Does Prevalence of Small Size Acetabular Bone Marrow Edema or Cystic Lesion on 3 Tesla MRI Correlate With Poor Clinical Outcomes After Hip Arthroscopy? An Analysis of 2 to 6 Year Follow-Up

Background: Subchondral bone marrow edema (BME) has been associated with articular cartilage loss, with the potential to be a negative prognostic indicator for clinical outcomes after microfracture. However, no single study has investigated the association between BME and clinical outcomes after microfracture for osteochondral lesions of the talus (OLTs) at midterm follow-up. Purpose: To clarify the association between postoperative subchondral BME and clinical outcomes in patients treated with microfracture for OLTs at both short-term and midterm follow-up using a grading system that classified the extent of BME of the talus. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent microfracture between 2008 and 2013 were assessed at 2- and 4-year postoperative follow-up. BME was evaluated using magnetic resonance imaging, and the presence of subchondral BME was determined with fat-suppressed T2-weighted sequences. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS). P < .05 was considered to be statistically significant. Results: Forty-three (83%) of 52 eligible patients were included. No significant differences were found in the FAOS between the BME and no BME groups at 2-year follow-up (83.1 ± 6.5 vs 88.6 ± 8.0, respectively; P = .109), but there was a significant difference at 4-year follow-up (77.5 ± 11.1 vs 84.7 ± 8.4, respectively; P = .041). A significant difference was found among BME grades at 4-year follow-up (grade 0: 84.7 ± 7.4, grade 1: 80.1 ± 10.5, grade 2: 74.0 ± 10.3, and grade 3: 67.5 ± 7.1; P = .035). A post hoc analysis showed significant differences between grades 0 and 2, 0 and 3, and 1 and 3 ( P = .041, .037, and .048, respectively). In addition, at 4-year follow-up, a significant correlation was noted between the FAOS and BME grade ( r = −0.453, P = .003) but not at 2-year follow-up ( r = −0.212, P = .178). Seventy-four percent of patients still had subchondral BME at 4-year follow-up after microfracture for OLTs. Conclusion: Patients with subchondral BME at midterm follow-up after microfracture for OLTs had worse clinical outcomes than those without subchondral BME. In addition, the degree of subchondral BME at midterm follow-up was correlated with clinical outcomes. However, at short-term follow-up, there were no significant differences in clinical outcomes based on both the presence and degree of BME, and no correlation was found between clinical outcomes and the degree of BME. The current study suggests that BME at short-term follow-up is a normal physiological reaction. However, BME at midterm follow-up after microfracture for OLTs may be pathological and is associated with poorer clinical outcomes.

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Quantitative characterization of bone marrow edema pattern in rheumatoid arthritis using 3 tesla MRI

Journal of Magnetic Resonance Imaging ◽

10.1002/jmri.22803 ◽

2011 ◽

Vol 35 (1) ◽

pp. 211-217 ◽

Cited By ~ 19

Author(s):

Xiaojuan Li ◽

Andrew Yu ◽

Warapat Virayavanich ◽

Susan M. Noworolski ◽

Thomas M. Link ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Bone Marrow ◽

Bone Marrow Edema ◽

3 Tesla ◽

Quantitative Characterization ◽

3 Tesla Mri ◽

Bone Marrow Edema Pattern ◽

Marrow Edema

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The Presence and Degree of Bone Marrow Edema Influence on Midterm Clinical Outcome Following Microfracture for Osteochondral Lesions of the Talus

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00111 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0011

Author(s):

Yoshiharu Shimozono ◽

Eoghan Hurley ◽

John Kennedy

Keyword(s):

Bone Marrow ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Bone Marrow Edema ◽

