scholarly journals Elderly patients with medial meniscus tear should be aware of the occurrence of osteonecrosis: A case report and literature review

2020 ◽  
Author(s):  
Weiming Yang ◽  
Caiqiong Zhao ◽  
Xuewei Cao
Keyword(s):  
Elderly Patients ◽  
Knee Pain ◽  
Subchondral Bone ◽  
Medial Meniscus ◽  
Early Stage ◽  
Weight Bearing ◽  
Left Knee ◽  
Meniscus Tear ◽  
Walking Ability ◽  
Meniscal Root Tear

Abstract Background: Spontaneous osteonecrosis of the knee (SONK) was defined as a distinct clinical entity with characteristical findings that subchondral lesions in the weight-bearing region of a single condyle. In the early stage of SONK, we usually think that injury of meniscus was to blame for the knee pain. Elderly patients with medial meniscus tear should be aware of the occurrence of osteonecrosis. Case presentation：A 67-year-old male complained of pain in the left knee for 3 months in 2013. Magnetic resonance imaging (MRI) revealed a medial meniscal root tear (level III), so that he patient underwent arthroscopic meniscectomy. However, no obvious pain relief achieved at the follow-up. The pain was associated with weight bearing, of which was initially intermittent, gradually progressed in intensity and became frequent even at rest. At 18 months after the first visit, we re-examined the knee MRI and results clearly revealed subchondral bone osteonecrosis of the condyle. Finally, we performed unicompartmental arthroplasty which significantly relieved the pain and restored the walking ability of the patient. Conclusions: Meniscus injury often coexist with SONK. In the early stages of SONK, the area of necrosis is small which is very easy to be ignored causing a misdiagnosis. The case reminds us should pay much attention to the possibility of subchondral bone necrosis in patients with knee pain and meniscal injury.

scholarly journals A TRIATHLETE WITH MEDIAL MENISCUS TEAR AND SUBCHONDRAL INSUFFICIENCY FRACTURE

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Azlan M. Naing ◽  
Mariam G.M.
Keyword(s):  
Knee Pain ◽  
Medial Meniscus ◽  
Weight Bearing ◽  
Insufficiency Fracture ◽  
Meniscus Tear ◽  
Unusual Site ◽  
Subchondral Insufficiency Fracture ◽  
Tibial Condyle ◽  
One Year ◽  
Work Up

Subchondral insufficiency fracture of the knee (SIFK) is an important differential diagnosis for knee pain. If diagnosed early, SIFK can be treated conservatively with non-weight bearing ambulation. If left untreated, this disease may lead to catastrophic complications such as subchondral fragment detachment and fragmentation or subchondral collapse which will warrant the need for surgical intervention. The author reports a 44-year-old triathlete that presented with complaint of a trivial left anteromedial knee pain for one-year duration. This disease presented at an unusual site of the medial tibial condyle. Moreover, the patient is a healthy triathlete that does not have any predisposing factors for SIFK. Magnetic resonance imaging showed subchondral insufficiency fracture of the medial tibial condyle with a complex multi-directional medial meniscus tear in the same knee. Could the undiagnosed medial meniscus injury be the causation leading to the development of SIFK? Here, the author will summarize the literature on various clinical features, work-up and management of SIFK.

scholarly journals Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial

2017 ◽  
Vol 77 (2) ◽  
pp. 188-195 ◽  
Author(s):  
Raine Sihvonen ◽  
Mika Paavola ◽  
Antti Malmivaara ◽  
Ari Itälä ◽  
Antti Joukainen ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Medial Meniscus ◽  
Controlled Trial ◽  
Partial Meniscectomy ◽  
Meniscus Tear ◽  
Arthroscopic Partial Meniscectomy ◽  
Serious Adverse Events ◽  
Secondary Outcomes

