Histological Findings of Bone Marrow Lesions on Magnetic Resonance Images in Patients with Varus Knee Osteoarthritis


Bone marrow lesions (BMLs) on magnetic resonance (MR) images in knee osteoarthritis patients are considered to predict the severity and progression of the disease. We evaluated the histological findings of BMLs on MR images of the subchondral area of the medial femoral condyle in varus osteoarthritic knees. In 24 patients with varus knee osteoarthritis who underwent total knee arthroplasty (TKA), sagittal T1- and T2-weighted MR images of the affected knee were acquired before TKA. During TKA, resected bone pieces from the distal medial femoral condyle were obtained. Sagittal specimens obtained from the center of the bone pieces were histologically examined. Twenty patients had BMLs. Histological findings of BMLs in the subchondral area showed various features, such as fibrovascular tissue, cyst formation, active bone remodeling with bone formation and bone resorption, and hyaline cartilage. BMLs were not found in four patients; histological findings of these patients showed normal bone marrow tissue with normal-thickness trabeculae. Subchondral bony end plate in knees with BMLs was usually thin or destroyed, while that without BMLs was thick or normal. The condition of the subchondral bony end plate would explain the differences in the severity and progression between patients with or without BMLs.

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Sugita, T. , Kawamata, T. , Aizawa, T. , Sasaki, A. , Miyatake, N. and Uehara, T. (2014) Histological Findings of Bone Marrow Lesions on Magnetic Resonance Images in Patients with Varus Knee Osteoarthritis. Open Journal of Orthopedics, 4, 327-334. doi: 10.4236/ojo.2014.412050.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Lawrence, R.C., Hochberg, M.C., Kelsey, J.L., McDuffie, F.C., Medsger, T.A., Felts, W.R. and Shulman, L.E. (1989) Estimates of the Prevalence of Selected Arthritic and Musculoskeletal Disease in the United States. The Journal of Rheumatology, 16, 427-431.
[2] Yoshimura, N., Muraki, S., Oka, H., Mabuchi, A., En-Yo, Y., Yoshida, M., Saika, A., Yoshia, H., Suzuki, T., Yamamoto, S., Ishibashi, H., Kawaguchi, H., Nakamura, K. and Akune, T. (2009) Prevalence of Knee Osteoarthritis, Lumbar Spondylosis, and Osteoporosis in Japanese Men and Women: The Research on Osteoarthritis/Osteoporosis against Disability Study. Journal of Bone and Mineral Metabolism, 27, 620-628.
[3] Rousseau, J.Ch. and Garnero, P. (2003) Biological Markers in Osteoarthritis. Bone, 51, 265-277.
[4] Link, T.M., Steinbach, L.S., Ghosh, S., Ries, M., Lu, Y., Lane, N. and Majumdar, S. (2003) Osteoarthritis: MR Imaging Findings in Different Stages of Disease and Correlation with Clinical Findings. Radiology, 226, 373-381.
[5] Akamatsu, Y., Mitsugi, N., Taki, N., Kobayashi, H. and Saito, T. (2012) Medial versus Lateral Condyle Bone Mineral Density Ratio in a Cross-Sectional Study—A Potential Marker for Medial Knee Osteoarthritis Severity. Arthritis Care & Research, 64, 1036-1045.
[6] Lo, G.H., Tassinari, A.M., Driban, J.B., Price, L.L., Schneider, E., Majumdar, S. and McAlindon, T.E. (2012) Cross-Sectional DXA and MR Measures of Tibial Periarticular Bone Associate with Radiographic Knee Osteoarthritis Severity. Osteoarthritis and Cartilage, 20, 686-693.
[7] Zanetti, M., Bruder, E., Romero, J. and Hodler, J. (2000) Bone Marrow Edema Pattern in Osteoarthritic Knees: Correlation between MR Imaging and Histologic Findings. Radiology, 215, 835-840.
