title: Bone marrow lesions and subchondral bone pathology of the knee.
abstract: Bone marrow lesions (BMLs) around the knee are a common magnetic resonance imaging (MRI) finding. However, despite the growing interest on BMLs in multiple pathological conditions, they remain controversial not only for the still unknown role in the etiopathological processes, but also in terms of clinical impact and treatment. The differential diagnosis includes a wide range of conditions: traumatic contusion and fractures, cyst formation and erosions, hematopoietic and infiltrated marrow, developmental chondroses, disuse and overuse, transient bone marrow oedema syndrome and, lastly, subchondral insufficiency fractures and true osteonecrosis. Regardless the heterogeneous spectrum of these pathologies, a key factor for patient management is the distinction between reversible and irreversible conditions. To this regard, MRI plays a major role, leading to the correct diagnosis based on recognizable typical patterns that have to be considered together with coexistent abnormalities, age, and clinical history. Several treatment options have been proposed, from conservative to surgical approaches. In this manuscript the main lesion patterns and their management have been analysed to provide the most updated evidence for the differential diagnosis and the most effective treatment.
authors.affiliation: Biomechanics and Technology Innovation Laboratory, II Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy. e.kon@biomec.ior.it.|Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy. e.kon@biomec.ior.it.
authors.forename: Elizaveta
authors.initials: E
authors.lastname: Kon
authors.affiliation: Orthopaedics and Traumatology - Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Ronga
authors.affiliation: Biomechanics and Technology Innovation Laboratory, II Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Filardo
authors.affiliation: OrthoIndy Cartilage Restoration Center, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Farr
authors.affiliation: Department of Orthopaedic Surgery, Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Madry
authors.affiliation: Department of Orthopaedics, Catholic University, A. Gemelli University Hospital, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Milano
authors.affiliation: Biomechanics and Technology Innovation Laboratory, II Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Andriolo
authors.affiliation: Department of Radiology, Hospital of University of Pennsylvania, Philadelphia, PA, USA.|Department of Radiology, HaEmek University Medical Center, Afula, Israel.
authors.forename: Nogah
authors.initials: N
authors.lastname: Shabshin
mesh_terms: D001853:Bone Marrow / Q000000981:diagnostic imaging* / Q000473:pathology; D001855:Bone Marrow Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000473:pathology; D002357:Cartilage Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D003288:Contusions / Q000000981:diagnostic imaging / Q000473:pathology; D003560:Cysts / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D004487:Edema / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging* / Q000473:pathology; D010020:Osteonecrosis / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: Bone marrow lesions; Bone marrow oedema; Knee; MRI; Osteonecrosis; Subchondral insufficiency fractures; Subchondral pathology