ObjectiveTo assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus.MethodsIn this multicentre, randomised, participant-blinded and outcome assessor-blinded, placebo-surgery controlled trial, 146 adults, aged 35–65 years, with knee symptoms consistent with degenerative medial meniscus tear and no knee osteoarthritis were randomised to APM or placebo surgery. The primary outcome was the between-group difference in the change from baseline in the Western Ontario Meniscal Evaluation Tool (WOMET) and Lysholm knee scores and knee pain after exercise at 24 months after surgery. Secondary outcomes included the frequency of unblinding of the treatment-group allocation, participants' satisfaction, impression of change, return to normal activities, the incidence of serious adverse events and the presence of meniscal symptoms in clinical examination. Two subgroup analyses, assessing the outcome on those with mechanical symptoms and those with unstable meniscus tears, were also carried out.ResultsIn the intention-to-treat analysis, there were no significant between-group differences in the mean changes from baseline to 24 months in WOMET score: 27.3 in the APM group as compared with 31.6 in the placebo-surgery group (between-group difference, −4.3; 95% CI, −11.3 to 2.6); Lysholm knee score: 23.1 and 26.3, respectively (−3.2; −8.9 to 2.4) or knee pain after exercise, 3.5 and 3.9, respectively (−0.4; −1.3 to 0.5). There were no statistically significant differences between the two groups in any of the secondary outcomes or within the analysed subgroups.ConclusionsIn this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.

scholarly journals Association of subchondral bone marrow lesion localisation with weight bearing pain in people with knee osteoarthritis: data from the Osteoarthritis Initiative

2021 ◽  
Author(s):  
Koji Aso ◽  
Seyed Mohsen Shahtaheri ◽  
Daniel F. McWilliams ◽  
David A. Walsh
Keyword(s):  
Bone Marrow ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Subchondral Bone ◽  
Negative Binomial ◽  
Weight Bearing ◽  
The Other ◽  
Knee Oa ◽  
Pain Scores ◽  
Osteoarthritis Initiative

Abstract Background Subchondral bone marrow lesions (BMLs) detected on MRI in knee osteoarthritis (OA) are associated with knee pain. The prevalence and progression of subchondral BMLs are increased by mechanical knee load. However, associations of subchondral BML location with weight-bearing knee pain are currently unknown. In this study, we aim to demonstrate associations of subchondral BML location and size with weight-bearing knee pain in knee OA.Methods We analyzed 1412 and 582 varus knees from cross-sectional and longitudinal Osteoarthritis Initiative datasets, respectively. BML scores were semi-quantitatively analysed with the MRI Osteoarthritis Knee Score for 4 subchondral regions (median and lateral femorotibial, medial and lateral patellofemoral) and subspinous region. Weight-bearing and non-weight-bearing pain scores were derived from WOMAC pain items. Correlation and negative binomial regression models were used for analysis of associations between the BML scores and pain at baseline, and changes in the BML scores and changes in pain after 24-month follow up.Results Greater BML scores at medial femorotibial and lateral patellofemoral compartments were associated with greater weight-bearing pain scores, and statistical significance was retained after adjusting for BML scores at the other 4 joint compartments and other OA features, as well as for non-weight-bearing pain, age, sex and Body Mass Index (BMI) (medial femorotibial; B=0.08, p=0.02. patellofemoral; B=0.13, p=0.01). Subanalysis revealed that greater medial femorotibial BML scores were associated with greater pain on walking and standing (B=0.11, p=0.01, and B=0.10, p=0.04, respectively). Lateral patellofemoral BML scores were associated with pain on climbing, respectively B=0.14, p=0.02. Increases or decreases over 24 months in BML score in the medial femorotibial compartment were significantly associated with increases or decreases in weight-bearing pain severity after adjusting for non-weight-bearing pain, age, sex, baseline weight-bearing pain, BMI, and BML at the other 4 joint compartments (B=0.10, p=0.01). Conclusions Subchondral BML size at the medial femorotibial joint compartment was specifically associated with the severity and the change in weight-bearing pain, independent of non-weight-bearing pain, in knee OA. Specific associations of weight-bearing pain with subchondral BMLs in weight-bearing compartments of the knee indicate that BMLs in subchondral bone contribute to biomechanically-induced OA pain.

