Original researchBone Marrow Edema Syndrome of the Medial Femoral Condyle Treated With Extracorporeal Shock Wave Therapy: A Clinical and MRI Retrospective Comparative Study
Section snippets
Methods
From July 2014 to January 2016, 56 patients (39 women, 17 men) came to our attention for knee pain and difficulty walking. All patients were assessed and diagnosed with symptomatic BME of the medial condyle. Informed consent was obtained from the patients for their participation in the study.
We applied the following inclusion criteria: knee pain at rest and during walking associated with MRI evidence of a bone marrow lesion, defined as a high-intensity bone signal on T2-weighted. Exclusion
Results
Both study groups were comparable and homogeneous in terms of distribution of age, sex, and affected side (table 1). Pretreatment group values for both KSS clinical scores (P=.2954) and KSS functional scores (P=.4153), VAS scores (P=.4486), and MRI edema area measurement (P=.2792) were comparable between the 2 groups.
In the ESWT group, KSS clinical scores at 1-month follow-up improved to 70.89 (+23.49%) compared with 59.29 (+13.91%) in the control group. At final follow-up, KSS clinical scores
Discussion
To this day, there is still no consensus regarding the etiology, pathogenesis, and treatment of BME. The cornerstone of BME therapy is following a protocol that avoids weight-bearing on the affected limb in association with the administration of nonsteroidal anti-inflammatory drugs, analgesics, and glucocorticosteroids. Further medical therapy can be adopted, including bisphosphonates, which improve bone density; prostaglandin analogs,11 which induce vasodilatation, reduce capillary
Conclusions
Given these encouraging results, the authors believe this protocol may be an effective alternative to the treatment of BME of the knee because it is noninvasive and short in duration, therefore allowing for good patient compliance, and with the exception of therapy-induced pain, results in no significant adverse effects.
Suppliers
- a.
Storz Medical Duolith SD1; Storz Medical AG.
- b.
ICIS View 2014.1. AGFA HealthCare.
Acknowledgments
We thank the nurse and orderly staff in our outpatient clinic at San Raffaele Hospital (Milan, Italy): Angela Marras, BSN, Nadia Spinelli, BSN, Graziella Saccà, BSN, Gianfranca Matera, BSN, Alessandra Izzo, Oronzo Vesmile, BSN, Fernando Prontera, BSN, and Ugo Angeli, BSN.
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The Efficacy of Conservative Treatment of Bone Marrow Edema Syndrome: A Scoping Review of the Last Ten Years of Literature
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Disclosures: none.