Martins Mariana, Araújo Raquel, Pinheiro Rosana, Costa Ana, Carvalho José Luís
Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de Lisboa Central, Lisboa, PRT.
Physical Medicine and Rehabilitation, Centro Hospitalar Universitário do Porto, Porto, PRT.
Cureus. 2023 Jan 30;15(1):e34366. doi: 10.7759/cureus.34366. eCollection 2023 Jan.
Subchondral insufficiency fracture of the knee (SIFK) is a non-traumatic condition that has been, historically, associated with the elderly. Early diagnosis and management are essential to prevent evolution to subchondral collapse and secondary osteonecrosis, developing prolonged pain and functional losses. This article presents the case of an 83-year-old patient with severe right knee pain with 15 months of evolution, with sudden onset, and no history of trauma or sprain. Upon observation, the patient presented with a limping gait, antalgic posture with the knee in semi-flexion, pain on palpation of the joint medial line, severe pain on passive mobilization, limited joint range of motion, and a positive McMurray test. The X-ray only demonstrated a gonarthrosis grade 1 in the Kellgren and Lawrence classification with medial compartment affection. Due to the exuberant clinical picture with marked functional compromise, as well as clinical radiological dissociation, MRI was requested to rule out SIFK, which was later confirmed. The therapeutic orientation was then adjusted with an indication for non-weight bearing and analgesia, as well as orientation to an orthopedics consultation to request a surgical evaluation. SIFK is difficult to diagnose and may have an unpredictable outcome due to delayed treatment approaches. This clinical case encourages clinicians to consider subchondral fracture in the differential diagnosis of knee pain when an older patient, with subnormal radiographic findings, reports severe knee pain in the absence of overt traumatic injury.
膝关节软骨下不全骨折（SIFK）是一种非创伤性疾病，在历史上一直与老年人相关。早期诊断和治疗对于防止发展为软骨下塌陷和继发性骨坏死、避免出现长期疼痛和功能丧失至关重要。本文介绍了一例83岁患者的病例，该患者右膝剧痛已持续15个月，起病突然，无创伤或扭伤史。经观察，患者表现为跛行步态、膝关节半屈曲的防痛姿势、关节中线触诊疼痛、被动活动时剧痛、关节活动范围受限以及麦氏试验阳性。X线检查仅显示在凯尔格伦和劳伦斯分类中为1级膝关节病，内侧关节间隙受累。由于临床表现明显且功能严重受损，以及临床与影像学表现不符，遂要求进行MRI检查以排除SIFK，后来得到证实。随后调整了治疗方向，指示患者不负重并给予镇痛治疗，同时安排其前往骨科会诊以进行手术评估。SIFK难以诊断，由于治疗方法延迟，其预后可能不可预测。该临床病例促使临床医生在老年患者影像学表现不典型且无明显创伤性损伤却报告严重膝关节疼痛时，在膝关节疼痛的鉴别诊断中考虑软骨下骨折。
