Skip to main content

14.01.2025 | Leitthema

Subchondral insufficiency fracture of the knee

verfasst von: Parker Scott, Brandon Cabarcas, Louis Kang, Mario Hevesi, Aaron J. Krych, M.D.

Erschienen in: Die Orthopädie

Einloggen, um Zugang zu erhalten

Abstract

Subchondral insufficiency fractures of the knee (SIFK) are a relatively common cause of knee pain, particularly in middle-aged and older adults. The SIFK is a type of stress fracture that occurs when excessive and repetitive or supraphysiologic loads are applied to subchondral bone [1]. Historically, this type of fracture was termed spontaneous osteonecrosis of the knee (SONK) until advances in MRI identified underlying fractures as well as meniscal deficiency as likely attributable etiologies. Consequently, SIFK has replaced SONK as the more appropriate term to refer to this category of conditions, with SONK now viewed as an advanced SIFK lesion. With greater availability of MRI, SIFK has been more frequently recognized and not as commonly mistaken for knee osteoarthritis as it had been in the past, with important implications for treatment and management of this condition.
Literatur
1.
Zurück zum Zitat Musbahi O et al (2023) Subchondral Insufficiency Fractures of the Knee: A Clinical Narrative Review. Jbjs Rev 11:10CrossRef Musbahi O et al (2023) Subchondral Insufficiency Fractures of the Knee: A Clinical Narrative Review. Jbjs Rev 11:10CrossRef
2.
Zurück zum Zitat Ahlbäck S, Bauer GCH, Bohne WH (1968) Spontaneous Osteonecrosis of the Knee. Arthritis Rheum 11(6):705–733CrossRefPubMed Ahlbäck S, Bauer GCH, Bohne WH (1968) Spontaneous Osteonecrosis of the Knee. Arthritis Rheum 11(6):705–733CrossRefPubMed
3.
Zurück zum Zitat Bangil M et al (1996) Subchondral insufficiency fracture of the femoral head. Rev Rhum Engl Ed 63(11):859–861PubMed Bangil M et al (1996) Subchondral insufficiency fracture of the femoral head. Rev Rhum Engl Ed 63(11):859–861PubMed
4.
Zurück zum Zitat Yamamoto T, Bullough PG (2000) Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Joint Surg Am 82(6):858–866CrossRefPubMed Yamamoto T, Bullough PG (2000) Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Joint Surg Am 82(6):858–866CrossRefPubMed
5.
Zurück zum Zitat Ochi J et al (2022) Subchondral insufficiency fracture of the knee: review of current concepts and radiological differential diagnoses. Jpn J Radiol 40(5):443–457CrossRefPubMed Ochi J et al (2022) Subchondral insufficiency fracture of the knee: review of current concepts and radiological differential diagnoses. Jpn J Radiol 40(5):443–457CrossRefPubMed
6.
Zurück zum Zitat Kosaka H et al (2021) Histopathologic evaluation of bone marrow lesions in early stage subchondral insufficiency fracture of the medial femoral condyle. Int J Clin Exp Pathol 14(7):819–826PubMedPubMedCentral Kosaka H et al (2021) Histopathologic evaluation of bone marrow lesions in early stage subchondral insufficiency fracture of the medial femoral condyle. Int J Clin Exp Pathol 14(7):819–826PubMedPubMedCentral
7.
Zurück zum Zitat Sayyid S et al (2019) Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome. Skelet Radiol 48(12):1961–1974CrossRef Sayyid S et al (2019) Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome. Skelet Radiol 48(12):1961–1974CrossRef
8.
Zurück zum Zitat Madry H, van Dijk CN, Mueller-Gerbl M (2010) The basic science of the subchondral bone. Knee Surg Sports Traumatol Arthrosc 18(4):419–433CrossRefPubMed Madry H, van Dijk CN, Mueller-Gerbl M (2010) The basic science of the subchondral bone. Knee Surg Sports Traumatol Arthrosc 18(4):419–433CrossRefPubMed
9.
Zurück zum Zitat Mears SC et al (2009) Characterization and pathological characteristics of spontaneous osteonecrosis of the knee. Iowa Orthop J 29:38–42PubMedPubMedCentral Mears SC et al (2009) Characterization and pathological characteristics of spontaneous osteonecrosis of the knee. Iowa Orthop J 29:38–42PubMedPubMedCentral
10.
Zurück zum Zitat Pareek A et al (2020) Spontaneous Osteonecrosis/Subchondral Insufficiency Fractures of the Knee: High Rates of Conversion to Surgical Treatment and Arthroplasty. J Bone Joint Surg Am 102(9):821–829CrossRefPubMed Pareek A et al (2020) Spontaneous Osteonecrosis/Subchondral Insufficiency Fractures of the Knee: High Rates of Conversion to Surgical Treatment and Arthroplasty. J Bone Joint Surg Am 102(9):821–829CrossRefPubMed
11.
Zurück zum Zitat Yokota S et al (2024) Osteoporosis, Osteoarthritis, and Subchondral Insufficiency Fracture: Recent Insights. Biomedicines 12(4) Yokota S et al (2024) Osteoporosis, Osteoarthritis, and Subchondral Insufficiency Fracture: Recent Insights. Biomedicines 12(4)
12.
Zurück zum Zitat Gourlay ML et al (2015) Subchondral insufficiency fracture of the knee: a non-traumatic injury with prolonged recovery time. BMJ Case Rep 2015: Gourlay ML et al (2015) Subchondral insufficiency fracture of the knee: a non-traumatic injury with prolonged recovery time. BMJ Case Rep 2015:
