title: The importance of early diagnosis in spontaneous osteonecrosis of the knee - A case series with six year follow-up.
abstract: BACKGROUND
  Spontaneous osteonecrosis of the knee has an unknown aetiology. Management options include conservative, surgical and pharmacological interventions. The aim of this study was to report the experience of the authors in conservative management of SONK using non-operative measures by analysing the functional outcome and need for surgical intervention.
  
  
  METHODS
  All patients treated for SONK between 1st August 2001 and 1st April 2014 were retrospectively reviewed. Treatment consisted of touch-down weight bearing for around six weeks. MR imaging was evaluated for size of lesion, the condyles involved and the time taken for resolution. Tegner Activity Scale, VAS pain, Lysholm, WOMAC and IKDC scores were recorded at presentation and final follow-up (mean six years, range six months to 13years).
  
  
  RESULTS
  Forty cases were included; the mean age of the group was 55.3years and 67.5% were male. The medial femoral condyle was the most commonly affected (52.5%). A statistically significant improvement was reported in all functional outcome measures (p<0.001). Only one patient required arthroscopic surgical intervention and no patients required arthroplasty during the follow-up period.
  
  
  CONCLUSIONS
  Early stage spontaneous osteonecrosis of the knee can be managed successfully without surgery if diagnosed early. Thus early investigation of acute knee pain with MRI scanning is recommended.
authors.affiliation: University Hospitals Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom. Electronic address: Robert.jordan@doctors.org.uk.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Jordan
authors.affiliation: Aparajit Orthopaedic and Maternity Nursing Home, 22, Near State Bank Of India, West High Court Road, Surendranagar, Nagpur 440015, India. Electronic address: aparajitprasad@yahoo.com.
authors.forename: Prasad
authors.initials: P
authors.lastname: Aparajit
authors.affiliation: Worcester Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, United Kingdom. Electronic address: Charles.docker@worcsacute.nhs.uk.
authors.forename: Charles
authors.initials: C
authors.lastname: Docker
authors.affiliation: Worcester Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, United Kingdom. Electronic address: umesh.udeshi@worcsacute.nhs.uk.
authors.forename: Umesh
authors.initials: U
authors.lastname: Udeshi
authors.affiliation: Droitwich Knee Clinic, 27 New Road, Bromsgrove, Worcestershire B60 2JL, United Kingdom. Electronic address: Mohi.el-shazly@droitwichkneeclinic.co.uk.
authors.forename: Mohi
authors.initials: M
authors.lastname: El-Shazly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072700:Conservative Treatment; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D020127:Recovery of Function; D012189:Retrospective Studies
keywords: Conservative; Knee; Non-operative; Osteonecrosis; Spontaneous osteonecrosis