MRI-demonstrated outcome of subchondral stress fractures of the knee after treatment with iloprost or tramadol: observations in 14 patients.
OBJECTIVE
To investigate the outcome of subchondral stress fractures (SSF) of the knee after treatment with the prostacyclin analogue Iloprost or the opioid analgesic Tramadol.


METHODS
Case series/retrospective review.


METHODS
Tertiary care center.


METHODS
Fourteen patients with at least a single subchondral stress fracture of the knee, surrounded by bone marrow edema, visible on T1-weighted and short tau inversion recovery magnetic resonance images.


METHODS
Nine patients had been treated with oral Iloprost (group 1; 11 SSF) and 5 patients with Tramadol (group 2; 5 SSF) for 4 weeks in the course of a double-blind, randomized clinical trial. MR images were obtained at baseline (1 day before the start of treatment), after 3 months, and after 1 year.


METHODS
SSF volumes and their rates of change between baseline and follow-up examinations, as determined on T1-weighted images by computer-assisted quantification.


RESULTS
After three months, the SSF volumes had decreased by a median of 42.2% in group 1 and increased by a median of 2.2% in group 2 (P = 0.008). After 1 year, the median decrease in SSF volumes was 100.0% in group 1 and 65.7% in group 2 (P = 0.017).


CONCLUSIONS
This small case series suggests that healing of SSF is more pronounced after Iloprost treatment.
Mayerhoefer
Marius E
ME
Department of Radiology, Medical University of Vienna/Vienna General Hospital, Vienna, Austria. marius.mayerhoefer@meduniwien.ac.at
Kramer
Josef
J
Breitenseher
Martin J
MJ
Norden
Cornelia
C
Vakil-Adli
Anosheh
A
Hofmann
Siegfried
S
Meizer
Roland
R
Siedentop
Harald
H
Landsiedl
Franz
F
Aigner
Nicolas
N
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D017102:Fracture Healing / Q000187:drug effects*; D015775:Fractures, Stress / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D016285:Iloprost / Q000627:therapeutic use*; D007718:Knee Injuries / Q000188:drug therapy* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014147:Tramadol / Q000627:therapeutic use*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
D000701:Analgesics, Opioid; D014665:Vasodilator Agents; D014147:Tramadol; D016285:Iloprost