scholarly journals PROLOTHERAPY COMBINED WITH PHYSICAL THERAPY IN A RECREATIONALLY ACTIVE MIDDLE-AGED MAN WITH CHONDROMALACIA PATELLA

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Kristin Bowne ◽  
Joshua Prall ◽  
Michael Ross
Keyword(s):  
Physical Therapy ◽  
Knee Pain ◽  
Physical Therapist ◽  
Weight Bearing ◽  
Left Knee ◽  
Middle Aged ◽  
Hamstring Muscles ◽  
Patient Reported ◽  
Chondromalacia Patella ◽  
Training Activities

The purpose of this case report is to describe the use of physical therapy combined with prolotherapy in a recreationally active, middle-aged man with knee pain and chondromalacia patella. The patient was a 50 year-old male triathlete presenting with a chief complaint of persistent left knee stiffness and anterolateral knee pain. The patient’s symptoms began insidiously 9 months prior after an increase in his triathlon training activities. His knee pain progressed to the point that he could not perform any weight bearing exercise without significant discomfort. Previous treatments included management by a physical therapist, as well as corticosteroid and hyaluronic acid injections. Although these previous treatments provided minimal benefit, the patient sought further management by another physical therapist. Magnetic resonance imaging findings revealed moderate to severe chondromalacia at the lateral patellar facet. In addition to management by a physical therapist, the patient received a series of three prolotherapy injections to the knee. Physical therapy management consisted of manual therapy for the lower quarter, targeted therapeutic exercise to address strength deficits of the quadriceps and hamstring muscles, and a gradual return to weight bearing exercise and functional activity. At 4 months following the physical therapy and prolotherapy injections, the patient reported no pain during daily activities. Additionally, he had returned to swimming, cycling, unlimited walking and hiking on various surfaces, and agility drills. In patients with knee pain and chondromalacia patella, especially those who have not responded to prior interventions, physical therapy combined with prolotherapy may serve as a treatment option. <p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0887/a.php" alt="Hit counter" /></p>

scholarly journals Association of subchondral bone marrow lesion localisation with weight bearing pain in people with knee osteoarthritis: data from the Osteoarthritis Initiative

2020 ◽  
Author(s):  
Koji Aso ◽  
Seyed Mohsen Shahtaheri ◽  
Daniel F. McWilliams ◽  
David A. Walsh
Keyword(s):  
Bone Marrow ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Subchondral Bone ◽  
Negative Binomial ◽  
Weight Bearing ◽  
The Other ◽  
Knee Oa ◽  
Pain Scores ◽  
Osteoarthritis Initiative

