Introduction Two distinct entities including secondary osteonecrosis of the knee (this topic) spontaneous osteonecrosis of the knee (SONK) Epidemiology demographic women:men 3:1 more common in women <55 years with risk factors reported to be found after knee arthroscopy in middle-aged women location typically involves more than one compartment of the knee or even the metaphysis 80% are bilateral multifocal lesions are not uncommon risk factors alcoholism dysbaric disorders (decompression sickness, "the bends") marrow-replacing diseases (e.g. Gaucher's disease) sickle cell disease hypercoagulable states steroids (either endogenous or exogenous) SLE inflammatory bowel disease transplant patient virus (CMV, hepatitis, HIV, rubella, rubeola, varicella) protease inhibitors (type of HIV medication) trauma Pathophysiology spontaneous osteonecrosis appears to represent a subchondral insufficiency fracture another hypothesis is an association with a meniscal root tear Prognosis self-limiting condition Physical Exam Symptoms pain with weightbearing, especially sitting to standing Imaging Radiographs first line imaging studies AP knee lateral knee merchant view knee findings wedge-shaped lesion on imaging MRI most useful study findings highest sensitivity and specificity T1: dark T2: bright (marrow edema) Differential Osteochondritis dissecans (OCD) more commonly found at lateral aspect of medial femoral condyle of 15 to 20-year-old males Transient osteoporosis more common in young to middle-aged men multiple joint involvement found in 40% of patients (transient migratory osteoporosis) Occult fractures and bone bruises associated with trauma, weak bones, or overuse Treatment Nonoperative NSAIDs, limited weightbearing, quadriceps strengthening, activity modification indications first-line of treatment outcomes favorable, but less so than nonoperative management for SONK Operative diagnostic arthroscopy indications remove small, unstable fragments from the joint core decompression indications extra-articular lesions osteochondral allograft indications large symptomatic lesions in younger patients that failed nonoperative management total knee arthroplasty (TKA) indications large area of involvement collapse osteonecrosis in multiple compartments
Technique Guide 10/4/2016 Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Microfracture of the Knee Orthobullets Team Knee & Sports - Osteonecrosis of the Knee
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Microfracture: Is There a Role in 2018 and How? - Jack Farr, II, MD (CSMS #46, 2018) Knee & Sports - Osteonecrosis of the Knee - All Jack Farr II, MDSession 4: Knee CartilageModerator: Adam B. Yanke, MDSeptember 8... 11/23/2018 295 views
Left knee osteonecrosis in a 34F (C101080) Knee & Sports - Osteonecrosis of the Knee HPI - This 34 year old lady mentioned occasional left hip and knee pain at our outpatient clinic on 2017-04. An X-ray of the left hip and knee at that point showed early stage osteonecrosis of left hip and no obvious bony lesion of the left knee. Conservative treatment was given initially. However, left knee pain worsened over the past month. Hence, she came back to our clinic. X-ray and MRI of the left knee were checked and showed osteonecrosis over the lateral & medial femoral condyle and the lateral and medial tibial plateau. She denied any autoimmune disease or steroid or alcohol consumption. How would you manage this patient's knee pain? 5/24/2018 154 6 3 MFC Knee OCD in a 36M (C2819) Knee & Sports - Osteonecrosis of the Knee HPI - 36 year old, Afro-Caribbean, athletic build, in open prison at the moment. Pain in R knee for 2-3 years. medial-sided, No sickle cell. XRay and MRI attached. What is your surgical management? 5/19/2017 120 1 0 Knee Lesion in a 40M (C2731) Knee & Sports - Osteonecrosis of the Knee HPI - 40 year old male presents with an ongoing history of right knee pain. He describes a 2 year history of aching knee pain that has recently gotten worse after injuring his knee while lifting a heavy object at work. He works as a general laborer in a warehouse. He does not describe any mechanical symptoms related to the knee (no clicking, catching, popping, or locking). His MRI does not reveal a meniscal tear. He isolates his pain to the medial aspect of his knee. What is the diagnosis? 11/14/2016 7681 22 17 See More See Less