Abstract
IntroductionRecent evidence suggests that bone marrow lesions (BMLs) play a pivotal role in knee osteoarthritis (OA). The aims of this study were to determine: 1) whether baseline BML presence and/or severity predict site-specific cartilage defect progression and cartilage volume loss; and 2) whether baseline cartilage defects predict site-specific BML progression.MethodsA total of 405 subjects (mean age 63 years, range 52 to 79) were measured at baseline and approximately 2.7 years later. Magnetic resonance imaging (MRI) of the right knee was performed to measure knee cartilage volume, cartilage defects (0 to 4), and BMLs (0 to 3) at the medial tibial (MT), medial femoral (MF), lateral tibial (LT), and lateral femoral (LF) sites. Logistic regression and generalized estimating equations were used to examine the relationship between BMLs and cartilage defects and cartilage volume loss.ResultsAt all four sites, baseline BML presence predicted defect progression (odds ratio (OR) 2.4 to 6.4, all P < 0.05), and cartilage volume loss (-0.9 to -2.9% difference per annum, all P < 0.05) at the same site. In multivariable analysis, there was a significant relationship between BML severity and defect progression at all four sites (OR 1.8 to 3.2, all P < 0.05) and BML severity and cartilage volume loss at the MF, LT, and LF sites (β -22.1 to -42.0, all P < 0.05). Additionally, baseline defect severity predicted BML progression at the MT and LF sites (OR 3.3 to 3.7, all P < 0.01). Lastly, there was a greater increase in cartilage volume loss at the MT and LT sites when both larger defects and BMLs were present at baseline (all P < 0.05).ConclusionsBaseline BMLs predicted site-specific defect progression and cartilage volume loss in a dose-response manner suggesting BMLs may have a local effect on cartilage homeostasis. Baseline defects predicted site-specific BML progression, which may represent increased bone loading adjacent to defects. These results suggest BMLs and defects are interconnected and play key roles in knee cartilage volume loss; thus, both should be considered targets for intervention.
Highlights
Recent evidence suggests that bone marrow lesions (BMLs) play a pivotal role in knee osteoarthritis (OA)
In unadjusted analysis, subjects who had a Bone marrow lesions (BMLs) at baseline had a higher prevalence of baseline cartilage defects, lost more cartilage volume from baseline to follow-up, and a higher proportion of them increased in cartilage defects from baseline to follow-up, compared with those subjects who did not have a BML at baseline
There was an interaction between BMLs and cartilage defects on cartilage volume loss, with a much greater rate of tibial cartilage loss when both larger defects and BMLs were present at baseline
Summary
Recent evidence suggests that bone marrow lesions (BMLs) play a pivotal role in knee osteoarthritis (OA). Baseline BMLs and increases cartilage over time [17] They reported that the absence of BMLs at baseline and follow-up was associated with a decreased risk of adjacent cartilage loss, while new or progressive BMLs displayed a high risk of adjacent cartilage loss [17]. Cartilage scores in both of these studies were assessed using the Whole-Organ Magnetic Resonance Imaging Score (WORMS) method, which semiquantitatively scores cartilage integrity by using one scale for both cartilage defects and cartilage loss. There is increasing evidence to demonstrate that BMLs predict site-specific cartilage changes; it remains unclear whether BMLs at one site predict cartilage changes in another
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