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Bone Marrow Edema Syndrome of the Medial Femoral Condyle Treated With Extracorporeal Shock Wave Therapy: A Clinical and MRI Retrospective Comparative Study

Published:December 06, 2017DOI:https://doi.org/10.1016/j.apmr.2017.10.025

      Abstract

      Objective

      To determine the validity of extracorporeal shock wave therapy (ESWT) in the treatment of bone marrow edema (BME) of the medial condyle of the knee.

      Design

      Retrospective.

      Setting

      Orthopedic Surgery outpatient clinic.

      Participants

      Symptomatic patients (N=56) affected by BME of the medial condyle of the knee. Patients were equally divided into an ESWT-treated group and a control group, which was managed conservatively.

      Interventions

      ESWT delivery to the medial condyle of the affected knee.

      Main Outcome Measures

      Clinical and functional assessment of the knee was performed with the use of the clinical and functional scores of the Knee Society Score (KSS). Pain was measured with the visual analog scale (VAS). BME area was measured with magnetic resonance imaging (MRI) before treatment and at 4 months' follow-up.

      Results

      Clinical evaluation of patients at final follow-up of 4 months posttreatment showed a significant improvement (P<.0001) of symptoms and knee functionality, both for range of motion and strength in both groups. VAS values were significantly improved (P<.0001) in both groups, with 3 patients in the ESWT group being pain-free (VAS=0) at 4 months' follow-up. At 4 months, MRI assessments on both sagittal and coronal views showed a significant reduction in BME in the ESWT group compared with the control group.

      Conclusions

      Our findings show that ESWT is a valid nonpharmacologic and noninvasive therapy for spontaneous BME of the medial condyle that improves the affected vascular and metabolic state present in this pathologic disorder through its metabolic mechanisms of action.

      Keywords

      List of abbreviations:

      AVN (avascular necrosis), BME (bone marrow edema), eNOS (endothelial nitric oxide synthase), ESWT (extracorporeal shock wave therapy), KSS (Knee Society Score), MRI (magnetic resonance imaging), PCNA (proliferating cell nuclear antigen), VAS (visual analog scale), VEGF (vascular endothelial growth factor)
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      References

