Patients with subchondral insufficiency fracture characteristically have unremarkable plain radiographs, while MRI examination may reveal extensive bone marrow oedema and subchondral bone collapse
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 Although the literature describing osteonecrosis of the knee and femoral head commonly refers to the initial fractures as subchondral insufficiency fractures, osteoporosis is not generally a diagnosis reliably made with MRI, so these injuries are referred to as subchondral fractures in this discussion The term insufficiency fracture implies bone that is inadequate to sustain a force or repeated forces that would be within the physiologic limits of normal bone. The term insufficiency fracture is often applied to subchondral bone changes seen on knee magnetic resonance images (MRIs) (Figure 1). These are typically located in th
Subchondral insufficiency fracture of the knee (SIFK) typically presents as a subchondral plate fracture surrounded by perifocal flame-like marrow edema, which can extend along and beyond the adjacent epiphysis Subchondral Insufficiency Fracture of the Knee Spontaneous osteonecrosis of the knee (SONK), also called subchondral insufficiency fractures of the knee (SIFK), was first described by Ahlback in 1968 and is a diagnosis that is sometimes overlooked and attributed to knee osteoarthritis Subchondral insufficiency fracture of the knee (SIFK) is a potentially devastating disorder that may progress rapidly to osteoarthritis with articular surface collapse. It should be suspected in th.. Magnetic resonance imaging (MRI) of the knee: a pattern approach for evaluating bone marrow edema. Crit Rev Diagn Imaging, 37 (1996), pp. 261-303. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Joint Surg Am, 82 (2000), pp. 858-866 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
Intraoperative fluoroscopy should be correlated with preoperative MRI, which better characterizes the bone marrow lesion. The level of subchondral bone is 5-10 mm below the articular surface of the knee. Periodic fluoroscopy should be used while drilling to avoid entry into an unwarranted site within the knee Most Commonly Imaged MSK Cases: Cincinnati Live Review presented by Dr. Stephen Pomeranz, MDhttps://mrionline.com/p/most-commonly-imaged-msk-cases-cincinnati.. Background: Subchondral insufficiency fracture greatly impacts the quality of life of patients, causes much pain, and has the potential to rapidly progress to degeneration of the knee. Application of a calcium phosphate bone graft to the subchondral insufficiency fracture area has emerged as a relevant therapeutic approach to improve symptoms and avoid the occurrence of bone collapse
T1-weighted MRI (bottom), with the presence of a subchondral fracture in type 2, subchondral cystic changes in type 3, and collapse in type 4 Table 1 Comparisons of demographic data, physical findings, and incidence of trauma between patients and control subject What is subchondral insufficiency fracture of the knee? Describe its MRI appearance. Subchondral insufficiency fracture of the knee is characterized by sudden onset of pain in the absence of trauma. It usually involves the weight-bearing surfaces and most commonly occurs in the central weight-bearing surface of the medial femoral condyle An electronic database research of 7926 knee MRI examinations was performed. Forty-eight scans were included in the study. The diagnosis of subchondral insufficiency fracture (SIF) was confirmed in a consensus review by one fellowship trained musculoskeletal (MSK) radiologist and one radiology fellow . Subchondral insufficiency fracture in the lateral compartment of the knee in a 64-year-old marathon runner. Knee Surg Relat Res 2017; 29:325-328 [Google Scholar] 82
The term insufficiency fracture implies inadequate bone and is applied to some subchondral knee magnetic resonance images. We reviewed bone mineral density, body mass index, meniscal extrusion, comorbidities, and demographics in 32 knee insufficiency fracture patients. Only five were osteoporotic Patients with subchondral insufficiency fracture characteristically have unremarkable plain radiographs, while MRI examination may reveal extensive bone marrow oedema and subchondral bone collapse. This article presents a 51-year-old postmenopausal woman, a physician, who had subchondral insufficiency fractures of the knee associated with.