[8] Felson, D.T., Chaisson, C.E., Hill, C.L., Totterman, S.M.S., Gale, M.E., Skinner, K.M., Kazis, L. and Gale, D.R. (2001) The Association of Bone Marrow Lesions with Pain in Knee Osteoarthritis. Annals of Internal Medicine, 134, 541-549.
[9] Lim, Y.Z., Wang, Y., Wluka, A.E., Davies-Tuck, M.L., Biomed, B., Hanna, F., Urquhart, D.M. and Cicuttini, F.M. (2014) Association of Obesity and Systemic Factors with Bone Marrow Lesions at the Knee—A Systematic Review. Seminars in Arthritis and Rheumatism, 43, 600-612.
[10] Iwasaki, J., Sasho, T., Nakagawa, K., Ogino, S., Ochiai, N. and Moriya, H. (2007) Irregularity of Medial Femoral Condyle on MR Imaging Serves as a Possible Indicator of Objective Severity of Medial-Type Osteoarthritic Knee—A Pilot Study. Clinical Rheumatology, 26, 1705-1708.
[11] Felson, D.T., McLaughlin, S., Goggings, J., La-Valley, M.P., Gale, M.E., Totterman, S., Li, W., Hill, C. and Gale, D. (2003) Bone Marrow Edema and Its Relation to Progression of Knee Osteoarthritis. Annals of Internal Medicine, 139, 330-337.
[12] Kubota, M., Ishijima, M., Kurosawa, H., Liu, L., Ikeda, H., Osawa, A., Takazawa, Y., Kawasaki, T., Saita, Y., Kimura, Y. and Kaneko, K. (2010) A Longitudinal Study of the Relationship between the Status of Bone Marrow Abnormalities and Progression of Knee Osteoarthritis. Journal of Orthopaedic Science, 15, 641-646.
[13] Hunter, D.J., Zhang, Y., Niu, J., Goggins, J., Amin, S., LaValley, M.P., Guermazi, A., Genant, H., Gale, D. and Felson, D.T. (2006) Increase in Bone Marrow Lesions Associated with Cartilage Loss. Arthritis and Rheumatism, 54, 1529-1535.
[14] Kijowski, R., Stanton, P., Fine, J. and De Smet, A. (2006) Subchondral Bone Marrow Edema in Patients with Degeneration of the Articular Cartilage of the Knee Joint. Radiology, 238, 943-949.
[15] Driban, J.B., Lo, G.H., Lee, J.Y., Ward, R.J., Miller, E., Pang, J., Price, L.L. and McAlindon, T.E. (2011) Quantitative Bone Marrow Lesion Size in Osteoarthritic Knees Correlates with Cartilage Damage and Predicts Longitudinal Cartilage Loss. BMC Musculoskeletal Disorders, 12, 217.
[16] Crema, M.D., Felson, D.T., Roemer, F.W., Wang, K., Marra, M.D., Nevitt, M.C., Lynch, J.A., Torner, J., Lewis, C.E. and Guermazi, A. (2013) Prevalent Cartilage Damage and Cartilage Loss over Time Are Associated with Incident Bone Marrow Lesions in the Tibiofemoral Compartments—The MOST Study. Osteoarthritis and Cartilage, 21, 306-313.
[17] Bergman, A.G., Willen, H.K., Linddstrand, A.L. and Pettersson, H.T.A. (1994) Osteoarthritis of the Knee-Correlation of Subchondral MR Signal Abnormalities with Histopathologic and Radiographic Features. Skeletal Radiology, 23, 445-448.
[18] Saadat, E., Jobke, B., Chu, B., Lu, Y., Cheng, J., Li, X., Ries, M.D., Majumdar, S. and Link, T.M. (2008) Diagnostic Performance of in Vivo 3-T MRI for Articular Cartilage Abnormalities in Human Osteoarthritic Knees Using Histology as Standard of Reference. European Radiology, 18, 2292-2302.
[19] Kellgren, J.H. and Lawrence, J.S. (1959) Radiological Assessment of Osteo-Arthrosis. Annals of the Rheumatic Diseases, 16, 494-502.
[20] Burr, D.B. (2003) Subchondral Bone in the Pathogenesis of Osteo-arthritis. Mechanical Aspect. In: Brandt, K.D., Doherty, M. and Lohmander, L.S., Eds., Osteoarthritis, 2nd Edition, Oxford University Press, Oxford, 161-166.

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