Osteochondral Lesions ◽

Short Term ◽

Significant Difference ◽

Marrow Edema ◽

Time Point

Category: Ankle Introduction/Purpose: Subchondral bone marrow edema (BME) has been associated with articular cartilage loss, with the potential to be a negative prognostic indicator for clinical outcome following microfracture. However, no single study has investigated the influence of BME on clinical outcome following microfracture for osteochondral lesions of the talus (OLT) at mid-term follow-up. The purpose of this study was to clarify the influence of postoperative subchondral BME on the clinical outcome in patients treated with microfracture for OLT at both short- and mid-term. Methods: Patients who underwent microfracture between 2008 and 2013 were assessed at 2- and 4-year postoperative follow-up. BME was evaluated using magnetic resonance imaging (MRI), and the presence of subchondral BME was determined with fat-suppressed T2-weighted sequences. BME was graded on a 0-3 scale based on the relation to total talar volume as follows: 0, no BME; 1, <25% of talar volume; 2, 25%<, >50% of talar volume; 3, >50% of talar vome. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS). The influence of postoperative subchondral BME on the clinical outcomes were evaluated as following; 1) the FAOS between the BME and the no BME groups were compared at 2 and 4 years post surgery, 2) the FAOS based on the BME grades were compared at each time point, and 3) correlation between the FAOS and BME grade was evaluated at each time point. Results: Forty-three (83%) of 52 eligible patients were included. No significant differences were found in FAOS between BME and no BME groups at 2-year follow-up (p=0.109), but there was a significant difference at 4-year follow-up (p = 0.041). A significant difference was found among BME grades at 4-year follow-up (p=0.035) (Table 1). A post hoc analysis showed significant differences between grade 0 and 2, 0 and 3, and 1 and 3 (p=0.041, 0.037 and 0.048, respectively). In addition, at 4-years follow-up, a significant correlation was noted between FAOS and BME grade (r= -0.453, p = 0.003) (Table 1), but not at 2-years (r = -0.212, p = 0.178). Seventy-four percent of patients still had subchondral BME at 4-year follow-up after microfracture for OLT. Conclusion: Patients with the presence of subchondral BME at mid-term follow-up after microfracture for OLT had worse clinical outcomes than those without subchondral BME. In addition, the degree of subchondral BME at mid-term follow-up was correlated with clinical outcome. However, in the short-term follow-up, there were no significant differences in clinical outcomes based on both the presence and degree of BME. The current study suggests that BME at short-term follow-up is a normal physiologic reaction. However, BME at mid-term following microfracture for OLT may be pathological, and is related to poorer clinical outcomes.

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Influence of Bone Marrow Edema on Medial Unicompartmental Knee Arthroplasty among Patients with Patellofemoral Osteoarthritis

The Journal of Knee Surgery ◽

10.1055/s-0037-1605560 ◽

2017 ◽

Vol 30 (08) ◽

pp. 816-821 ◽

Cited By ~ 1

Author(s):

Jiaji Yue ◽

Xiaojun Ma ◽

Yaqiang Li ◽

Yu Wang ◽

Yuchang Zhu ◽

...

Keyword(s):

Bone Marrow ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Bone Marrow Edema ◽

Patellofemoral Osteoarthritis ◽

Vas Scores ◽

Marrow Edema

AbstractThis study aims to compare clinical outcomes in unicompartmental knee arthroplasty (UKA) patients with or without magnetic resonance imaging (MRI) evidence of bone marrow edema (BME) in the patella and to evaluate the effect of functional outcomes after UKA in patients with patellofemoral osteoarthritis (PF OA). Outcomes of 146 knees in 141 patients who underwent medial UKA were included. According to their preoperative condition of patellofemoral joints, patients were divided into three groups: Group A, non-PF OA (Kellgren–Lawrence [K–L] scale = 0); group B, PF OA without BME (K–L ≥ 1, bone marrow edema pattern [BMEP] = 0); group C, PF OA with BME (K–L ≥ 1, BMEP ≥ 1). Clinical outcomes including visual analog scale (VAS) scores of knee pain, Hospital for Special Surgery (HSS) scores, and range of motions (ROMs) were evaluated and analyzed at the postoperative follow-up of 3 months and 2 years. From our results, BME was highly correlated to poor outcome in patients with UKA. At follow-up of 3 months, BME influenced the clinical outcome of UKA at an early postoperative stage in terms of VAS scores, HSS scores, and ROMs. At the final follow-up of 2 years, the clinical outcome was improved in terms of HSS score, although the anterior knee pain and active ROMs were still worse than that of patients without BME. In conclusion, there was no significant difference in clinical outcomes in patients without BME regardless of PF OA. However, the condition of BME should be taken serious consideration because of its indication of an adverse effect on the outcome after UKA.

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Rock climbing related bone marrow edema of the hand: A follow up study

Orthopedic & Muscular System ◽

10.4172/2161-0533.c1.028 ◽

2016 ◽

Vol 05 (03) ◽

Cited By ~ 2

Author(s):

Christoph Lutter

Keyword(s):

Bone Marrow ◽

Bone Marrow Edema ◽

Rock Climbing ◽

Follow Up Study ◽

Marrow Edema ◽

Related Bone Marrow

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Hip Arthroscopic Management Can Improve Osteitis Pubis and Bone Marrow Edema in Competitive Soccer Players With Femoroacetabular Impingement

The American Journal of Sports Medicine ◽

10.1177/0363546518819099 ◽

2019 ◽

Vol 47 (2) ◽

pp. 408-419 ◽

Cited By ~ 5

Author(s):

Masayoshi Saito ◽

Hajime Utsunomiya ◽

Akihisa Hatakeyama ◽

Hirotaka Nakashima ◽

Haruki Nishimura ◽

...

