Beckwée David, Vaes Peter, Shahabpour Maryam, Muyldermans Ronald, Rommers Nikki, Bautmans Ivan
Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium.
Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Am J Sports Med. 2015 Dec;43(12):3093-107. doi: 10.1177/0363546514565092. Epub 2015 Jan 29.
Bone marrow lesions (BMLs) are considered as predictors of pain, disability, and structural progression of knee osteoarthritis. The relationship between knee loading and BMLs is not yet completely understood.
To summarize the available evidence regarding the relationship between joint loading and the prevalence and progression of BMLs in the tibiofemoral joint.
Meta-analysis.
Three databases (PubMed, Web of Science, and The Cochrane Library) were systematically screened for studies encompassing BMLs and changes in knee loading. A methodological quality assessment was conducted, and a meta-analysis computing overall odds ratios (ORs) was performed where possible.
A total of 29 studies involving 7641 participants were included. Mechanical loading was categorized as body weight and composition, compartmental load, structural lesion, and physical activity. High compartmental loads and structural lesions increased the risk for BMLs (overall ORs ranging from 1.56 [95% CI, 1.13-2.15] to 8.2 [95% CI, 4.4-15.1]; P = .006). Body weight increased the risk for BMLs to a lesser extent (overall OR, 1.03; 95% CI, 1.01-1.05; P = .007). Contradictory results for the effect of physical activity on BMLs were found.
Augmented compartmental loads and structural lesions increased the risk of the presence or progression of BMLs. Body weight increased the risk for BMLs to a lesser extent. Contradictory results for the effect of physical activity on BMLs may be explained by a dose-response relationship, knee alignment, and structural lesions.
It has been shown that unloading the knee temporarily may induce beneficial effects on osteoarthritis-related structural changes. Therefore, an early recognition of BMLs in the aging athlete's knee may provide information to counter the onset and aggravation of symptomatic knee osteoarthritis by reducing the knee load.
骨髓损伤（BMLs）被认为是膝关节骨关节炎疼痛、功能障碍和结构进展的预测指标。膝关节负荷与BMLs之间的关系尚未完全明确。
总结关于关节负荷与胫股关节BMLs患病率及进展之间关系的现有证据。
荟萃分析。
系统检索三个数据库（PubMed、科学网和考克兰图书馆），查找包含BMLs和膝关节负荷变化的研究。进行方法学质量评估，并在可能的情况下进行荟萃分析以计算总体比值比（ORs）。
共纳入29项研究，涉及7641名参与者。机械负荷分为体重及组成、关节间负荷、结构损伤和身体活动。高关节间负荷和结构损伤会增加BMLs风险（总体ORs范围为1.56[95%CI，1.13 - 2.15]至8.2[95%CI，4.4 - 15.1]；P = 0.006）。体重增加BMLs风险的程度较小（总体OR，1.03；95%CI，1.01 - 1.05；P = 0.007）。关于身体活动对BMLs影响的结果相互矛盾。
增加的关节间负荷和结构损伤会增加BMLs存在或进展的风险。体重增加BMLs风险的程度较小。身体活动对BMLs影响的矛盾结果可能由剂量反应关系、膝关节对线和结构损伤来解释。
已表明暂时减轻膝关节负荷可能对骨关节炎相关的结构变化产生有益影响。因此，早期识别老年运动员膝关节中的BMLs可能通过减轻膝关节负荷为对抗症状性膝关节骨关节炎的发生和加重提供信息来源。
