Prevalence of Undiagnosed Subchondral Insufficiency Fractures of the Knee in Middle Age Adults with Knee Pain and Suspected Meniscal Tear.
Prevalence of Undiagnosed Subchondral Insufficiency Fractures of the Knee in Middle Age Adults with Knee Pain and Suspected Meniscal Tear.
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DOI：
10.1016/j.ocarto.2020.100089
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发表时间：
2020-12-01
期刊：
影响因子：
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通讯作者：
Katz, Jeffrey N
中科院分区：
文献类型：
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作者：
Huizinga, Jamie L;Shah, Nehal;Katz, Jeffrey N
目的：有症状的膝骨关节炎 (OA) 和半月板撕裂通常通过负重锻炼进行治疗，无需进行高级成像（例如 MRI）。这可能会导致膝关节软骨下关闭不全骨折（SIFK）的漏诊。未能诊断出 SIFK 会对治疗产生影响，因为 SIFK 患者通常会接受一段减少负重的治疗。本研究的主要目的是确定因膝关节疼痛和疑似半月板撕裂而接受非手术治疗的患者中未确诊 SIFK 的患病率。 方法：随机对照试验 TeMPO（半月板问题和骨关节炎的治疗）招募了临床医生怀疑同时存在半月板撕裂和膝关节 OA 的受试者。 TeMPO 参与者接受研究要求的 MRI，以确认半月板撕裂。所有显示骨折的研究安排的 MRI 均由两名研究放射科医生进行审查，他们记录了骨折和关节的特征。我们报告了这些受试者的 SIFK 患病率以及临床和影像学特征，置信区间为 95%。 结果：340 项研究安排的 MRI 中有 10 例患有 SIFK，估计患病率为 2.94%（95% CI：1.15%，4.71%）。 10 名 SIFK 参与者中有 8 名骨折位于内侧。其中 5 名参与者的股骨受累，4 名参与者的胫骨受累，1 名参与者的股骨受累。 10 名参与者中有 5 名没有半月板撕裂。 结论：据我们所知，这是对患有膝关节疼痛的成人中未确诊 SIFK 的唯一报道估计。大约 3% 因疑似半月板撕裂而进行负重运动的患者可能患有 SIFK，这种诊断通常采用减少负重的方法进行治疗。
OBJECTIVE: Symptomatic knee osteoarthritis (OA) and meniscal tear are often treated with weight-bearing exercises and without ordering advanced imaging (e.g. MRI). This may lead to missed diagnoses of subchondral insufficiency fracture of the knee (SIFK). Failure to diagnose SIFK has treatment implications, as patients with SIFK are typically managed with a period of reduced weight-bearing. The primary objective of this study is to determine the prevalence of undiagnosed SIFK among persons treated non-operatively for knee pain and suspected meniscal tear(s).METHODS: The randomized controlled trial, TeMPO (Treatment of Meniscal Problems and Osteoarthritis), enrolls subjects whose clinicians suspect concomitant meniscal tear and knee OA. TeMPO participants undergo MRI ordered by the study to confirm meniscal tear. All study-ordered MRIs revealing a fracture were reviewed by two study radiologists who noted features of the fracture and joint. We report prevalence of SIFK and clinical and imaging features on these subjects with 95% confidence intervals.RESULTS: Ten of the 340 study-ordered MRIs had SIFK, resulting in an estimated prevalence of 2.94% (95% CI: 1.15%, 4.71%). Eight of the ten participants with SIFK had fractures located medially. The femur was involved in five of these participants, tibia in four, and both in one. Five of the ten participants did not have meniscal tears.CONCLUSIONS: This is the only reported estimate of undiagnosed SIFK in adults with knee pain, to our knowledge. Approximately 3% of patients managed with weight-bearing exercise for suspected meniscal tear may have SIFK, a diagnosis typically treated with reduced weight-bearing approaches.