Department of Epidemiology and Preventive Medicine, School Public Health and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia.
Semin Arthritis Rheum. 2013 Oct;43(2):187-94. doi: 10.1016/j.semarthrit.2013.03.002.
To systematically review the literature to determine whether biomechanical factors, meniscal pathology, and physical activity are risk factors for bone marrow lesions (BMLs) at the knee identified from magnetic resonance imaging in pre-osteoarthritis and osteoarthritis populations.
Electronic searches of MEDLINE and EMBASE were performed from January 1, 1996 to October 31, 2012 using the keywords of bone marrow lesion(s), bone marrow (o)edema, osteoarthritis, and knee. Studies examining biomechanical factors, meniscal pathology, or physical activity in relation to the presence, incidence, or change in BMLs at the knee were included. Two independent reviewers extracted the data and assessed the methodological quality of selected studies. Due to the heterogeneity of the studies, we performed a best evidence synthesis.
Fifteen studies were included in this review, of which 9 were considered high quality. The study populations were heterogeneous in terms of the symptoms and radiographic knee osteoarthritis. There was strong evidence for relationships of mechanical knee alignment and meniscal pathology with BMLs in osteoarthritis populations. There was a paucity of evidence for a relationship between physical activity and BMLs.
Despite the heterogeneity of included studies, these data suggest that mechanical knee alignment and meniscal pathology are risk factors for BMLs in knee osteoarthritis. It suggests that BMLs in individuals with osteoarthritis are more susceptible to mechanical knee alignment. Given the role of BMLs in the pathogenesis of knee osteoarthritis, identifying strategies to modify these risk factors will be important in slowing the progression and reducing the burden of knee osteoarthritis.
系统回顾文献，以确定在骨关节炎前期和骨关节炎人群中，从磁共振成像中发现的膝关节骨髓病变（BML）是否与生物力学因素、半月板病变和体力活动有关。
从 1996 年 1 月 1 日至 2012 年 10 月 31 日，通过 MEDLINE 和 EMBASE 电子检索，使用骨髓病变、骨髓（o）水肿、骨关节炎和膝关节等关键词进行检索。纳入研究生物力学因素、半月板病变或体力活动与膝关节 BML 存在、发生率或变化有关的研究。两名独立的综述者提取数据，并评估了所选研究的方法学质量。由于研究的异质性，我们进行了最佳证据综合。
本综述共纳入 15 项研究，其中 9 项被认为是高质量的。研究人群在症状和放射学膝骨关节炎方面存在异质性。在骨关节炎人群中，膝关节机械对线和半月板病变与 BML 之间存在很强的关系。体力活动与 BML 之间的关系证据不足。
尽管纳入的研究存在异质性，但这些数据表明，膝关节机械对线和半月板病变是膝关节骨关节炎 BML 的危险因素。这表明骨关节炎患者的 BML 更容易受到膝关节机械对线的影响。鉴于 BML 在膝骨关节炎发病机制中的作用，确定改变这些危险因素的策略将对减缓疾病进展和减轻膝骨关节炎的负担非常重要。