13.
Zurück zum Zitat Allam E et al (2021) Subchondral insufficiency fracture of the knee: unicompartmental correlation to meniscal pathology and degree of chondrosis by MRI. Skelet Radiol 50(11):2185–2194CrossRef Allam E et al (2021) Subchondral insufficiency fracture of the knee: unicompartmental correlation to meniscal pathology and degree of chondrosis by MRI. Skelet Radiol 50(11):2185–2194CrossRef
14.
Zurück zum Zitat Clark SC et al (2024) High incidence of medial meniscus root/radial tears and extrusion in 253 patients with subchondral insufficiency fractures of the knee. Knee Surg Sports Traumatol Arthrosc 32(11):2755–2761CrossRefPubMed Clark SC et al (2024) High incidence of medial meniscus root/radial tears and extrusion in 253 patients with subchondral insufficiency fractures of the knee. Knee Surg Sports Traumatol Arthrosc 32(11):2755–2761CrossRefPubMed
15.
Zurück zum Zitat Jose J et al (2015) Subchondral insufficiency fractures of the knee: review of imaging findings. Acta Radiol 56(6):714–719CrossRefPubMed Jose J et al (2015) Subchondral insufficiency fractures of the knee: review of imaging findings. Acta Radiol 56(6):714–719CrossRefPubMed
16.
Zurück zum Zitat Lee S, Saifuddin A (2019) Magnetic resonance imaging of subchondral insufficiency fractures of the lower limb. Skelet Radiol 48(7):1011–1021CrossRef Lee S, Saifuddin A (2019) Magnetic resonance imaging of subchondral insufficiency fractures of the lower limb. Skelet Radiol 48(7):1011–1021CrossRef
17.
Zurück zum Zitat Malghem J et al (2023) Subchondral insufficiency fractures, subchondral insufficiency fractures with osteonecrosis, and other apparently spontaneous subchondral bone lesions of the knee-pathogenesis and diagnosis at imaging. Insights Imaging 14(1):164CrossRefPubMedPubMedCentral Malghem J et al (2023) Subchondral insufficiency fractures, subchondral insufficiency fractures with osteonecrosis, and other apparently spontaneous subchondral bone lesions of the knee-pathogenesis and diagnosis at imaging. Insights Imaging 14(1):164CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Delsmann MM et al (2024) Advantages of cone beam computed tomography for evaluation of subchondral insufficiency fractures of the knee compared to MRI. Sci Rep 14(1):15278CrossRefPubMedPubMedCentral Delsmann MM et al (2024) Advantages of cone beam computed tomography for evaluation of subchondral insufficiency fractures of the knee compared to MRI. Sci Rep 14(1):15278CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Wilmot AS et al (2016) Subchondral insufficiency fracture of the knee: A recognizable associated soft tissue edema pattern and a similar distribution among men and women. Eur J Radiol 85(11):2096–2103CrossRefPubMed Wilmot AS et al (2016) Subchondral insufficiency fracture of the knee: A recognizable associated soft tissue edema pattern and a similar distribution among men and women. Eur J Radiol 85(11):2096–2103CrossRefPubMed
20.
Zurück zum Zitat Posadzy M, Desimpel J, Vanhoenacker F (2018) Cone beam CT of the musculoskeletal system: clinical applications. Insights Imaging 9(1):35–45CrossRefPubMedPubMedCentral Posadzy M, Desimpel J, Vanhoenacker F (2018) Cone beam CT of the musculoskeletal system: clinical applications. Insights Imaging 9(1):35–45CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Plett SK et al (2015) Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome. Skelet Radiol 44(12):1785–1794CrossRef Plett SK et al (2015) Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome. Skelet Radiol 44(12):1785–1794CrossRef
22.
Zurück zum Zitat Aglietti P et al (1983) Idiopathic osteonecrosis of the knee. Aetiology, prognosis and treatment. J Bone Joint Surg Br 65(5):588–597CrossRefPubMed Aglietti P et al (1983) Idiopathic osteonecrosis of the knee. Aetiology, prognosis and treatment. J Bone Joint Surg Br 65(5):588–597CrossRefPubMed
23.
Zurück zum Zitat Nelson FR et al (2014) Subchondral insufficiency fractures and spontaneous osteonecrosis of the knee may not be related to osteoporosis. Arch Osteoporos 9:194CrossRefPubMed Nelson FR et al (2014) Subchondral insufficiency fractures and spontaneous osteonecrosis of the knee may not be related to osteoporosis. Arch Osteoporos 9:194CrossRefPubMed
24.
Zurück zum Zitat Krych AJ et al (2020) Investigating the Chronology of Meniscus Root Tears: Do Medial Meniscus Posterior Root Tears Cause Extrusion or the Other Way Around? Orthop J Sports Med 8(11):2325967120961368CrossRefPubMedPubMedCentral Krych AJ et al (2020) Investigating the Chronology of Meniscus Root Tears: Do Medial Meniscus Posterior Root Tears Cause Extrusion or the Other Way Around? Orthop J Sports Med 8(11):2325967120961368CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Hussain ZB et al (2019) The Role of Meniscal Tears in Spontaneous Osteonecrosis of the Knee: A Systematic Review of Suspected Etiology and a Call to Revisit Nomenclature. Am J Sports Med 47(2):501–507CrossRefPubMed Hussain ZB et al (2019) The Role of Meniscal Tears in Spontaneous Osteonecrosis of the Knee: A Systematic Review of Suspected Etiology and a Call to Revisit Nomenclature. Am J Sports Med 47(2):501–507CrossRefPubMed
