Jordan Robert W, Aparajit Prasad, Docker Charles, Udeshi Umesh, El-Shazly Mohi
University Hospitals Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
Aparajit Orthopaedic and Maternity Nursing Home, 22, Near State Bank Of India, West High Court Road, Surendranagar, Nagpur 440015, India.
Knee. 2016 Aug;23(4):702-7. doi: 10.1016/j.knee.2016.04.005. Epub 2016 May 17.
Spontaneous osteonecrosis of the knee has an unknown aetiology. Management options include conservative, surgical and pharmacological interventions. The aim of this study was to report the experience of the authors in conservative management of SONK using non-operative measures by analysing the functional outcome and need for surgical intervention.
All patients treated for SONK between 1st August 2001 and 1st April 2014 were retrospectively reviewed. Treatment consisted of touch-down weight bearing for around six weeks. MR imaging was evaluated for size of lesion, the condyles involved and the time taken for resolution. Tegner Activity Scale, VAS pain, Lysholm, WOMAC and IKDC scores were recorded at presentation and final follow-up (mean six years, range six months to 13years).
Forty cases were included; the mean age of the group was 55.3years and 67.5% were male. The medial femoral condyle was the most commonly affected (52.5%). A statistically significant improvement was reported in all functional outcome measures (p<0.001). Only one patient required arthroscopic surgical intervention and no patients required arthroplasty during the follow-up period.
Early stage spontaneous osteonecrosis of the knee can be managed successfully without surgery if diagnosed early. Thus early investigation of acute knee pain with MRI scanning is recommended.
膝关节自发性骨坏死的病因不明。治疗选择包括保守治疗、手术治疗和药物干预。本研究的目的是通过分析功能结果和手术干预需求，报告作者采用非手术措施对膝关节自发性骨坏死进行保守治疗的经验。
对2001年8月1日至2014年4月1日期间接受膝关节自发性骨坏死治疗的所有患者进行回顾性研究。治疗包括大约六周的触地负重。对磁共振成像进行评估，观察病变大小、受累髁以及病变消退所需时间。在就诊时和最终随访时（平均六年，范围为六个月至13年）记录Tegner活动量表、视觉模拟评分法疼痛评分、Lysholm评分、WOMAC评分和国际膝关节文献委员会（IKDC）评分。
纳入40例患者；该组患者的平均年龄为55.3岁，67.5%为男性。股骨内侧髁是最常受累的部位（52.5%）。所有功能结果指标均有统计学意义的改善（p<0.001）。随访期间只有1例患者需要关节镜手术干预，没有患者需要关节置换术。
膝关节早期自发性骨坏死如果早期诊断，无需手术即可成功治疗。因此，建议对急性膝关节疼痛早期进行磁共振成像扫描检查。