        • Sampson M.J.
        • Kabbani M.
        • Krishnan R.
        • Nganga M.
        • Theodoulou A.
        • Krishnan J.
        Improved clinical outcome measures of knee pain and function with concurrent resolution of subchondral bone marrow edema lesion and joint effusion in an osteoarthritic patient following pentosan polysulphate sodium treatment: a case report.
        BMC Musculoskelet Disord. 2017; 18: 396
        • Gao F.
        • Sun W.
        • Li Z.
        • et al.
        Extracorporeal shock wave therapy in the treatment of primary bone edema syndrome of the knee: a prospective randomized controlled study.
        BMC Musculoskelet Disord. 2015; 16: 379
        • Eriksen E.F.
        Treatment of bone marrow lesions (bone marrow edema).
        Bonekey Rep. 2015; 4: 755
        • Mirghasemi S.A.
        • Trepman E.
        • Sadeghi M.S.
        • Rahimi N.
        • Rashidinia S.
        Bone marrow edema syndrome in the foot and ankle.
        Foot Ankle Int. 2016; 37: 1364-1373
        • Patel S.
        Primary bone marrow edema syndromes.
        Rheumatology (Oxford). 2014; 53: 785-792
        • Manara M.
        • Varenna M.
        A clinical overview of bone marrow edema.
        Reumatismo. 2014; 66: 184-196
        • Bonadio M.B.
        • Ormond Filho A.G.
        • Helito C.P.
        • Stump X.M.
        • Demange M.K.
        Bone marrow lesion: image, clinical presentation, and treatment.
        Magn Reson Insights. 2017; 10 (1178623x17703382)
        • Geith T.
        • Niethammer T.
        • Milz S.
        • Dietrich O.
        • Reiser M.
        • Baur-Melnyk A.
        Transient bone marrow edema syndrome versus osteonecrosis: perfusion patterns at dynamic contrast-enhanced MR imaging with high temporal resolution can allow differentiation.
        Radiology. 2017; 283: 478-485
        • Insall J.N.
        • Dorr L.D.
        • Scott R.D.
        • Scott W.N.
        Rationale of the Knee Society clinical rating system.
        Clin Orthop Relat Res. 1989; : 13-14
        • Asif S.
        • Choon D.S.
        Midterm results of cemented Press Fit Condylar Sigma total knee arthroplasty system.
        J Orthop Surg (Hong Kong). 2005; 13: 280-284
        • Claßen T.
        • Becker A.
        • Landgraeber S.
        • et al.
        Long-term clinical results after iloprost treatment for bone marrow edema and avascular necrosis.
        Orthop Rev (Pavia). 2016; 8: 6150
        • Hofmann S.
        • Kramer J.
        • Schneider W.
        • et al.
        Transient osteoporosis may represent a reversible early form of avascular necrosis of the hip joint.
        Curr Orthop. 1997; 11: 164-172
        • Aigner N.
        • Petje G.
        • Steinboeck G.
        • et al.
        Treatment of bone-marrow edema of the talus with the prostacyclin analogue iloprost. An MRI-controlled investigation of a new method.
        J Bone Joint Surg Br. 2001; 83: 855-858
        • Meizer R.
        • Radda C.
        • Stolz G.
        • et al.
        MRI-controlled analysis of 104 patients with painful bone marrow edema in different joint localizations treated with the prostacyclin analogue iloprost.
        Wien Klin Wochenschr. 2005; 117: 278-286
        • Baier C.
        • Schaumburger J.
        • Götz J.
        • et al.
        Bisphosphonates or prostacyclin in the treatment of bone-marrow oedema syndrome of the knee and foot.
        Rheumatol Int. 2013; 33: 1397-1402
        • Agarwala S.
        • Jain D.
        • Joshi V.R.
        • Sule A.
        Efficacy of alendronate, a bisphosphonate, in the treatment of AVN of the hip. A prospective open-label study.
        Rheumatology (Oxford). 2005; 44: 352-359
        • Papadopoulos E.C.
        • Papagelopoulos P.J.
        • Kaseta M.
        • Themistocleous G.S.
        • Korres D.S.
        Bone marrow edema syndrome of the knee: a case report and review of the literature.
        Knee. 2003; 10: 295-302
        • Beckmann J.
        • Schmidt T.
        • Schaumburger J.
        • et al.
        Infusion, core decompression, or infusion following core decompression in the treatment of bone edema syndrome and early avascular osteonecrosis of the femoral head.
        Rheumatol Int. 2013; 33: 1561-1565
        • Hofmann S.
        • Engel A.
        • Neuhold A.
        • Leder J.
        • Kramer J.
        • Plenk Jr., H.
        Bone marrow oedema syndrome and transient osteoporosis of the hip. An MRI-controlled study of treatment by core decompression.
        J Bone Joint Surg Br. 1993; 75: 210-216
        • Gao F.
        • Sun W.
        • Li Z.
        • Guo W.
        • Kush N.
        • Ozaki K.
        Intractable bone marrow edema syndrome of the hip.
        Orthopedics. 2015; 38: e263-e270
        • Mariotto S.
        • Carcereri de Prati A.
        • Cavalieri E.
        • et al.
        Extracorporeal shock wave therapy in inflammatory diseases: molecular mechanisms that trigger anti-inflammatory action.
        Curr Med Chem. 2009; 16: 2366-2372
        • Wang F.S.
        • Yang K.D.
        • Kuo Y.R.
        • et al.
        Temporal and spatial expression of bone morphogenetic proteins in extracorporeal shock wave-promoted healing of segmental defect.
        Bone. 2003; 32: 387-396
        • Frairia R.
        • Berta L.
        Biological effects of extracorporeal shock waves on fibroblasts: a review.
        Muscles Ligaments Tendons J. 2012; 1: 138-147
        • Hsu S.L.
        • Wang C.J.
        • Lee M.S.
        • Chan Y.S.
        • Huang C.C.
        • Yang K.D.
        Cocktail therapy for femoral head necrosis of the hip.
        Arch Orthop Trauma Surg. 2010; 130: 23-29
        • Wang C.-J.
        • Wang F.-S.
        • Yang K.D.
        • et al.
        Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits.
        J Orthop Res. 2003; 21: 984-989
        • D'Agostino C.
        • Romeo P.
        • Lavanga V.
        • Pisani S.
        • Sansone V.
        Effectiveness of extracorporeal shock wave therapy in bone marrow edema syndrome of the hip.
        Rheumatol Int. 2014; 34: 1513-1518
        • Sansone V.
        • Romeo P.
        • Lavanga V.
        Extracorporeal shock wave therapy is effective in the treatment of bone marrow edema of the medial compartment of the knee: a comparative study.
        Med Princ Pract. 2017; 26: 23-29