title: Subchondral insufficiency fracture of the knee: a non-traumatic injury with prolonged recovery time.
abstract: Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. Patients with subchondral insufficiency fracture characteristically have unremarkable plain radiographs, while MRI examination may reveal extensive bone marrow oedema and subchondral bone collapse. This article presents a 51-year-old postmenopausal woman, a physician, who had subchondral insufficiency fractures of the knee associated with prolonged standing during clinical work. She was treated with partial weight bearing on crutches until 14 months after the injury, viscosupplementation at 4 months to treat osteoarthritis and teriparatide treatment to improve bone healing at 7 months. By 26 months after the injury, she tolerated independent walking with a fabric knee support but still experienced mild posterolateral knee pain and numbness on prolonged standing.
authors.affiliation: Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Gourlay
authors.affiliation: Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Jordan B
authors.initials: JB
authors.lastname: Renner
authors.affiliation: Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Spang
authors.affiliation: Department of Medicine/Endocrinology, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Rubin
mesh_terms: D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002358:Cartilage, Articular; D019468:Disease Management; D005260:Female; D005269:Femur / Q000473:pathology*; D015775:Fractures, Stress / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007717:Knee / Q000473:pathology*; D007719:Knee Joint / Q000473:pathology*; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology; D020370:Osteoarthritis, Knee / Q000628:therapy; D011187:Posture; D019379:Teriparatide / Q000627:therapeutic use; D055676:Viscosupplementation; D016474:Weight-Bearing
chemical_list: D050071:Bone Density Conservation Agents; D019379:Teriparatide