Keyword(s):

Bone Marrow ◽

Clinical Outcomes ◽

Femoroacetabular Impingement ◽

Bone Marrow Edema ◽

Soccer Players ◽

Harris Hip Score ◽

Osteitis Pubis ◽

Arthroscopic Management ◽

Modified Harris Hip Score ◽

Marrow Edema

Background: There is a dearth of knowledge regarding the correlation between femoroacetabular impingement (FAI) and osteitis pubis (OP) among symptomatic soccer players. Purpose: To elucidate whether arthroscopic FAI correction is effective for young competitive soccer players with FAI combined with OP or perisymphyseal pubic bone marrow edema (BME). Study Design: Case series; Level of evidence, 4. Methods: A total of 577 consecutive patients who underwent arthroscopic FAI correction were retrospectively reviewed with a minimum 2-year follow-up. Competitive soccer players who were professional, college, and high school athletes were included. The authors assessed the modified Harris Hip Score and Nonarthritic Hip Score preoperatively and at 6 months, 1 year, and 2 years after surgery. In addition, players were divided into groups according to radiographic evidence of OP and BME (2 groups each). Clinical outcomes, return to play, and radiographic assessments were compared between groups. Results: Twenty-eight hips met the inclusion criteria. The median modified Harris Hip Score significantly improved after hip arthroscopy (81.4, preoperatively; 95.7 at 6 months, P = .0065; 100 at 1 year, P = .0098; 100 at 2 years, P = .013). The median Nonarthritic Hip Score also significantly improved (75.0, preoperatively; 96.3 at 6 months, P = .015; 98.8 at 1 year, P = .0029; 100 at 2 years, P = .015). Furthermore, 92.0% of players returned to play soccer at the same or higher level of competition at a median 5.5 months (range, 4-15 months); 67.8% had radiological confirmation of OP; and 35.7% had pubic BME. The alpha angle was significantly higher in pubic BME group than the no–pubic BME group (64.8° vs 59.2°, P = .027), although there was no significant difference between the OP and no-OP groups. The prevalence of tenderness of the pubic symphysis significantly decreased preoperatively (32.1%) to postoperatively (3.6%). Magnetic resonance imaging findings confirmed that pubic BME disappeared in all players at a median 11 months (range, 6-36) after initial surgery. Conclusions: Arthroscopic management for FAI provides favorable clinical outcomes, a high rate of return to sports, and, when present, resolution of pubic BME among competitive soccer players.

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The role of bone marrow edema on autologous matrix induced chondrogenesis for the treatment of osteochondral lesions of the talus

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000151 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Riccardo D’Ambrosi ◽

Camilla Maccario ◽

Federico Giuseppe Usuelli

Keyword(s):

Bone Marrow ◽

Repeated Measures ◽

Bone Marrow Edema ◽

Lesion Size ◽

Osteochondral Lesions ◽

Significant Difference ◽

T1 And T2 ◽

Marrow Edema

Category: Ankle, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: to assess the functional and radiological outcomes after AT-AMIC® (arthroscopic talus autologous matrix induced chondrogenesis) in 2 groups: patients with and without bone marrow edema (BME). Methods: Thirty-seven patients of which 24 without edema (GNE) and 13 with edema (GE) were evaluated. All patients were treated with AT-AMIC® repair for osteochondral talar lesion. MRI and CT-scan evaluations, as well as clinical evaluations measured by the VAS score for pain, AOFAS and SF-12 were performed preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively. Results: GNE consisted of 24 patients while GE consisted of 13 patients. In both groups we found a significant difference for clinical and radiological parameters with ANOVA for repeated measures through four time points(p<0.001). In GNE, AOFAS improved significantly at each follow-up(p<0.05); while CT and MRI showed a significant decrease between T1 and T2 and T2 and T3(p<0.05). In GE, AOFAS improved significantly between T0 and T1 and T2 and T3(p<0.05); CT decreased between T1 and T2(p<0.05), while MRI showed a reduction at each follow-up(p<0.05). Lesion size was significantly higher both in MRI and CT in GE in respect to GNE(p<0.05). In the GNE no patients presented edema at T3, while in GE only 23.08% of the patients presented edema at T3. Conclusion: The study revealed that osteochondral lesions of the talus were characterized by bigger size both in MRI and CT in patients with edema. We conclude that AT-AMIC® can be considered a safe and reliable procedure that allows effective healing, regardless of edema and more than half of patients did not present edema six months after surgery.