26.
Zurück zum Zitat Allaire R et al (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 90(9):1922–1931CrossRefPubMed Allaire R et al (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 90(9):1922–1931CrossRefPubMed
27.
Zurück zum Zitat Barras LA et al (2021) Post-arthroscopic Subchondral Insufficiency Fractures of the Knee Yield High Rate of Conversion to Arthroplasty. Arthroscopy 37(8):2545–2553CrossRefPubMed Barras LA et al (2021) Post-arthroscopic Subchondral Insufficiency Fractures of the Knee Yield High Rate of Conversion to Arthroplasty. Arthroscopy 37(8):2545–2553CrossRefPubMed
28.
Zurück zum Zitat Akamatsu Y et al (2012) Low bone mineral density is associated with the onset of spontaneous osteonecrosis of the knee. Acta Orthop 83(3):249–255CrossRefPubMedPubMedCentral Akamatsu Y et al (2012) Low bone mineral density is associated with the onset of spontaneous osteonecrosis of the knee. Acta Orthop 83(3):249–255CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Choi HG et al (2021) The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures. Am J Sports Med 49(6):1551–1560CrossRefPubMed Choi HG et al (2021) The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures. Am J Sports Med 49(6):1551–1560CrossRefPubMed
30.
Zurück zum Zitat Iwasaki K et al (2012) Prognostic factors associated with a subchondral insufficiency fracture of the femoral head. Br J Radiol 85(1011):214–218CrossRefPubMedPubMedCentral Iwasaki K et al (2012) Prognostic factors associated with a subchondral insufficiency fracture of the femoral head. Br J Radiol 85(1011):214–218CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Okazaki Y et al (2022) Grade of Subchondral Insufficiency Fracture of the Knee and the Presence of a Posterior Shiny-Corner Lesion are Correlated with Duration of Medial Meniscus Posterior Root Tear in Women. Acta Med Okayama 76(2):121–127PubMed Okazaki Y et al (2022) Grade of Subchondral Insufficiency Fracture of the Knee and the Presence of a Posterior Shiny-Corner Lesion are Correlated with Duration of Medial Meniscus Posterior Root Tear in Women. Acta Med Okayama 76(2):121–127PubMed
32.
Zurück zum Zitat Pareek A et al (2020) The SIFK score: a validated predictive model for arthroplasty progression after subchondral insufficiency fractures of the knee. Knee Surg Sports Traumatol Arthrosc 28(10):3149–3155CrossRefPubMed Pareek A et al (2020) The SIFK score: a validated predictive model for arthroplasty progression after subchondral insufficiency fractures of the knee. Knee Surg Sports Traumatol Arthrosc 28(10):3149–3155CrossRefPubMed
33.
Zurück zum Zitat Yates PJ et al (2007) Early MRI diagnosis and non-surgical management of spontaneous osteonecrosis of the knee. Knee 14(2):112–116CrossRefPubMed Yates PJ et al (2007) Early MRI diagnosis and non-surgical management of spontaneous osteonecrosis of the knee. Knee 14(2):112–116CrossRefPubMed
34.
Zurück zum Zitat Suh DK et al (2023) Functional improvement of unicompartmental knee arthroplasty compared with total knee arthroplasty for subchondral insufficiency fracture of the knee. Sci Rep 13(1):20041CrossRefPubMedPubMedCentral Suh DK et al (2023) Functional improvement of unicompartmental knee arthroplasty compared with total knee arthroplasty for subchondral insufficiency fracture of the knee. Sci Rep 13(1):20041CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Flury A et al (2021) Total and unicondylar knee arthroplasty are equivalent treatment options in end-stage spontaneous osteonecrosis of the knee, and the size of the lesion has no influence on the results. Knee Surg Sports Traumatol Arthrosc 29(10):3254–3261CrossRefPubMed Flury A et al (2021) Total and unicondylar knee arthroplasty are equivalent treatment options in end-stage spontaneous osteonecrosis of the knee, and the size of the lesion has no influence on the results. Knee Surg Sports Traumatol Arthrosc 29(10):3254–3261CrossRefPubMed
36.
Zurück zum Zitat Okazaki Y et al (2021) Medial meniscus posterior root repair prevents the progression of subchondral insufficiency fracture of the knee. J Orthop Sci 26(6):1051–1055CrossRefPubMed Okazaki Y et al (2021) Medial meniscus posterior root repair prevents the progression of subchondral insufficiency fracture of the knee. J Orthop Sci 26(6):1051–1055CrossRefPubMed
Metadaten
Titel
Subchondral insufficiency fracture of the knee
verfasst von
Parker Scott
Brandon Cabarcas
Louis Kang
Mario Hevesi
Aaron J. Krych, M.D.
Publikationsdatum
14.01.2025
Verlag
Springer Medizin
Erschienen in
Die Orthopädie
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI
https://doi.org/10.1007/s00132-024-04595-3