Case Discussion. Features are suggestive of subchondral insufficiency fracture of the knee (previously known as spontaneous osteonecrosis of the knee), affecting the medial femoral condyle What is subchondral insufficiency fracture of the knee? Describe its MRI appearance. Subchondral insufficiency fracture of the knee is characterized by sudden onset of pain in the absence of trauma. It usually involves the weight-bearing surfaces and most commonly occurs in the central weight-bearing surface of the medial femoral condyle MRI shows a linear or crescent-shaped subchondral fracture line with extensive adjacent subchondral marrow edema . The descriptor spontaneous in the term spontaneous osteonecrosis of the knee is, in fact, a misnomer because the development of osteonecrosis is now believed to be secondary to a subchondral fracture in osteoporotic bone
This pictorial review presents an overview of common interpretation errors and pitfalls in magnetic resonance imaging (MRI) of the knee. Instead of being exhaustive, we will emphasize those pitfalls that are most commonly encountered by young residents or less experienced radiologists. (Figure 11) and subchondral insufficiency fractures. Hi Dr. Brims, The MRI showed a subchondral fracture of the Medial femoral condyle in my right knee. I also have a medial meniscus tear in that knee from April 2012. I started getting pain and limping read mor The triad of issues that arise in this situation is a common cause of severe medial knee pain or pain on the inner side of your knee in people between 45-75 years of age. Your knee MRI will often show a: Root tear (Radial tear) of the medial meniscus. mild or moderate knee arthritis. bone marrow edema, or an insufficiency fracture i n the inner. Subchondral insufficiency fracture of the knee (SIFK) is a potentially devastating disorder that may progress rapidly to osteoarthritis with articular surface collapse. It should be suspected in the appropriate clinical setting, as in early stages it is usually indistinct on initial plain radiographs and magnetic resonance imaging is required. . Due to the failure of the conservative management, the patient was advised surgical management
Subchondral insufficiency fracture in a 69-year-old woman who presented with acutely worsening knee pain without known trauma. (a) Anteroposterior radiograph of the right knee shows possible. 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. Diagnosis is radiographic for advanced disease but requires MRI for detection of early or subclinical disease Subchondral insufficiency fractures of the knee (SIFK) are painful, nontraumatic fractures that occur predominantly in the medial femoral condyle of postmenopausal osteoporotic women in their fifth and sixth decades of life. SIFK typically presents with acute knee pain localized to the area of the subchondral fracture [1,2]
. When patients report joint pain in the absence of radiographic ﬁnd-ings, MRI is usually not indicated, and observation and conser Subchondral insufficiency fractures of the knee (SIFK) can be reversible, but also progress to SONK and rapidly destructive OA. 33 All transient conditions have a similar MRI presentation of diffuse subchondral bone marrow high-signal intensity with indistinct margins, reaching but preserving the joint surface (Fig. 5). Gender, age, and.
Spontaneous osteonecrosis of the knee (SONK) is an idiopathic condition that leads to the development of a crescent shaped osteonecrosis lesion, mostly commonly in the epiphysis of the medial femoral condyle. Diagnosis can be radiographic for advanced disease but may require MRI in determining the extent of disease Methods and Materials: Clinical and imaging records (radiographs and MRI) of 15 consecutive patients (6 males, 9 females) diagnosed to have SIF of knee over 2 years period (2000-2002) were reviewed. Presence of low signal intensity band in subchondral bone surrounded by bone marrow edema on T1 and T2 weighted images was considered to be. Insufficiency fracture Acute onset of medial joint pain. There is diffuse marrow edema on T2W-image. On T1W-image the focal abnormality is not directly subchondral. The abnormality on the T1 is more inside the edema. On the T1W-image a dark line is visible indicating a insufficiency fracture. This patient will get better with no weight bearing. 10 primary subchondral fractures in the femoral head, a condition not previously described in the literature. These reports include descriptions of stress osteopathy of the femoral head in young military trainees (10 cases) (2) and insufficiency fracture of the femoral head in renal transplant recipients (8 cases) or in elderly people (7 cases) (3. Subchondral insufficiency fractures of the knee (SIFK) are painful, nontraumatic fractures that occur predominantly in the medial femoral condyle of postmenopausal osteoporotic women in their fifth and sixth decades of life. SIFK typically presents with acute knee pain localized to the area of the subchondral fracture [1 ,2 ]
