Bone marrow edema of the knee: a narrative review

TL;DR

This review discusses bone marrow edema in the knee, its causes, diagnosis via MRI, and treatment options ranging from rest to surgery.

Contribution

The paper provides a structured narrative review of BME classification, diagnostic methods, and treatment strategies.

Findings

MRI is the gold standard for diagnosing bone marrow edema in the knee.

Conservative therapy is effective for most cases, while surgery is reserved for advanced stages.

Early diagnosis and treatment are crucial to prevent joint destruction.

Abstract

Bone marrow edema (BME) is a frequent MRI finding in patients with knee pain. According to the etiology, BME of the knee can be classified into three main categories: ischemic, mechanic, and reactive. The diagnosis may be difficult, because of the specificity of symptoms and the poor radiographic findings. MRI is the gold standard, showing an area of altered signal of the bone with an high signal intensity on fat-suppressed, T2 weighted images, usually in combination with an intermediate or low signal intensity on T1 weighted images. Bone marrow edema tends to be self-limiting and, in most cases, resolves without any consequences in a varying amount of time. However, since it may evolve to complete joint destruction, early diagnosis and correct treatment are crucial to prevent the articular degeneration. Conservative therapy is the first step, with no weight-bearing for 3 to 6 weeks on the affected side, in combination with the administration of anti-inflammatory drugs or painkillers to manage symptoms. In non-responding forms and more advanced stages, minimally invasive preservative surgery can provide significant results, with subchondroplasty and core decompression being the two main procedures available. Knee arthroplasty, both total (TKA) or unicompartmental (UKA), is the only effective option when the degradation of cartilage is diffuse and in patients with subchondral bone collapse.

The online version contains supplementary material available at 10.1007/s00402-024-05332-3.

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