Natural course of intra-articular shifting bone marrow edema syndrome of the knee.
BACKGROUND
Intra-articular shift (migration) of bone marrow edema syndrome (BMES) is a very rare disease. Only a few cases have been reported thus far. The condition may cause the clinician to suspect an aggressive disease.


METHODS
We reviewed eight patients (four women and four men) with unilateral BMES located in the knee. The patients were aged 39 to 56 years (mean, 49.2 years). In all patients, bone marrow edema (BME) initially observed on magnetic resonance imaging (MR imaging) shifted within the same joint, i.e. from the medial to the lateral femoral condyle or the adjacent bone. Seven patients were given conservative therapy, including limited weight-bearing, for a period of three weeks after the initial detection of BMES, whereas one patient underwent surgical core decompression twice.


RESULTS
MR imaging showed complete restitution in 6 cases and a small residual edema in one case. A final control MR could not be obtained for one patient, who had no pain. A further patient had an avascular necrosis of the contralateral hip after 16 months. Improvement on MR imaging was correlated with the clinical outcome in all cases. All patients became asymptomatic after a mean period of 9 months (6-11).


CONCLUSIONS
Intra-articular shifting BMES is a very rare condition. As the disease is self-limiting, conservative therapy may be recommended.
Aigner
Nicolas
N
Orthopaedic Hospital Vienna - Speising, Speisingerstrasse 109, 1130 Vienna, Austria. nicolas.aigner@oss.at
Meizer
Roland
R
Petje
Gerd
G
Meizer
Elisabeth
E
Abdelkafy
Ashraf
A
Landsiedl
Franz
F
D000328:Adult; D001855:Bone Marrow Diseases / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D002358:Cartilage, Articular / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D019299:Decompression, Surgical; D018450:Disease Progression; D004487:Edema / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D013577:Syndrome; D013997:Time Factors; D016474:Weight-Bearing