Abstract Background: Subchondral bone marrow lesions (BMLs) detected on MRI in knee osteoarthritis (OA) are associated with knee pain. The prevalence and progression of subchondral BMLs are increased by mechanical knee load. However, associations of subchondral BML location with weight-bearing knee pain are currently unknown. In this study, we aim to demonstrate associations of subchondral BML location and size with weight-bearing knee pain in knee OA. Methods: We analyzed 1412 and 582 varus knees from cross-sectional and longitudinal Osteoarthritis Initiative datasets, respectively. BML scores were semi-quantitatively analysed with the MRI Osteoarthritis Knee Score for 4 subchondral region s (median and lateral femorotibial, medial and lateral patellofemoral) and subspinous region. Weight-bearing and non-weight-bearing pain scores were derived from WOMAC pain items. Correlation and negative binomial regression models were used for analysis of associations between the BML scores and pain at baseline, and changes in the BML scores and changes in pain after 24-month follow up. Results: Greater BML scores at medial femorotibial and lateral patellofemoral compartments were associated with greater weight-bearing pain scores, and statistical significance was retained after adjusting for BML scores at the other 4 joint compartments and other OA features, as well as for non-weight-bearing pain, age, sex and Body Mass Index (BMI) (medial femorotibial; B=0.08, p=0.02. patellofemoral; B=0.13, p=0.01). Subanalysis revealed that greater medial femorotibial BML scores were associated with greater pain on walking and standing (B=0.11, p=0.01, and B=0.10, p=0.04, respectively ). Lateral patellofemoral BML scores were associated with pain on climbing, respectively B=0.14, p=0.02. Increases or decreases over 24 months in BML score in the medial femorotibial compartment were significantly associated with increases or decreases in weight-bearing pain severity after adjusting for non-weight-bearing pain, age, sex, baseline weight-bearing pain, BMI, and BML at the other 4 joint compartments (B=0.10, p=0.01). Conclusions: Subchondral BML size at the medial femorotibial joint compartment was specifically associated with the severity and the change in weight-bearing pain, independent of non-weight-bearing pain, in knee OA. Specific associations of weight-bearing pain with subchondral BMLs in weight-bearing compartments of the knee indicate that BMLs in subchondral bone contribute to biomechanically-induced OA pain.

scholarly journals Association of subchondral bone marrow lesion localisation with weight bearing pain in people with knee osteoarthritis: data from the Osteoarthritis Initiative

2021 ◽  
Author(s):  
Koji Aso ◽  
Seyed Mohsen Shahtaheri ◽  
Daniel F. McWilliams ◽  
David A. Walsh
Keyword(s):  
Bone Marrow ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Subchondral Bone ◽  
Negative Binomial ◽  
Weight Bearing ◽  
The Other ◽  
Knee Oa ◽  
Pain Scores ◽  
Osteoarthritis Initiative

Abstract Background Subchondral bone marrow lesions (BMLs) detected on MRI in knee osteoarthritis (OA) are associated with knee pain. The prevalence and progression of subchondral BMLs are increased by mechanical knee load. However, associations of subchondral BML location with weight-bearing knee pain are currently unknown. In this study, we aim to demonstrate associations of subchondral BML location and size with weight-bearing knee pain in knee OA.Methods We analyzed 1412 and 582 varus knees from cross-sectional and longitudinal Osteoarthritis Initiative datasets, respectively. BML scores were semi-quantitatively analysed with the MRI Osteoarthritis Knee Score for 4 subchondral regions (median and lateral femorotibial, medial and lateral patellofemoral) and subspinous region. Weight-bearing and non-weight-bearing pain scores were derived from WOMAC pain items. Correlation and negative binomial regression models were used for analysis of associations between the BML scores and pain at baseline, and changes in the BML scores and changes in pain after 24-month follow up.Results Greater BML scores at medial femorotibial and lateral patellofemoral compartments were associated with greater weight-bearing pain scores, and statistical significance was retained after adjusting for BML scores at the other 4 joint compartments and other OA features, as well as for non-weight-bearing pain, age, sex and Body Mass Index (BMI) (medial femorotibial; B=0.08, p=0.02. patellofemoral; B=0.13, p=0.01). Subanalysis revealed that greater medial femorotibial BML scores were associated with greater pain on walking and standing (B=0.11, p=0.01, and B=0.10, p=0.04, respectively). Lateral patellofemoral BML scores were associated with pain on climbing, respectively B=0.14, p=0.02. Increases or decreases over 24 months in BML score in the medial femorotibial compartment were significantly associated with increases or decreases in weight-bearing pain severity after adjusting for non-weight-bearing pain, age, sex, baseline weight-bearing pain, BMI, and BML at the other 4 joint compartments (B=0.10, p=0.01). Conclusions Subchondral BML size at the medial femorotibial joint compartment was specifically associated with the severity and the change in weight-bearing pain, independent of non-weight-bearing pain, in knee OA. Specific associations of weight-bearing pain with subchondral BMLs in weight-bearing compartments of the knee indicate that BMLs in subchondral bone contribute to biomechanically-induced OA pain.

