Elsevier

The Knee

Volume 12, Issue 4, August 2005, Pages 267-269
The Knee

Transient bone marrow oedema of the knee

https://doi.org/10.1016/j.knee.2004.05.009Get rights and content

Abstract

Objective

To evaluate the role of MRI in the diagnosis of transient bone marrow oedema of the knee.

Design

All cases were analysed with plain film and MR. Bone scan was performed to one of them. Laboratory tests were obtained in all 8 cases and core decompression was performed in two cases.

Patients

The study includes 8 patients, 7 men and 1 woman with ages ranging from 33 to 74 years with severe knee pain, tenderness and slightly limited range of motion.

Results and conclusions

Radiographs were unremarkable in terms of osteopenia because they were obtained early in the course of the disease and proved to be of no value in the diagnosis. MR is the imaging modality of choice showing low signal intensity in T1WI and increased signal intensity in T2WI with no joint destruction, fractures, bone death, periostitis or cortical disruption. Bone scan showed increase uptake of the affected area. Laboratory tests were normal. Spontaneous resolution was the rule. It should not be a diagnosis of exclusion and it should be ruled out every time a patient presents with pain and limited range of motion in the absence of history of trauma.

Introduction

Transient bone marrow oedema syndrome is a disorder characterized by gradual onset of pain and rapidly developing osteoporosis of the involved area in the absence of trauma that follows a self-limited course. Range of motion is usually limited and weight-bearing painful. Plain radiographs are initially unremarkable but after several weeks they show severe osteopenia. Increase uptake of the affected area is seen in radionuclide studies within days following the onset of symptoms and MRI plays a key role providing essential information. Findings include bone marrow oedema with no cortical disruption or joint space involvement.

It was first described by Curtis and Kincaid [1] in the hip in 1959. This entity was first named “transient osteoporosis” but many other names have been proposed ever since. It is now widely known as transient bone marrow oedema syndrome [2]. The hip is the classic joint affected but the knee, the foot or the ankle may also be involved [3], [4], [5].

Section snippets

Patients and methods

This study included eight patients with severe knee pain, tenderness and slightly limited range of motion. There were seven men and one woman with ages ranging from 33 to 74 years. All eight cases were analysed by plain X-rays and MR imaging. For MR we used a 0.5-T imaging system (Vectra, GE Medical System, Milkwaukee, WI). Spin echo T1 and Gradient echo T2 as well as STIR were obtained using a surface coil. Section thickness was 3–5 mm with 1-mm interval and an imaging matrix of 192×224 mm.

Results

Radiographs showed mild to moderate degenerative changes but osteopenia was not seen in any case.

MRI showed decreased signal intensity in SE T1 (Fig. 2a) and increased signal intensity in GE T2 WI and STIR (Fig. 1, Fig. 2b) in the involved area which represents an increase in bone marrow water content. Accompanying joint effusion was present in two cases (Fig. 1). No evidence of joint destruction, fractures, bone death, periostitis or cortical disruption was seen.

Bone scan showed increase

Discussion

This entity was first named transient osteoporosis by Hunder and Kelly [6]. However, osteoporosis was a rare finding in cases were biopsies were obtained [2], [7], so Wilson suggested the term transient bone marrow oedema syndrome, which is now widely accepted. We support the theory that bone marrow oedema syndrome (BMOS) might represent a reversible stage of avascular necrosis [9], [12].

Although BMOS most frequently involves the hip, other joints may also be affected and the knee constitutes

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