Abstract Objective. To correlate the magnetic resonance imaging (MRI) features with the histopathologic findings in subchondral insufficiency fracture (SIF) of the femoral head. Design and patients. This study was based on a retrospective review of the MRI features and histopathologic findings in seven patients with SIF who had had total hip replacement Subchondral insufficiency fractures (SIF) are a type of stress fracture which occurs below the cartilage on the weight bearing surface of a bone. SIF occur when normal physiological forces are repeatedly applied to an area of bone compromised by non-tumorous disease, resulting in fracture The pathology is classified as a SIFK (Subchondral Insufficiency Fracture of the Knee) and in the initial stages of SONK (Spontaneous Osteonecrosis of the Knee). The patient that presents with this pathology, suffers from relatively early osteoarthritis and consults the clinical specialist as a result of intense pain that does not correspond to. Subchondral insufficiency fracture of the knee (SIFK) typically presents as a subchondral plate fracture surrounded by perifocal flame-like marrow edema, which can extend along and beyond the adjacent epiphysis. It results when a weakened A. Patient with osteoarthritis and new knee pain. There is a subchondral insufficiency fracture (white arrow); B. Two months later. Marked progression of the insufficiency fracture with loss of the femoral articular surface and a large fragment in the joint (white arrow). Note: These images are both of the same patient
Additionally, the authors recommended a change in nomenclature, as they believed that abandoning the term SONK in favor of subchondral insufficiency fractures of the knee (SIFK) would better reflect the disease pathogenesis. Epidemiology. Spontaneous osteonecrosis of the knee is the most common form of knee osteonecrosis The differential diagnosis includes a wide range of conditions: traumatic contusion and fractures, cyst formation and erosions, hematopoietic and infiltrated marrow, developmental chondroses, disuse and overuse, transient bone marrow oedema syndrome and, lastly, subchondral insufficiency fractures and true osteonecrosis Magnetic resonance imaging (MRI) can detect early changes in the subchondral area and assist in the diagnosis of SPONK. This report describes a very rare case of SPONK simultaneously involving the MFC and the MTP and associated with subchondral insufficiency fractures. This condition was diagnosed on MRI soon after symptom onset. 2. Case Repor The crescent sign on radiographs is a subchondral fracture resulting from bone resorption. It is characteristic of ON but is not an early finding. Magnetic resonance imaging (MRI) is the most sensitive and specific test for the diagnosis of ON (or infarct), but false-negative cases have been reported
Typical MRI findings in insufficiency fractures include a pattern of bone marrow edema with a low-signal-intensity line (resp. fracture) on the T1-weighted images parallel to the subchondral bone. In general, the circumscribed lesions on MRI, which are commonly observed in osteonecrosis, are not found (Yamamoto et al. 2007 ) These changes may lead to increased contact pressures, insufficiency fractures, synovial fluid leakage, and eventual necrosis. Pathophysiology: SONK is thought to occur secondary to vascular ischemia, although controversy exists over whether vascular disruption is due to subchondral insufficiency fractures or the progression of underlying.
Abstract: HTML Purpose: The association of so-called spontaneous osteonecrosis of the femoral condyle (SOFC) with meniscal tears, first reported by arthrography and recently by MRI, suggests loss of protective mechanism of the menisci promoting subchondral insufficiency fracture as the possible etiology A subchondral cyst is an area of sparse bone beneath the cartilage, i.e, in the bone, which u may have had since birth. Synchondrosis is a joint type, where flat parts of 2 bones touch. Marrow edema refers to inflammation/swelling from trauma. What type of symptoms do you have that led to the MRI
Bone marrow edema is commonly seen with fractures and other serious bone or joint injuries, especially those involving the spine, hip, knees, or ankle. Within the context of an injury, the term is relatively non-specific and may refer to an accumulation of fluid or blood or the build-up of fluids resulting from fibrosis (scarred tissue) or. Subchondral insufficiency fracture of the knee (SIFK) is a potentially devastating disorder that may progress rapidly to osteoarthritis with articular surface collapse. Bone marrow lesions (BMLs) in the knee represent focal edema caused by subchondral bone attrition and microfractures to the trabecular bone Subchondral insufficiency fracture (SIF) is a non-traumatic condition that has historically been associated with elderly, osteo- porotic women and patients with systemic conditions. There has been much work done to determine the pathogenesis of SIF
