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

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.

The Presence and Degree of Bone Marrow Edema Influence Midterm Clinical Outcomes After Microfracture for Osteochondral Lesions of the Talus

2018 ◽  
Vol 46 (10) ◽  
pp. 2503-2508 ◽  
Author(s):  
Yoshiharu Shimozono ◽  
Eoghan T. Hurley ◽  
Youichi Yasui ◽  
Timothy W. Deyer ◽  
John G. Kennedy
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Bone Marrow Edema ◽  
Prognostic Indicator ◽  
Osteochondral Lesions ◽  
Short Term ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Marrow Edema

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.

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

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.

scholarly journals Analysis of the Changes in the Clinical Outcomes According to Time After Arthroscopic Microfracture of Osteochondral Lesions of the Talus

2018 ◽  
Vol 40 (1) ◽  
pp. 74-79 ◽  
Author(s):  
Tae Yong Kim ◽  
Seung Hyun Song ◽  
Jong Hun Baek ◽  
Yeok Gu Hwang ◽  
Bi O Jeong
Keyword(s):  
Bone Marrow ◽  
Clinical Outcome ◽  
Bone Marrow Edema ◽  
Symptomatic Improvement ◽  
Lesion Size ◽  
Osteochondral Lesions ◽  
Arthroscopic Microfracture ◽  
Outcome Differences ◽  
Marrow Edema

Background: Arthroscopic microfracture can effectively treat osteochondral lesions of the talus (OLTs). However, very few studies have reported on symptomatic improvement duration and time when symptomatic improvement ceases. This study aimed to investigate the clinical outcome changes after arthroscopic microfracture in patients with OLT. Methods: Among patients who underwent arthroscopic microfracture for OLT, 70 patients were available for follow-up for more than 3 years. Of these, 6 patients who showed worsening or no improvement in the 6 months after surgery were excluded, and a total of 64 patients were included in the analysis. To analyze and compare the clinical outcome changes according to time, the visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores were evaluated every 3 months up to 1 year postoperatively and every 1 year thereafter. The clinical outcome differences based on the lesion size, lesion location, lesion containment, presence of cyst and bone marrow edema, age, sex, and obesity were analyzed. Results: The preoperative and final follow-up VAS scores significantly improved from 6.2 ± 1.1 to 1.2 ± 1.1 ( P< .05) and the AOFAS score from 63.1 ± 7.3 to 91.0 ± 7.3 ( P< .05). The overall success rate for arthroscopic microfracture in this study was 88.6%. The postoperative VAS and AOFAS scores at 3, 6, 9, 12, 24, and 36 months were 3.7 ± 1.4, 2.5 ± 1.3, 2.0 ± 1.1, 1.6 ± 1.2, 1.2 ± 1.2, and 1.3 ± 1.2 and 74.7 ± 10.3, 80.5 ± 8.9, 84.3 ± 7.4, 88.3 ± 7.3, 91.1 ± 7.2, and 90.8 ± 7.5, respectively, showing significant improvements up to 2 years. After 2 years, the symptoms did not improve but were maintained at a certain level up to 3 years. No clinical outcome differences based on the lesion size, lesion containment, presence of cyst and bone marrow edema, age, sex, and obesity were observed. Conclusion: Symptomatic improvement early after arthroscopic microfracture for OLT was observed continuously for up to 2 years postoperatively. Symptom improvement was maintained without worsening for up to 3 years after surgery. Determining the final outcome of microfracture at least after 2 years would be reasonable. Level of Evidence: Level IV, case series.

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

2017 ◽  
Vol 30 (08) ◽  
pp. 816-821 ◽  
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.