scholarly journals Association of Bone Marrow Lesion Localisation with Weight Bearing Pain in People with Knee Osteoarthritis: Data From The Osteoarthritis Initiative

2020 ◽  
Author(s):  
Koji Aso ◽  
Seyed Mohsen Shahtaheri ◽  
Daniel F. McWilliams ◽  
David A. Walsh
Keyword(s):  
Bone Marrow ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Subchondral Bone ◽  
Negative Binomial ◽  
Weight Bearing ◽  
The Other ◽  
Knee Oa ◽  
Pain Scores ◽  
Osteoarthritis Initiative

Abstract Background: Subchondral bone marrow lesions (BMLs) detected on MRI in knee osteoarthritis (OA) are associated with knee pain. The prevalence and progression of BMLs are increased by mechanical knee load. However, associations of BML location with weight-bearing knee pain are currently unknown. In this study, we aim to demonstrate associations of BML location with weight-bearing knee pain in knee OA.Methods: We analyzed 1412 and 582 varus knees from cross-sectional and longitudinal Osteoarthritis Initiative datasets, respectively. BML scores were analysed for 5 anatomical regions (median and lateral femorotibial, medial and lateral patellofemoral, and subspinous). Weight-bearing and non-weight-bearing pain scores were derived from WOMAC pain items. Correlation and negative binomial regression models were used for analysis of associations between the BML scores and pain at baseline, and changes in the BML scores and changes in pain after 24-month follow up.Results: Greater BML scores at medial femorotibial and lateral patellofemoral compartments were associated with total and weight-bearing pain scores, and statistical significance was retained after adjusting for BML scores at the other 4 joint compartments and other OA features, as well as for non-weight-bearing pain, age, sex and Body Mass Index (BMI) (femorotibial; B=0.08 (95%CI, 0.01-0.09) p=0.02, patellofemoral; B=0.13 (95%CI, 0.03-0.23) p=0.01). BML scores were not significantly associated with non-weight-bearing pain after adjustment for weightbearing pain and other demographic and OA features. Change over 24 months in BML score in the medial femorotibial compartment was significantly associated with change in weight-bearing pain after adjusting for non-weight-bearing pain, age, sex, baseline weight-bearing pain, BMI, and BML at the other 4 joint compartments (B=0.10 (95%CI, 0.02-0.18) p=0.01). Conclusions: BML size at the medial femorotibial joint compartment was specifically associated with the severity and the change in weight-bearing pain, independent of non-weight-bearing pain, in knee OA. Specific associations of weight-bearing pain with BMLs in weight-bearing compartments of the knee indicate that BMLs in subchondral bone contribute to biomechanically-induced OA pain.

scholarly journals Association of subchondral bone marrow lesion localization with weight-bearing pain in people with knee osteoarthritis: data from the Osteoarthritis Initiative

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Koji Aso ◽  
Seyed Mohsen Shahtaheri ◽  
Daniel F. McWilliams ◽  
David A. Walsh
Keyword(s):  
Bone Marrow ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Subchondral Bone ◽  
Negative Binomial ◽  
Weight Bearing ◽  
The Other ◽  
Knee Oa ◽  
Pain Scores ◽  
Osteoarthritis Initiative