MRI characteristics were considered to be useful for the differentiation between osteonecrosis and SIF. Several pathological conditions may be related to SIF of the femoral head, but its detailed pathogenesis is still unknown. Keywords: Subchondral insufficiency fracture, Total Knee Arthroplasty, Osteoporosis, Osteonecrosis, Pathological, Femoral MRI of the right knee suggested extensive subchondral marrow edema at the lateral femoral condyle which may indicate a subchondral insufficiency trabecular microfracture. Various treatment options were discussed at length with the patient and the patient opted for surgical management Subchondral insufficiency fracture in a 69-year-old woman who presented with acutely worsening knee pain without known trauma. (a) Anteroposterior radiograph of the right knee shows possible medial compartment joint space narrowing (arrows) without osteophytes tive treatment magnetic resonance imaging (MRI) was ordered, which revealed T2 signal intensity in the medial femoral condyle along with a linear low-intensity subchondral line immediately beneath the articular surface resembling an insufficiency fracture (Figure 1). Age, history, and imaging studies were most consistent with a diagnosis of. subchondral insufficiency fracture (SIF) that has already progressed into collapse, with secondary necrosis found in the collapsed specimens . Natural course of SONK as a consequence of subchondral collapse and necrosis may alter biomechanics of the knee joint due to structural changes and eventually joint destruction [4, 5]. In up to 94%.
FRACTURE 8; HIP 20; HOW TO LEARN 5; KNEE 42. ACL 5; Medial Collateral Ligament 2; Meniscus 12; MINI-FELLOWSHIPS 9. Ankle MRI 1; Foot and Toes MRI 1; Hip MRI 1; Knee MRI 2; Shoulder MRI 2; Spine & SIJ 1; PATELLA 5; RADIOLOGY ANATOMY 8; SHOULDER 46. Acromion 3; Biceps 8; Gleno Humeral Ligaments 7; Rotator cuff 11; SPINE 102. Cord 23. Subchondral insufficiency fracture of the knee (SIFK) is 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 terms of spontaneous osteonecrosis of the knee (SONK) and subchondral insufficiency fracture are used interchangeably MRI scans of the left knee, made three months after the onset of symptoms, demonstrated bone marrow edema in the medial femoral condyle as well as a horizontal cleavage tear of the posterior horn of the lateral meniscus (Fig. 5). subchondral insufficiency fractures typically involve smaller and more focal areas. The presence of a. Subchondral insufficiency fractures of the femoral head (SIFFH) are a cause of femoral head collapse which can lead to degeneration of the joint. Statistical analysis was utilized to calculate mean age, mean BMI, prevalence of bone marrow edema (BME) on magnetic resonance imaging (MRI), prevalence of treatment, etiology, mean follow-up and.
Pathologists have shown that bone marrow lesions represent a healing response surrounding small defects in the subchondral bone, such as micro trabecular fractures. For that reason, the lesions can also be referred to as insufficiency fractures. This type of defect can be found throughout the extremities and pelvis MRI may thus be considered useful for the diagnosis of SIF.23The concept of subchondral insufficiency fracture has now been expanded to include the knee and shoulder joint.56 As subchondral collapse is commonly observed in patients with symptoms of osteonecrosis in any joints, previous reports of SIF have stressed th the onset of SONK and subchondral fracture, which was sup-ported by later reports based on MRI and pathological find-ings (Lecouvet et al. 1998, Yamamoto and Bullough 2000, Takeda et al. 2008). A subchondral insufficiency fracture may result from underlying osteoporosis (Yamamoto and Bullough 2000) Subchondral insufficiency fracture in a 69-year-old woman who presented with acutely worsening knee pain without known trauma. (a) Anteroposterior radiograph o - absence of focal subchondral defect to indicate etiology due to AVN or fracture - signal abnormality resolves over 3-6 months if followed with sequential MRI Fractures • MRI sensitive & specific for occult fracture detection - stress fractures - non-displaced traumatic fractures (e.g. femoral neck 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. Because this mechanism is similar to the humeral head that has an impact on the glenoid during an anterior shoulder dislocation, such an osteochondral fracture can be considered.