Association Between Bone Mineral Density And Meniscus Lesions And Subchondral Insufficiency Fractures Of Knee

Part 1 Association between bone mineral density and subchondral insufficiency fractures of kneeObjective:To investigate whether osteoporosis is associated with the occurrence of subchondral insufficiency fractures of the knee.Methods : Retrospective analysis was performed on 24 patients with subchondral insufficiency fractures of the knee and 24 patients with medial compartment osteoarthritis who were admitted to our hospital from January 2015 to October 2019.Basic demographic characteristics,knee pain score information(KSS),associated imaging examinations(including knee MRI and X-ray)and bone mineral density data were collected for all patients.Differences in BMD between SIFK patients and MOA patients were compared to explore the relationship between BMD and the occurrence of SIFK.The correlation factors of SIFK occurrence were studied by multivariate logistic regression analysis.Results:Among SIFK group,11(46%)had osteoporosis;while 10(42%)had osteoporosis among the control MOA group.There was no significant statistical difference in the mean T-score of lumbar L1-L4,left femoral neck and left hip joint between the two groups.However,the Z-score of bone mineral density in lumbar L1-L4,left femoral neck and left hip joint in SIFK group was lower than that in MOA group,and it was statistically significant.Multivariate logistic regression analysis showed no significant correlation factors.Conclusion:Our results do not support that subchondral insufficiency fractures of knee are a result of systemically osteoporosis,and that only some SIFK patients have osteoporosis.Part 2 Association between meniscus lesions and Subchondral insufficiency fractures of kneeObjective:To analyze the clinical and imaging features of SIFK and describe the abnormalities of related cartilage,bone marrow edema and ligament.To study the association between meniscus lesions and the occurrence of SIFK,and to explore the association between meniscus lesions and the range of SIFK lesions on MRI.Methods : Retrospective analysis was performed on 38 patients with subchondral insufficiency fractures of the knee and 38 patients with medial compartment osteoarthritis who were admitted to our hospital from from January 2015 to February2020.Basic demographic characteristics and related imaging examinations(including knee MRI and X-ray)were collected for all patients.To analyze SIFK lesion location,size range,bone marrow edema degree,meniscal tear location,medial meniscus extrusion distance,the extent of cartilage defects,etc.The differences in the incidence of meniscus posterior horn root tear,medial meniscus extrusion,meniscus degeneration and bone marrow edema between patients with SIFK and patients with MOA were compared.Multivariate logistic regression analysis was used to study the related factors of the occurrence of SIFK;the range of MRI lesions on SIFK was measured and calculated,Spearman correlation analysis or Kendall’s tau-b correlation analysis was used to evaluate the relationship between meniscus lesions and the range of SIFK lesions on MRI.Results:The majority of SIFK patients were female(82%,),with an average age of66.8 years(47-81)and an average BMI of 24.64 kg/m2(18.18-29.28),the lesion site was 85% in the medial femoral condyle;While female patients in the MOA group accounted for 82%,with an average age of 65.8 years(50-79)and an average BMI of27.07kg/m2(18.42-32.88),there was no significant statistical difference in gender,age and BMI between the two groups(P>0.05)..Of all SIFK patients,67% had mild bone marrow edema,54% had mild cartilage defects,and 28% had ligament injuries.The incidence of moderate to severe bone marrow edema in the SIFK group was higher than that in the MOA group(33% vs.13%,P=0.042);The incidence of medial meniscus posterior root tear was significantly higher than that of MOA group(72.0%vs.18%,P<0.001);The incidence of severe meniscus degeneration in the MOA group was significantly higher than that in the SIFK group(64% vs.39%,P=0.023);The average distance of medial meniscus extrusion(0.47±0.091cm)was greater than that of the MOA group(0.26±0.40 mm,P=0.005).Multivariate logistic regression analysis showed that,compared with MOA,the occurrence of SIFK was more strongly correlated with the presence of moderate to severe BME,MMPRT,higher meniscus extrusion distance and more severe cartilage defects.Spearman or Kendall’s tau-bcorrelation analysis showed no significant correlation between medial meniscus lesions and range of SIFK lesion on MRI.Conclusion:The presence of medial meniscus posterior root tear,the degree of larger meniscus extrusion,the presence of moderate to severe bone marrow edema,and severe cartilage defect were significantly correlated with the occurrence of subchondral insufficiency fractures of the knee.There was no significant relationship between meniscus lesion and range of SIFK lesion on MRI.