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Porous tantalum implant for treatment of early-stage osteonecrosis of the femoral head: a minimum 5-year follow-up study

BMC Surgery ◽

10.1186/s12893-021-01352-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yu Zhang ◽

Wang Chen ◽

Zhi Yang ◽

Jian-Ning Sun ◽

Zheng-Hao Hu ◽

...

Keyword(s):

Risk Factors ◽

Bone Marrow ◽

Femoral Head ◽

Bone Marrow Edema ◽

Operation Time ◽

Harris Hip Score ◽

Porous Tantalum ◽

Imaging Results ◽

Marrow Edema

Abstract Background To evaluate the survival rate of porous tantalum rod implantation in the treatment of osteonecrosis of the femoral head (ONFH), evaluate its clinical effect and imaging results. Methods From January 2008 to December 2013, porous tantalum rod implantation for ONFH was performed in two institutions. Statistical analysis of operation data, including operation time, blood loss and blood transfusion were recorded. Results 52 hips received complete follow-up, the average follow-up time was 85.7 months (60–132 months). 24 hips turned to THA at the end of follow-up (46.2%), the average time was 44.3 ± 32.8 months, and the average Harris hip score before THA was 57.1 ± 7.6. Cox proportional-hazards model revealed that Association Research Circulation Osseous (ARCO) stage (P = 0.017), bone marrow edema (P = 0.006) and age > 40 years (P = 0.043) were independent risk factors for conversion to THA. Conclusion ARCO stage, age and bone marrow edema were risk factors for the failure of porous tantalum rod implantation to convert to THA.

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Treatment of Bone Marrow Edema of the Foot and Ankle With the Prostacyclin Analog Iloprost

Foot & Ankle International ◽

10.1177/1071100718778557 ◽

2018 ◽

Vol 39 (10) ◽

pp. 1183-1191 ◽

Cited By ~ 9

Author(s):

Hubert Hörterer ◽

Sebastian Felix Baumbach ◽

Johanne Gregersen ◽

Stefanie Kriegelstein ◽

Oliver Gottschalk ◽

...

Keyword(s):

Bone Marrow ◽

Outcome Measures ◽

Bone Marrow Edema ◽

Pain Treatment ◽

Short Form ◽

Foot And Ankle ◽

Level Of Evidence ◽

Prostacyclin Analog ◽

Marrow Edema

Background: Bone marrow edema (BME) of the foot and ankle is challenging to treat. One approach is intravenous Iloprost treatment, which is a vasoactive prostacyclin analog. The aim of this study was to evaluate the early and intermediate outcome of intravenous Iloprost therapy on BME of the foot and ankle and to analyze the influence of its etiology and Association Research Circulation Osseous (ARCO) stage on the outcome. Methods: This was a retrospective study with prospective follow-up. All patients treated by intravenous Iloprost for BME of the foot and ankle (ARCO I-III) at a single orthopedic reference center were included. Demographics, medical history, and MRIs were assessed prior to treatment (t0). MRIs were used to assess the BMEs’ etiology (idiopathic/ischemic/metabolic, mechanical/degenerative, traumatic) and severity (ARCO). Complications as well as changes in pain, treatment, and MRI were evaluated after 3 months (t1). The following patient-rated outcome measures (PROMs) were assessed prospectively (t2): 12-Item Short Form Health Survey (SF-12), Visual Analog Scale Foot and Ankle (VAS FA), and the Foot Function Index (FFI) (also at t0). The descriptive outcomes and the influence of the etiology and ARCO on the outcome parameters were evaluated. Out of 70 eligible patients, 42 patients (60%; 47 ± 15 years; 30% female) with a mean follow-up of 28 ± 19 months were included. Results: Twelve patients reported minor complications during Iloprost therapy. At t1, pain decreased significantly in 56%, and the amount of BME decreased in 83% of patients. Both parameters correlated moderately (r = −0.463, P = .015). The PROMs at t2 revealed moderate results. The overall FFI improved from 59 ± 21 to 30 ± 22 ( P < .001), the overall VAS FA was 68 ± 20, the SF-12 Physical Component Summary 42 ± 12 and Mental Component Summary 50 ± 9. Subgroup analysis revealed no significant influence of the etiology or ARCO stage on any outcome measure. Conclusion: Iloprost therapy for BME of the foot and ankle resulted in a 60% pain and 80% edema decrease after 3 months. After 2 years, patient-rated outcome measures showed residual impairment. Neither the etiology nor ARCO stage significantly influenced the outcome. Level of Evidence: Level III, comparative study.

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