Levy Andrew S, Cousins Kevin
The Center for Advanced Sports Medicine Knee and Shoulder, 90 Millburn Ave, Suite 204 Millburn, NJ, USA.
J Orthop. 2020 Mar 27;22:48-52. doi: 10.1016/j.jor.2020.03.047. eCollection 2020 Nov-Dec.
Evaluation and treatment of workplace knee injuries with pre existing arthritis is difficult from both a causality and a clinical perspective. The current study evaluates the relevance and treatment of the bone marrow edema (BME) in injured workers.
179 patients who injured their knee at work and were found to have arthritis and BME and subsequently underwent subchondral calcium phosphate injections (subchondroplasty) were reviewed.
Radiographic arthritic status was Kellgren Lawrence 3-4 in 56%. Cartilage status was outerbridge III/IV. 86% reported marked improvement at 6 months. 74% at 3 years and 83% at 5 years. RTW was 78% at 3 months & 85% by 6 months. Survivorship was 98% at one year, 86% at 2 years, 81% at 5 years & 76% at 7 years post op.
BME (associated with trabecular fracture) is an objective measure of causality in the injured worker. The treatment of BME positive arthritis in injured workers is highly successful in terms of decreasing pain, improving function and expediting return to work.
从因果关系和临床角度来看，对患有已有关节炎的工作场所膝关节损伤进行评估和治疗都很困难。本研究评估了受伤工人骨髓水肿（BME）的相关性及治疗方法。
回顾了179名在工作中膝关节受伤、被发现患有关节炎和BME且随后接受了磷酸钙软骨下注射（软骨下成形术）的患者。
56%的患者影像学关节炎状态为凯尔格伦·劳伦斯3 - 4级。软骨状态为Outerbridge III/IV级。86%的患者在6个月时报告有明显改善。3年时为74%，5年时为83%。3个月时恢复工作率为78%，6个月时为85%。术后1年生存率为98%，2年时为86%，5年时为81%，7年时为76%。
BME（与小梁骨折相关）是受伤工人因果关系的客观指标。在受伤工人中，对BME阳性关节炎的治疗在减轻疼痛、改善功能和加快重返工作方面非常成功。
