Aetiology and Pathogenesis of Bone Marrow Lesions and Osteonecrosis of the Knee

Overview

Journal EFORT Open Rev

Specialty Orthopedics

Date 2017 May 3

PMID 28461951

Citations 14

Authors

Maurilio Marcacci

Luca Andriolo

Elizaveta Kon

Nogah Shabshin

Giuseppe Filardo

Affiliations

Soon will be listed here.

Abstract

Bone marrow lesions (BML) of the knee are a frequent MRI finding, present in many different pathologies including trauma, post-cartilage surgery, osteoarthritis, transient BML syndromes, spontaneous insufficiency fractures, and true osteonecrosis.Osteonecrosis (ON) is in turn divided into spontaneous osteonecrosis (SONK), which is considered to be correlated to subchondral insufficiency fractures (SIFK), and avascular necrosis (AVN) which is mainly ascribable to ischaemic events.Every condition has a MRI pattern, a different clinical presentation, and specific histological features which are important in the differential diagnosis.The current evidence supports an overall correlation between BML and patient symptoms, although literature findings are variable, and very little is known about the natural history and the progression of these lesions.A full understanding of BML will be mandatory in the future to better address the different pathologies and develop appropriately-targeted treatments. Cite this article: Marcacci M, Andriolo L, Kon E, Shabshin N, Filardo G. Aetiology and pathogenesis of bone marrow lesions and osteonecrosis of the knee. 2016;1:219-224. DOI: 10.1302/2058-5241.1.000044.

Citing Articles

A case of subchondral insufficiency fracture of the knee potentially caused by mediolateral knee laxity without structural abnormalities.

Oshima Y, Watanabe N, Kajikawa Y, Yotsumoto T, Watanabe Y, Majima T BMC Musculoskelet Disord. 2025; 26(1):197.

PMID: 40001123 PMC: 11852882. DOI: 10.1186/s12891-025-08452-y.

Bone marrow lesion and medial meniscus extrusion width changes following arthroscopic partial meniscectomy for medial meniscal flap tears.

Sekiya H, Takatoku K, Okami H, Kanaya Y, Yanagisawa K J Orthop Surg Res. 2025; 20(1):123.

PMID: 39891265 PMC: 11783904. DOI: 10.1186/s13018-025-05535-3.

A nosographic and etiopathogenetic framework for subchondral bone marrow lesions in the knee: A narrative review.

Andriolo L, Sangiorgio A, Galea A, Linder-Ganz E, Orth P, Shabshin N J Exp Orthop. 2025; 12(1):e70071.

PMID: 39822660 PMC: 11736153. DOI: 10.1002/jeo2.70071.

Dual-energy CT: Impact of detecting bone marrow oedema in occult trauma in the Emergency.

Ahmad M, Liu L, Sheikh A, Nicolaou S BJR Open. 2024; 6(1):tzae025.

PMID: 39345237 PMC: 11427222. DOI: 10.1093/bjro/tzae025.

Subchondral bone: An emerging target for the treatment of articular surface lesions of the knee.

Sangiorgio A, Andriolo L, Gersoff W, Kon E, Nakamura N, Nehrer S J Exp Orthop. 2024; 11(3):e12098.

PMID: 39040436 PMC: 11260998. DOI: 10.1002/jeo2.12098.

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