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BONE MARROW OEDEMA AND ITS RELATION TO PROGRESSION OF KNEE OSTEOARTHRITIS
Background: Lesions on bone scan which correspond to bone marrow edema lesions seen on magnetic resonance imaging (MRI) may increase the risk for radiographic deterioration in knee osteoarthritis.
Research question/s: Do oedema lesions in the sub-articular bone in patients with knee osteoarthritis increase the risk for radiographic progression and are the lesions associated with limb malalignment?
Methodology: Subjects: 233 subjects (> 45 yrs) with symptomatic knee osteoarthritis.
Experimental procedure: Subjects underwent baseline assessments including MRI of the knee and fluoroscopically positioned radiography. Repeated radiography (at 15 months) with long-limb films was obtained to assess mechanical alignment (varus, valgus). During follow up at 15 and 30 months, progression (defined as an increase over follow-up in medial or lateral joint space narrowing) was measured.
Measures of outcome: Relation of medial bone marrow oedema lesions to medial progression and lateral lesions to lateral progression, before and after adjustment for limb alignment.
Main finding/s: Progression: 36% of knees with medial lesions showed medial progression compared with 8.1% of knees without lesions (OR for progression, 6.5 [95% CI, 3.0–14.0]): 26% of knees with lateral lesions showed lateral progression compared with 5.5% of knees without lesions (8.1%) (OR for progression, 6.1 [95% CI, 2.2–16.5]).
Conclusion/s: The presence of bone marrow oedema on MRI is a potent risk factor for structural deterioration in knee osteoarthritis, and its relation to progression is explained in part by its association with limb alignment.
Evidence based rating: 7/10
Clinical interest rating: 8/10
Type of study: Prospective cohort study
Methodological considerations: Well conducted study, malalignment was assessed in middle not beginning of study, most subjects were men
Keywords: knee, osteoarthritis, malalignment, bone marrow oedema
ARTHROSCOPIC TREATMENT OF OSTEOCHONDRAL LESIONS OF THE TALUS
Background: Non-operative treatment or excision alone of osteochondral lesions of the talus give poor results, but it appears that both excision, curettage …
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