Abstract Background Subchondral bone marrow lesions (BMLs) detected on MRI in knee osteoarthritis (OA) are associated with knee pain. The prevalence and progression of subchondral BMLs are increased by mechanical knee load. However, associations of subchondral BML location with weight-bearing knee pain are currently unknown. In this study, we aim to demonstrate associations of subchondral BML location and size with weight-bearing knee pain in knee OA. Methods We analyzed 1412 and 582 varus knees from cross-sectional and longitudinal Osteoarthritis Initiative datasets, respectively. BML scores were semi-quantitatively analyzed with the MRI Osteoarthritis Knee Score for 4 subchondral regions (median and lateral femorotibial, medial and lateral patellofemoral) and subspinous region. Weight-bearing and non-weight-bearing pain scores were derived from WOMAC pain items. Correlation and negative binomial regression models were used for analysis of associations between the BML scores and pain at baseline and changes in the BML scores and changes in pain after 24-month follow-up. Results Greater BML scores at medial femorotibial and lateral patellofemoral compartments were associated with greater weight-bearing pain scores, and statistical significance was retained after adjusting for BML scores at the other 4 joint compartments and other OA features, as well as for non-weight-bearing pain, age, sex, and body mass index (BMI) (medial femorotibial; B = 0.08, p = 0.02. patellofemoral; B = 0.13, p = 0.01). Subanalysis revealed that greater medial femorotibial BML scores were associated with greater pain on walking and standing (B = 0.11, p = 0.01, and B = 0.10, p = 0.04, respectively). Lateral patellofemoral BML scores were associated with pain on climbing, respectively (B = 0.14, p = 0.02). Increases or decreases over 24 months in BML score in the medial femorotibial compartment were significantly associated with increases or decreases in weight-bearing pain severity after adjusting for non-weight-bearing pain, age, sex, baseline weight-bearing pain, BMI, and BML at the other 4 joint compartments (B = 0.10, p = 0.01). Conclusions Subchondral BML size at the medial femorotibial joint compartment was specifically associated with the severity and the change in weight-bearing pain, independent of non-weight-bearing pain, in knee OA. Specific associations of weight-bearing pain with subchondral BMLs in weight-bearing compartments of the knee indicate that BMLs in subchondral bone contribute to biomechanically induced OA pain.

scholarly journals A Serum Metabolomics Classifier Derived from Elderly Patients with Metastatic Colorectal Cancer Predicts Relapse in the Adjuvant Setting

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2762
Author(s):  
Samantha Di Donato ◽  
Alessia Vignoli ◽  
Chiara Biagioni ◽  
Luca Malorni ◽  
Elena Mori ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Stratification ◽  
Elderly Patients ◽  
Metastatic Colorectal Cancer ◽  
Early Stage ◽  
Prospective Trial ◽  
Proton Nuclear Magnetic Resonance ◽  
P Value ◽  
Resonance Spectroscopy ◽  
Metabolomic Fingerprinting

Adjuvant treatment for patients with early stage colorectal cancer (eCRC) is currently based on suboptimal risk stratification, especially for elderly patients. Metabolomics may improve the identification of patients with residual micrometastases after surgery. In this retrospective study, we hypothesized that metabolomic fingerprinting could improve risk stratification in patients with eCRC. Serum samples obtained after surgery from 94 elderly patients with eCRC (65 relapse free and 29 relapsed, after 5-years median follow up), and from 75 elderly patients with metastatic colorectal cancer (mCRC) obtained before a new line of chemotherapy, were retrospectively analyzed via proton nuclear magnetic resonance spectroscopy. The prognostic role of metabolomics in patients with eCRC was assessed using Kaplan–Meier curves. PCA-CA-kNN could discriminate the metabolomic fingerprint of patients with relapse-free eCRC and mCRC (70.0% accuracy using NOESY spectra). This model was used to classify the samples of patients with relapsed eCRC: 69% of eCRC patients with relapse were predicted as metastatic. The metabolomic classification was strongly associated with prognosis (p-value 0.0005, HR 3.64), independently of tumor stage. In conclusion, metabolomics could be an innovative tool to refine risk stratification in elderly patients with eCRC. Based on these results, a prospective trial aimed at improving risk stratification by metabolomic fingerprinting (LIBIMET) is ongoing.

Sign in / Sign up

Export Citation Format

Share Document