title: The Use of Tomosynthesis in the Global Study of Knee Subchondral Insufficiency Fractures.
abstract: Subchondral insufficiency fractures (SIF), previously termed spontaneous osteonecrosis of the knee, are marked by a sudden onset of severe pain. Other than the size of the lesion, prediction for progression to joint replacement is difficult. The objective was to determine if quantitative analysis of bone texture using digital tomosynthesis imaging would be useful in predicting more rapid progression to joint replacement.
  
  
  
  Tomosynthesis studies of 30 knees with documented SIF were quantified by fractal, mean intercept length (MIL), and line fraction deviation analyses. Fractal dimension, lacunarity, MIL, and line fraction deviation variables measured from these analyses were then correlated to short interval progression to joint replacement surgery.
  
  
  
  Higher odds for joint replacement were related to higher values of the standard deviation of slope lacunarity and to morphometric measures (eg, MIL).
  
  
  
  Using digital tomosynthesis images for bone texture assessment may help distinguish condylar bone response in SIF, potentially acting as a clinically relevant predictive tool. In the future, contrasting SIF to the more gradual long-term process of osteoarthritis, there may be a better understanding of the different mechanisms for the two conditions.
authors.affiliation: Department of Orthopaedics, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202. Electronic address: fnelson1@hfhs.org.
authors.forename: Fred
authors.initials: F
authors.lastname: Nelson
authors.affiliation: Department of Physical Medicine & Rehabilitation (Oakwood Hospital), Wayne State University, Dearborn, Michigan.
authors.forename: Omaima
authors.initials: O
authors.lastname: Bokhari
authors.affiliation: Bone & Joint Center, Department of Orthopaedics, Henry Ford Health System, Detroit, Michigan.
authors.forename: Daniel
authors.initials: D
authors.lastname: Oravec
authors.affiliation: Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana.
authors.forename: Woong
authors.initials: W
authors.lastname: Kim
authors.affiliation: Department of Radiology, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Flynn
authors.affiliation: Department of Otolaryngology, Georgetown University, Washington, District of Columbia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lumley
authors.affiliation: Bay Street Orthopaedics, Petoskey, Michigan.
authors.forename: Austin
authors.initials: A
authors.lastname: McPhilamy
authors.affiliation: Bone & Joint Center, Department of Orthopaedics, Henry Ford Health System, Detroit, Michigan.
authors.forename: Yener N
authors.initials: YN
authors.lastname: Yeni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D017709:Fractals; D015775:Fractures, Stress / Q000175:diagnosis*; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis*; D007719:Knee Joint / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000175:diagnosis*
keywords: Tomosynthesis; bone; fractal; insufficiency fracture; knee