AB0298 LONG-TERM SUPPRESSION OF RAPID RADIOGRAPHIC PROGRESSION AFTER DISCONTINUATION/REDUCTION OF SHORT-TERM BIOLOGIC THERAPY IN PATIENTS WITH EARLY DESTRUCTIVE RHEUMATOID ARTHRITIS ACCOMPANIED WITH EXTENSIVE BONE MARROW EDEMA.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1448-1449
Author(s):  
K. Katayama ◽  
T. Okubo ◽  
T. Sato ◽  
R. Fukai ◽  
M. Yuichi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Marrow ◽  
Biological Treatment ◽  
Bone Marrow Edema ◽  
Radiographic Progression ◽  
Term Treatment ◽  
Short Term ◽  
Short Term Treatment ◽  
Significant Difference ◽  
Marrow Edema

Background:We reported that short-term (3 or 6 months) treatment with biologics (BIO) group compared with conventional synthetic non-biological disease-modifying anti rheumatic drug (csDMARDs) enhanced group is more effective in the reducing bone marrow edema (BE) and improving structural remission in early destructive RA accompanied with extensive hand BM despite csDMARDs therapy (1).Objectives:Purpose of this extended study is to investigate whether suppression of RRP will maintain after the discontinuation/reduction of short term biological treatment during over 1 year. Clinical registration number; (UMIN-CTR 000013614)(Figure 1)Methods:RA disease activity was evaluated by DAS28-ESR after BIO withdrawal/reduction at 12 months. Bone destruction was determined by modified total Sharp scoring (mTSS) using by conventional radiography expressed as yearly progression of mTSS (ΔmTSS/y) at 12 months. Statistical analysis were performed by t-test or Wilcoxon rank sum test using SAS .13.2 softwareResults:Fourteen out of 23 patients in BIO group achieved improvement of BM (>70% improvement of baseline BE). Three patient continued BIO. Among 11 patient started to discontinuation/reduction of BIO, 7 patients were successful for discontinuation of BIO. Four patients flared (Table 1). Mean DAS28-ESR, mean ΔmTSS/y at 0, 12 months after discontinuation in 7 patients were 1.77, 2.02 and -0.66,-0.44, respectively (no significant difference between values in 0 and12 month). In contrast, those in 4 flared patients were 1.91, 4.08 and 0, 1.83, respectively (significant difference). Finally, to resolve baseline prognostic factors for improvement of BE for biological treatment, we compared baseline data between 14 BE improved and 9 BE unimproved RA patients. Low DAS28-ESR at 3 or 6 month (P<0.001) are indicated for significant prognostic factor for improvement of BE, although Low DAS28-ESR at baseline (P=0.07) may associate improvement of BE.Table 1.Summary of 1 year clinical data in 11 patients treated in BIO discontinuation/reduction after improvement of BE by short-term treatment of BIOConclusion:Results of this study indicated suppression of RRP will maintain during over 1 year after the discontinuation of short term biological treatment in some patients. We recommend that a short-term treatment with biologics for early RA patients, who are resistant to non-bio DMARDs therapy and at high risk to transit to RRP, will be an effective and economical treatment strategy.References:[1]K. Katayama, T. Okubo, S. Sato et al. Prevention of extensive bone marrow edema and consequent rapid radiographic progression by short term usage of biologics in DMARDs resistant patients with early destructive rheumatoid arthritis. EULAR meeting. FRI 0124(2018).Disclosure of Interests:None declared

Calcium-Suppressed Technique in Dual-Layer Detector Computed Tomography to Evaluate Knee Articular Cartilage

2020 ◽  
Vol 16 ◽  
Author(s):  
Qinglin Meng ◽  
Mengqi Liu ◽  
Weiwei Deng ◽  
Ke Chen ◽  
Botao Wang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Marrow ◽  
Articular Cartilage ◽  
Bone Marrow Edema ◽  
Knee Joints ◽  
Infrapatellar Fat Pad ◽  
Proton Density ◽  
Knee Cartilage ◽  
Significant Difference ◽  
Marrow Edema