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie erweitert durch Fallbeispiele, Videos und Abbildungen. Zur Fortbildung und Wissenserweiterung, verfasst und geprüft von Expertinnen und Experten der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA).


Jetzt entdecken!

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knapp 2% mit Infektionen nach Hüftfraktur-Op.

Infekte im Op.-Bereich sind die häufigsten spezifischen Komplikationen nach einer Hüftfraktur-Op. Längerfristig machen vor allem ein Versagen der Fixierung sowie periprothetische oder periimplantäre Frakturen zu schaffen. Darauf deutet eine Analyse von 95 Studien.

Hamstring-Reparatur des Kreuzbandes ist revisionsanfällig

Die operative Rekonstruktion eines gerissenen vorderen Kreuzbandes löst die Probleme nicht immer dauerhaft. Wie oft, wann und warum Revisionseingriffe fällig werden, haben norwegische Orthopäden untersucht.

Ab sofort gelten die neuen Verordnungsausnahmen für Lipidsenker

Freie Fahrt für Lipidsenker? Das nicht, doch mit niedrigerem Schwellenwert fürs Infarktrisiko und neuen Indikationen hat der G-BA die Verordnungs-Handbremse ein gutes Stück weit gelockert.

Aerobes Training hilft bei Fibromyalgie

Sport im aeroben Bereich ist ein veritables Mittel, um die Schmerzen von Menschen mit Fibromyalgie zu reduzieren, wie eine Metaanalyse zeigt. Frequenz, Dauer und Intensität der Übungen geben den Ausschlag.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.