title: Central bone marrow lesions in symptomatic knee osteoarthritis and their relationship to anterior cruciate ligament tears and cartilage loss.
abstract: OBJECTIVE
  Medial and lateral compartment bone marrow lesions (BMLs) have been tied to cartilage loss. We undertook this study to assess 2 types of BMLs in the central region of the knee (type 1 BMLs, which are related anatomically to anterior cruciate ligament [ACL]/posterior cruciate ligament [PCL] insertions, and type 2 BMLs, which encompass both the central region and either the medial or the lateral compartment) and determine their relationship to cartilage loss and ACL tears.
  
  
  METHODS
  Magnetic resonance imaging (MRI) of the knee was performed at baseline and at followup (15 and/or 30 months) in 258 subjects with symptomatic osteoarthritis (OA). At baseline, we assessed ACL tears and central BMLs located at or between the tibial spines or adjacent to the femoral notch. Cartilage loss was present if the score in any region of the tibiofemoral joint increased by >or= 1 units at the last available followup, using a modified Whole-Organ MRI Score. We used logistic regression adjusted for alignment, body mass index, Kellgren/Lawrence score, sex, and age.
  
  
  RESULTS
  One hundred thirty-nine knees (53.8%) had central BMLs, of which 129 had type 1 BMLs (96 abutted the ACL and had no coexistent type 2 features) and 25 had type 2 BMLs (often overlapped with type 1). Type 1 lesions were associated with ACL tears (odds ratio [OR] 5.9, 95% confidence interval [95% CI] 2.2-16.2) but not with cartilage loss (OR 1.6, 95% CI 0.8-3.1), while medial type 2 BMLs were related to medial cartilage loss (OR 6.1, 95% CI 1.0-35.2).
  
  
  CONCLUSIONS
  Central BMLs that abutted the ACL were highly prevalent and strongly related to ACL pathology, suggesting a role of enthesopathy in OA. Only BMLs with medial extension were related to ipsilateral cartilage loss.
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts 02118, USA.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Hernández-Molina
authors.forename: Ali
authors.initials: A
authors.lastname: Guermazi
authors.forename: Jingbo
authors.initials: J
authors.lastname: Niu
authors.forename: Daniel
authors.initials: D
authors.lastname: Gale
authors.forename: Joyce
authors.initials: J
authors.lastname: Goggins
authors.forename: Shreyasee
authors.initials: S
authors.lastname: Amin
authors.forename: David T
authors.initials: DT
authors.lastname: Felson
mesh_terms: D000368:Aged; D016118:Anterior Cruciate Ligament / Q000473:pathology*; D000070598:Anterior Cruciate Ligament Injuries; D001853:Bone Marrow / Q000473:pathology; D001855:Bone Marrow Diseases / Q000453:epidemiology / Q000473:pathology*; D002358:Cartilage, Articular / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000453:epidemiology / Q000473:pathology*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000453:epidemiology / Q000473:pathology*; D015995:Prevalence