A. Poggi (bologna, IT)Rizzoli orthopaedic Institute Clinica Ortopedica e Traumatologica 2
Presenter Of 2 Presentations
P156 - Bone Marrow Edema does not influence the Clinical Outcome of PRP injections in the Knee Osteoarthritis
The current literature supports the efficacy of PRP in the treatment of knee osteoarthritis (OA). Nevertheless, it is not clear if the subchondral bone edema, also called “bone marrow edema” (BME), can influence the response to PRP intra-articular treatment. The aim of this study was to investigate the influence of BME (assessed with magnetic resonance imaging - MRI) in the clinical outcome of patients with knee OA who underwent intra-articular PRP injection.
Methods and Materials
A total of 204 patients (138 men and 66 women) treated with knee intra-articular PRP injections (1 to 3 consecutive injections) was included in this study. A clinical evaluation with the IKDC subjective score was performed at baseline and at 2,6, 12 months of follow-up. Moreover, patients were evaluated at baseline with an MRI to assess the presence of BME which was classified according to the WORMS score. Based on MRI analysis, patients were divided in two groups for a comparison: BME group (n=82) and no-BME group (n=122). In the BME group, further analysis was performed based on BME degree and BME location.
Both groups reported a significant improvement for the IKDC subjective score from baseline to all follow-ups. In particular, the BME group improved from 49.2±16.5 to 64.7±17.2 at 12 months (p>0.0005), while the no-BME group improved from 48.9±15.7 to 62.6±19.8 at 12 months (p>0.0005). No significant differences in terms of IKDC subjective score were reported between the two groups in terms of clinical improvement. The sub-analyses performed on BME degree (WORMS 1, 2, 3) and BME location (femur, tibia, patella) did not show any significant differences in terms of IKDC score improvement.
This study showed that intra-articular PRP injections provided a significant clinical improvement up to 12 months in patients with knee OA, and BME did not significantly influence the effect of PRP and clinical outcome.
P189 - Bone Bruise Assessment in Knees with ACL Lesions: Comparison of Semi-quantitative and Quantitative Scores
Bone marrow oedema (BME) is a common finding following severe acute knee trauma, like those responsible for anterior cruciate ligament (ACL) tears. Magnetic resonance imaging (MRI) is the method of choice to study bone bruise and different evaluation scores have been developed to detect and quantify BME extent. Nevertheless, the most reliable method to detect and quantify bone bruise is still unknown. The purpose of this study was to identify the most reliable method to evaluate bone bruise in knees with ACL injury.
Methods and Materials
One-hundred knee MRIs of patients with an ACL lesion were retrieved from the institutional Picture Archiving and Communication Systems (PACS) database between 2010 and 2018 and selected for the purpose of this study. Bone bruise evaluation in each knee MRI was assessed by applying the most clinically used semi-quantitative scores, WORMS and MOAKS, and by area measurement as quantitative evaluation by different evaluators: two musculoskeletal radiologists, one senior and one young orthopedics. The obtained values were analyzed to obtain the inter-rater and intra-rater reliability assessment.
WORMS and MOAKS showed a moderate agreement among the all operators with a Fleiss-K value of 0.459 and 0.45 respectively, while area measurement resulted in a poor agreement resulting in ICC ≤ 0.130. Higher agreement rates have been obtained for intra-test assessment performed by the same medical researcher. Specifically, WORMS and MOAKS resulted in almost perfect agreement while the area measurement showed a good agreement.
WORMS and MOAKS represent suitable tools to assess BME in patients affected by ACL injury, presenting good results in term of reliability. On the other hand, area measurement showed worse results in term of reliability compared to the semi-quantitative parameters. Further high-quality studies are needed to confirm these results and the best approach for the assessment of bone bruise in knees affected by ACL lesion.