Central bone marrow lesions in symptomatic knee osteoarthritis and their relationship to anterior cruciate ligament tears and cartilage loss
Central bone marrow lesions in symptomatic knee osteoarthritis and their relationship to anterior cruciate ligament tears and cartilage loss
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DOI：
10.1002/art.23173
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发表时间：
2008-01-01
影响因子：
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通讯作者：
Felson, David T.
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文献类型：
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作者：
Hernandez-Molina, Gabriela;Guermazi, Ali;Felson, David T.
Objective.内侧和外侧间室骨髓病变（BML）与软骨损失有关。我们进行了这项研究，以评估2种类型的BML在中央区域的膝盖（I型BML，这是相关的解剖学上的前交叉韧带[ACL]/后交叉韧带[PCL]插入，和2型BML，其中包括中央区域和内侧或外侧室），并确定其与软骨损失和ACL撕裂的关系。在基线和随访（15和/或30个月）时，对258例症状性骨关节炎（OA）受试者进行膝关节磁共振成像（MRI）。在基线时，我们评估了ACL撕裂和位于胫骨棘或胫骨棘之间或股骨切迹附近的中央BML。如果在最后一次随访时，使用改良的全器官MRI评分，胫股关节任何区域的评分增加>= 1个单位，则存在腕关节丢失。我们采用logistic回归分析调整了队列、体重指数、Kellgren/Lawrence评分、性别和年龄。139个膝关节（53.8%）有中央BML，其中129个为I型BML（96个位于ACL周围，没有共存的2型特征），25个为2型BML（通常与1型重叠）。1型病变与ACL撕裂相关（比值比[OR] 5.9，95%可信区间[95% CI] 2.2-16.2），但与软骨丢失无关（OR 1.6，95% CI 0.8-3.1），而内侧2型BML与内侧软骨丢失相关（OR 6.1，95% CI 1.0-35.2）。ACL周围的中央BML非常普遍，并且与ACL病理学密切相关，表明末端病在OA中的作用。只有内侧延伸的BML与同侧软骨损失有关。
Objective. Medial and lateral compartment bone marrow lesions (BMLs) have been tied to cartilage loss. We undertook this study to assess 2 types of BMLs in the central region of the knee (type I BMLs, which are related anatomically to anterior cruciate ligament [ACL]/posterior cruciate ligament [PCL] insertions, and type 2 BMLs, which encompass both the central region and either the medial or the lateral compartment) and determine their relationship to cartilage loss and ACL tears.Methods. Magnetic resonance imaging (MRI) of the knee was performed at baseline and at followup (15 and/or 30 months) in 258 subjects with symptomatic osteoarthritis (OA). At baseline, we assessed ACL tears and central BMLs located at or between the tibial spines or adjacent to the femoral notch. Cartilage loss was present if the score in any region of the tibiofemoral joint increased by >= 1 units at the last available followup, using a modified Whole-Organ MRI Score. We used logistic regression adjusted for alignment, body mass index, Kellgren/Lawrence score, sex, and age.Results. One hundred thirty-nine knees (53.8%) had central BMLs, of which 129 had type I BMLs (96 abutted the ACL and had no coexistent type 2 features) and 25 had type 2 BMLs (often overlapped with type 1). Type 1 lesions were associated with ACL tears (odds ratio [OR] 5.9, 95% confidence interval [95% CI] 2.2-16.2) but not with cartilage loss (OR 1.6, 95% CI 0.8-3.1), while medial type 2 BMLs were related to medial cartilage loss (OR 6.1, 95% CI 1.0-35.2).Conclusion. Central BMLs that abutted the ACL were highly prevalent and strongly related to ACL pathology, suggesting a role of enthesopathy in OA. Only BMLs with medial extension were related to ipsilateral cartilage loss.