Huizinga Jamie L, Shah Nehal, Smith Stacy E, Notino Anthony, Kluczynski Melissa A, Jordan Kelly, Bisson Leslie J, Chen Antonia F, Selzer Faith, Losina Elena, Katz Jeffrey N
Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA.
Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, MA.
Osteoarthr Cartil Open. 2020 Dec;2(4). doi: 10.1016/j.ocarto.2020.100089. Epub 2020 Aug 19.
Symptomatic knee osteoarthritis (OA) and meniscal tear are often treated with weight-bearing exercises and without ordering advanced imaging (e.g. MRI). This may lead to missed diagnoses of subchondral insufficiency fracture of the knee (SIFK). Failure to diagnose SIFK has treatment implications, as patients with SIFK are typically managed with a period of reduced weight-bearing. The primary objective of this study is to determine the prevalence of undiagnosed SIFK among persons treated non-operatively for knee pain and suspected meniscal tear(s).
The randomized controlled trial, TeMPO (Treatment of Meniscal Problems and Osteoarthritis), enrolls subjects whose clinicians suspect concomitant meniscal tear and knee OA. TeMPO participants undergo MRI ordered by the study to confirm meniscal tear. All study-ordered MRIs revealing a fracture were reviewed by two study radiologists who noted features of the fracture and joint. We report prevalence of SIFK and clinical and imaging features on these subjects with 95% confidence intervals.
Ten of the 340 study-ordered MRIs had SIFK, resulting in an estimated prevalence of 2.94% (95% CI: 1.15%, 4.71%). Eight of the ten participants with SIFK had fractures located medially. The femur was involved in five of these participants, tibia in four, and both in one. Five of the ten participants did not have meniscal tears.
This is the only reported estimate of undiagnosed SIFK in adults with knee pain, to our knowledge. Approximately 3% of patients managed with weight-bearing exercise for suspected meniscal tear may have SIFK, a diagnosis typically treated with reduced weight-bearing approaches.
有症状的膝关节骨关节炎（OA）和半月板撕裂通常采用负重锻炼进行治疗，且不进行高级影像学检查（如磁共振成像[MRI]）。这可能导致漏诊膝关节软骨下不全骨折（SIFK）。未能诊断出SIFK会对治疗产生影响，因为SIFK患者通常需要一段时间减少负重。本研究的主要目的是确定在因膝关节疼痛和疑似半月板撕裂而接受非手术治疗的人群中，未被诊断出的SIFK的患病率。
随机对照试验TeMPO（半月板问题与骨关节炎治疗）纳入临床医生怀疑合并半月板撕裂和膝关节OA的受试者。TeMPO参与者接受研究安排的MRI检查以确认半月板撕裂。两位研究放射科医生对所有显示骨折的研究安排的MRI进行了审查，他们记录了骨折和关节的特征。我们报告了这些受试者中SIFK的患病率以及临床和影像学特征，并给出95%置信区间。
在340例研究安排的MRI中，有10例存在SIFK，估计患病率为2.94%（95%CI：1.15%，4.71%）。10例患有SIFK的参与者中有8例骨折位于内侧。其中5例参与者的股骨受累，4例胫骨受累，1例股骨和胫骨均受累。10例参与者中有5例没有半月板撕裂。
据我们所知，这是唯一报道的对膝关节疼痛成人中未被诊断出的SIFK的估计。在因疑似半月板撕裂而接受负重锻炼治疗的患者中，约3%可能患有SIFK，这一诊断通常采用减少负重的方法进行治疗。
