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Subchondral insufficiency fracture of the knee: unicompartmental correlation to meniscal pathology and degree of chondrosis by MRI

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Abstract

Objective

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.

Materials and methods

Our retrospective study included 219 patients with knee pain and SIFK seen on MRI. SIFK lesions were categorized from grade 1 to 4 with a low grade (1 and 2) vs high grade (3 and 4) distinction. Associations between SIFK grade, location, lesion dimensions, edema-like marrow signal intensity, incidence of meniscal tears/type/location, and chondrosis (grade 0 to grade 4), as well as patients’ age and weight, were assessed.

Results

Our analysis consisted of 115 males and 104 females with 17% of the patients showing grade 1 SIFK, 59% grade 2, 16% grade 3, and 8% grade 4. No chondrosis or low-grade chondrosis was mostly present in patients with low-grade SIFK (68.9%), whereas high-grade chondrosis was mostly present in patients with high-grade SIFK lesions (65.4%) (p < 0.01). Further sub-analysis demonstrated that high-grade SIFK was associated with high-grade chondrosis in the same compartment (p < 0.01) but not in the adjacent compartment. There was a significant difference in the extent of edema-like marrow signal intensity between the two groups, with high-grade SIFK more frequently demonstrating severe edema-like marrow signal intensity compared to low-grade SIFK (p < 0.01).

Conclusion

High-grade SIFK lesions are associated with unicompartmental high-grade chondrosis.

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Abbreviations

SIFK:

Subchondral insufficiency fracture of the knee

SONK:

Spontaneous osteonecrosis of the knee

MRI:

Magnetic resonance imaging

ROC:

Receiver operating characteristic

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Acknowledgements

The authors would like to thank Yara Younan and Monica Umpierrez for their dedicated support with this work.

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Authors and Affiliations

  1. Department of Radiology, Loyola University Medical Center, Chicago, IL, USA

    Emad Allam & George Boychev

  2. Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Samuel Aiyedipe

  3. Department of Radiology and Imaging Sciences, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    William Morrison & Johannes B. Roedl

  4. Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA

    Adam D. Singer & Felix M. Gonzalez

Authors
  1. Emad Allam
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  2. George Boychev
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  3. Samuel Aiyedipe
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  4. William Morrison
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  5. Johannes B. Roedl
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  6. Adam D. Singer
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  7. Felix M. Gonzalez
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Correspondence to Felix M. Gonzalez.

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Allam, E., Boychev, G., Aiyedipe, S. et al. Subchondral insufficiency fracture of the knee: unicompartmental correlation to meniscal pathology and degree of chondrosis by MRI. Skeletal Radiol 50, 2185–2194 (2021). https://doi.org/10.1007/s00256-021-03777-w

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  • DOI: https://doi.org/10.1007/s00256-021-03777-w

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