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Rofo 2024; 196(11): 1143-1154
DOI: 10.1055/a-2344-5337
Review

Subchondral insufficiency fractures: overview of MRI findings from hip to ankle joint

Subchondrale Insuffizienzfrakturen: Überblick der MRT-Zeichen vom Hüftgelenk zum Sprunggelenk
Monica Maria Buturoiu 
1   Radiology, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania (Ringgold ID: RIN87267)
,
Sorin Ghiea
2   Imaging Department, Monza Hospital, Bucharest, Romania
,
Marc-André Weber 
3   Rostock University Medical Center, Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock, Germany
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Abstract

Background

Subchondral insufficiency fracture (SIF) represents a potentially severe condition that can advance to osteoarthritis, with collapse of the articular surface. SIF manifests as a fracture in bone weakened by non-tumorous disease, precipitated by repetitive physiological stress, without a clear history of major trauma. It is observed along the central weight-bearing region of the femoral condyle, with a higher incidence in the medial femoral condyle, but also in other large weight-bearing synovial joints, such as the femoral head, tibial plateau, or talus.

Method

A review of the literature from the past six years was performed by searching PubMed and ScienceDirect databases, using the keywords “subchondral insufficiency fracture” and “spontaneous osteonecrosis of the knee”. The inclusion criteria were scientific papers presented in the English language that reported on the magnetic resonance imaging (MRI) aspects of SIF of the lower limb.

Results and Conclusion

Detecting SIF at the level of the hip, knee, and ankle may present challenges both clinically and radiologically. The MRI appearance is dominated by a bone marrow edema-like signal and subchondral bone changes that can sometimes be subtle. Subchondral abnormalities are more specific than the pattern of bone marrow edema-like signal and are best shown on T2-weighted and proton-density-weighted MR images. MRI plays an important role in accurately depicting even subtle subchondral fractures at the onset of the disease and proves valuable in follow-up, prognosis, and the differentiation of SIF from other conditions.

Key Points

  • Subchondral insufficiency fractures may affect the hip, knee, and ankle.

  • Subchondral insufficiency fractures may heal spontaneously or progress to collapse.

  • MRI is important for the detection, follow-up, and prognosis of subchondral insufficiency fractures.

  • Differential diagnosis may include transient osteoporosis and osteonecrosis of systemic origin.

Citation Format

  • Buturoiu MM, Ghiea S, Weber M. Subchondral insufficiency fractures: overview of MRI findings from hip to ankle joint. Fortschr Röntgenstr 2024; 196: 1143 – 1154

Zusammenfassung

Hintergrund

Die subchondrale Insuffizienzfraktur (SIF) stellt eine potenziell ernste Erkrankung dar, die zu einer Osteonekrose und oder einem Fortschreiten der Arthrose mit Kollaps der Gelenkoberfläche führen kann. SIF manifestiert sich als Fraktur im durch nicht-neoplastische Krankheiten geschwächten Knochen. Diese Fraktur wird ausgelöst durch wiederholten physiologischen Stress, jedoch ohne klare Anamnese eines schwerwiegenden Traumas. Sie tritt entlang der zentralen, gewichtstragenden Region der Femurkondyle auf, mit einer höheren Inzidenz im medialen Femurkondylus, aber auch in anderen großen, gewichtstragenden mit Synovia ausgekleideten Gelenken, wie dem Knie- und Sprunggelenk.

Methode

Es wurde eine retrospektive Literaturanalyse der letzten sechs Jahre durchgeführt, indem PubMed- und ScienceDirect-Datenbanken nach den Schlüsselwörtern „subchondrale Insuffizienzfraktur“ und „spontane Osteonekrose des Knies“ durchsucht wurden. Die Einschlusskriterien waren wissenschaftliche Arbeiten in englischer Sprache, die sich mit den magnetresonanztomografischen (MRT) Aspekten der SIF der unteren Extremität befassten.

Ergebnisse und Schlussfolgerung

Die Detektion von SIF im Bereich von Hüfte, Knie und Sprunggelenk kann sowohl klinisch als auch radiologisch herausfordernd sein. In der MRT zeigen sich Veränderungen, wie sie auch bei einem Knochenmarködem festzustellen sind. Außerdem zeigen sich subchondrale Knochenveränderungen, die manchmal auch nur subtil sein können. Subchondrale Abnormalitäten sind spezifischer als das eher unspezifische Knochenmarködem und werden am besten auf T2-gewichteten und Protonendichte-gewichteten MRT-Sequenzen dargestellt. Die MRT spielt eine wichtige Rolle dabei, auch subtile subchondrale Frakturen zu Beginn der Erkrankung genau darzustellen und erweist sich als wertvoll bei der Verlaufskontrolle, Prognose und Differenzierung von SIF zu anderen Pathologien.

Kernaussagen

  • Subchondrale Insuffizienzfrakturen können spontan heilen oder zu einem Kollaps fortschreiten.

  • MRT ist wichtig für die Erkennung, Nachsorge und Prognose von subchondralen Insuffizienzfrakturen.

  • Die Differentialdiagnose kann transiente Osteoporose und Osteonekrose systemischen Ursprungs umfassen.

Keywords

Subchondral insufficiency fracture - Hip - Knee - ankle - Magnetic resonance imaging


Publication History

Received: 12 January 2024

Accepted after revision: 04 June 2024

Article published online:
19 July 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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