Spontaneous collapse of the tibial plateau: radiological staging.
OBJECTIVE
This paper proposes a radiological staging system for necrosis of the tibial plateau, similar to those already developed for the hip and the medial femoral condyle.


METHODS
We retrospectively studied the clinical case histories and radiographic findings of 14 patients (15 affected knees) with histologically proven osteonecrosis of the tibial plateau.


RESULTS
Stage I was marked by normal radiograph, but increased uptake in bone scan and subchondral areas of abnormal marrow signal intensity in magnetic resonance imaging (MRI), as reported in other osteonecrosis sites. Stage II was characterised by cystic and sclerotic changes, and stage III fracture of the medial rim of the medial tibial plateau and tibial plateau collapse were present. Stage IV was marked by joint narrowing. These changes appeared earlier and were more pronounced when there was genu varum/valgum or involvement of the lateral tibial plateau.


CONCLUSIONS
The radiological evolution of the disease appears to follow a four-stage course over a period of roughly one year from the onset of symptoms.
Carpintero
P
P
Orthopaedic Department, University Hospital Reina Sofia, Avenue Menendez Pidal S/N, 14004 Cordoba, Spain. pcarpinterob@medynet.com
Leon
F
F
Zafra
M
M
Montero
R
R
Carreto
A
A
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007717:Knee; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010020:Osteonecrosis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D011859:Radiography; D013977:Tibia / Q000000981:diagnostic imaging* / Q000473:pathology