outcome and assess risk factors. Coronal (A) and sagittal (B) T2-weighted, fat-suppressed MRI of the right knee 58, Anteroposterior radiograph of both knees, Anteroposterior radiograph of both knees (A) and a lateral radiograph of the right, MeSH Eur Radiol. Clin Rheumatol. Subchondral insufficiency fracture of the knee (SIFK) is a common cause of knee joint pain in older adults. By 26 months after the injury, she tolerated independent walking with a fabric knee support but still experienced mild posterolateral knee pain and numbness on prolonged standing. SUBCORTICAL SUBCHONDRAL FRACTURE KNEE MRI TIBIAL PLATEAU DISCUSSION Subchondral or subcortical fractures of the knee can occur in the femoral condyles or tibial plateau. Sakai Y, Souza F, Lang P. Quantitative measurement of femoral condyle cartilage in the knee by MRI: validation study by . Saucerized defect (arrow) of the epiphysis can be observed in the medial femoral condyle of the left knee. The lateral (13%) and medial (10%) central weight bearing surfaces of the femoral condyle are less common. A grading system was introduced that classifies lesions as low- vs high-grade. Skeletal Radiol. Subchondral bone attrition is the flattening or depression of the bone surface that forms part of a joint. Coronal and sagittal MRI scans are shown in Figures 11a and 11b. Features can vary depending on the stage and are best characterized on T2-weighted and proton density-weighted sequences. 2021 Nov;50(11):2185-2194. doi: 10.1007/s00256-021-03777-w. Epub 2021 Apr 17. Introduction. Please enable it to take advantage of the complete set of features! Orthopedics 2005;28:236,333-336. . SIFFH is often mistaken for osteonecrosis given similar clinical and radiographic features. Our retrospective study included 219 patients with knee pain and SIFK seen on MRI. Lotke PA, Nelson CL, Lonner JH. Materials . A SIFK grading system for MRI is introduced. 2004;35 (3): 365-70, x. Pathologic Fractures [Figure 4-30-3] 5-10% of all patients with mets 50% or more cortex gone - 2/3 will develop pathologic fracture 61 year old woman with breast Less than 50% cortex gone - 1/5 will develop pathologic fracture cancer, focal depression of L2 Any lesion in femoral neck superior endplate is indicative of Avulsion of lesser . Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome.
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