Background: Calcium-suppressed (CaSupp) technique involving spectral-based images has been used to observe bone marrow edema by removing calcium components from the image. Objective: This study aimed to evaluate the knee articular cartilage using the CaSupp technique in dual-layer detector computed tomography (DLCT). Methods: Twenty-eight healthy participants and two patients with osteoarthritis were enrolled, who underwent DLCT and magnetic resonance imaging (MRI) examination. CaSupp images were reconstructed from spectral-based images using a calcium suppression algorithm and were overlaid conventional CT images for visual evaluation. The morphology of the knee cartilage was evaluated, and the thickness of the articular cartilage was measured on sagittal proton density– weighted and CaSupp images in the patellofemoral compartment. Results: No abnormal signal or density, cartilage defect, and subjacent bone ulceration were observed in the lateral and medial femorotibial compartments and the patellofemoral compartment on MRI images and CaSupp images for the 48 normal knee joints. CaSupp images could clearly identify cartilage thinning, defect, subjacent bone marrow edema, and edema of the infrapatellar fat pad in the same way as MRI images in the three knee joints with osteoarthritis. A significant difference was found in the mean thickness of the patellar cartilage between MRI images and CaSupp images, while the femoral cartilage presented no significant difference in thickness between MRI images and CaSupp images over all 48 knee joints. Conclusion: The present study demonstrated that CaSupp images could effectively be used to perform the visual and quantitative assessment of knee cartilage.

scholarly journals Satisfactory long-term clinical outcomes after bone marrow stimulation of osteochondral lesions of the talus

2021 ◽  
Author(s):  
Quinten G. H. Rikken ◽  
Jari Dahmen ◽  
Sjoerd A. S. Stufkens ◽  
Gino M. M. J. Kerkhoffs
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Degenerative Changes ◽  
Osteochondral Lesions ◽  
Ankle Osteoarthritis ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
The Mean

Abstract Purpose The purpose of the present study was to evaluate the clinical and radiological outcomes of arthroscopic bone marrow stimulation (BMS) for the treatment of osteochondral lesions of the talus (OLTs) at long-term follow-up. Methods A literature search was conducted from the earliest record until March 2021 to identify studies published using the PubMed, EMBASE (Ovid), and Cochrane Library databases. Clinical studies reporting on arthroscopic BMS for OLTs at a minimum of 8-year follow-up were included. The review was performed according to the PRISMA guidelines. Two authors independently conducted the article selection and conducted the quality assessment using the Methodological index for Non-randomized Studies (MINORS). The primary outcome was defined as clinical outcomes consisting of pain scores and patient-reported outcome measures. Secondary outcomes concerned the return to sport rate, reoperation rate, complication rate, and the rate of progression of degenerative changes within the tibiotalar joint as a measure of ankle osteoarthritis. Associated 95% confidence intervals (95% CI) were calculated based on the primary and secondary outcome measures. Results Six studies with a total of 323 ankles (310 patients) were included at a mean pooled follow-up of 13.0 (9.5–13.9) years. The mean MINORS score of the included studies was 7.7 out of 16 points (range 6–9), indicating a low to moderate quality. The mean postoperative pooled American Orthopaedic Foot and Ankle Society (AOFAS) score was 83.8 (95% CI 83.6–84.1). 78% (95% CI 69.5–86.8) participated in sports (at any level) at final follow-up. Return to preinjury level of sports was not reported. Reoperations were performed in 6.9% (95% CI 4.1–9.7) of ankles and complications related to the BMS procedure were observed in 2% (95% CI 0.4–3.0) of ankles. Progression of degenerative changes was observed in 28% (95% CI 22.3–33.2) of ankles. Conclusion Long-term clinical outcomes following arthroscopic BMS can be considered satisfactory even though one in three patients show progression of degenerative changes from a radiological perspective. These findings indicate that OLTs treated with BMS may be at risk of progressing towards end-stage ankle osteoarthritis over time in light of the incremental cartilage damage cascade. The findings of this study can aid clinicians and patients with the shared decision-making process when considering the long-term outcomes of BMS. Level of evidence Level IV.

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