Association between Bone marrow lesions & synovitis and symptoms in symptomatic knee osteoarthritis.

T A Perry, M J Parkes, R J Hodgson, D T Felson, N K Arden, T W O'Neill

Journal: Osteoarthritis and cartilage 2021;28(3):316-323

PMID: 31877381

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Abstract

OBJECTIVE

Bone marrow lesions (BMLs) on MRI are typically subchondral in location, however, a proportion occur at knee ligament attachments and also include a cyst-like component. Our aim was to determine whether the volume of BML subtypes and synovial tissue volume (STV) was associated with symptoms in symptomatic knee OA.

METHOD

Images were acquired in a sub-sample who had taken part in a randomised trial of vitamin D therapy in knee OA (UK-VIDEO). Contrast-enhanced (CE) MRI was performed annually. In those who had ≥1 follow-up and a baseline scan (N = 50), STV and BML volume was assessed. BMLs were categorised by location and by the presence/absence of a cyst-like component. WOMAC was assessed annually. We used fixed-effects panel-regression modelling to examine the association between volume and symptoms.

RESULTS

There was no association between knee pain and total subchondral BML volume (b = 0.3 WOMAC units, 95% CI -0.3 to 1.0) or total ligament-based BML volume (b = 1.9, 95% CI -1.6 to 5.3). The volume of subchondral BMLs with a cyst-like component was not associated with pain (b = 0.8, 95% CI -0.5 to 2.1) however, the volume of the cyst-like component itself was associated with pain (b = 51.8, 95% CI 14.2 to 89.3). STV was associated with pain (b = 2.2, 95% CI 0.6 to 3.7).

CONCLUSION

The volume of the cyst-like component from subchondral BMLs with a cyst-like component was associated with knee pain. BML location, however, did not influence symptoms. STV was also associated with knee symptoms.

Address: Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. Electronic address: [email protected].; Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. Electronic address: [email protected].; Centre for Imaging Sciences, Institute of Population Health, University of Manchester, Manchester, UK. Electronic address: [email protected].; Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Clinical Epidemiology Research and Training Unit Boston University School of Medicine, Boston, MA, USA. Electronic address: [email protected].; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK. Electronic address: [email protected].; Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK. Electronic address: [email protected].

DOI: 10.1016/j.joca.2019.12.002

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MeSH Terms: Aged, Anterior Cruciate Ligament, Bone Marrow Diseases, Edema, Female, Femur, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Organ Size, Osteoarthritis, Knee, Patella, Posterior Cruciate Ligament, Randomized Controlled Trials as Topic, Synovial Membrane, Synovitis, Tibia