Natural course of intra-articular shifting bone marrow edema syndrome of the knee.

BACKGROUND: Intra-articular shift (migration) of bone marrow edema syndrome (BMES) is a very rare disease. Only a few cases have been reported thus far. The condition may cause the clinician to suspect an aggressive disease. METHODS: We reviewed eight patients (four women and four men) with unilateral BMES located in the knee. The patients were aged 39 to 56 years (mean, 49.2 years). In all patients, bone marrow edema (BME) initially observed on magnetic resonance imaging (MR imaging) shifted within the same joint, i.e. from the medial to the lateral femoral condyle or the adjacent bone. Seven patients were given conservative therapy, including limited weight-bearing, for a period of three weeks after the initial detection of BMES, whereas one patient underwent surgical core decompression twice. RESULTS: MR imaging showed complete restitution in 6 cases and a small residual edema in one case. A final control MR could not be obtained for one patient, who had no pain. A further patient had an avascular necrosis of the contralateral hip after 16 months. Improvement on MR imaging was correlated with the clinical outcome in all cases. All patients became asymptomatic after a mean period of 9 months (6-11). INTERPRETATION: Intra-articular shifting BMES is a very rare condition. As the disease is self-limiting, conservative therapy may be recommended.

A new soft transglenoidal suture anchor for arthroscopic labrum fixation.

Inherent in most transglenoidal suture stabilization techniques of unstable shoulders is the unreliable fixation of posterior knots on the fascia. The transglenoidal suture anchor (TSA) technique overcomes this disadvantage. The TSA is a 1.5-cm loop of a No. 3 braided polyester thread with 5 knots. The loop is loaded with 1 or 2 sutures. Using a transglenoidal shuttle suture, it is pulled into a transglenoidal drill hole from the back in a retrograde fashion. The anchor is stopped at the posterior cortex of the glenoid by the knot. Using an arthroscopic suture passer technique (Bird Beak; Arthrex, Naples, FL) sutures are applied in the anterior-inferior part of the capsule, tied with a self-locking sliding knot, and secured with 2 or 3 additional throws. Two or 3 TSAs with 1 or 2 threads per anchor are used in most cases. The ultimate failure load of 10 samples of the anchor was tested with porcine scapulae. It was more than 156 N in every case. This technique enables the surgeon to use up to 4 anchors in the unstable shoulder with 1 or 2 sutures per anchor. The anchors are inexpensive. No problems are encountered in case of revision. There is no abrasion in the eyelet of the anchor as with metallic anchors and no synovitis as with some absorbable anchors.

Bone marrow edema of the forefoot after chevron osteotomy--a rare cause of metatarsalgia: a case report.

Treatment options of bone marrow edema syndrome, which is associated with vascular disturbances, are protracted nonoperative treatment or core decompression which still demands several weeks until complete recovery. We obtained excellent results by the use of the vasoactive drug iloprost, a stable prostacyclin analogue, leading to a complete relief of symptoms in cases of bone marrow edema which had initially suggested early avascular necrosis of the second metatarsal head. The bone marrow edema of the second metatarsal bone was thought to be due to altered biomechanics following a distal first metatarsal chevron osteotomy. During the five days of iloprost infusion, the patient reported relief of rest pain. After therapy, the pedobarogram was normalized. The AOFAS forefoot score improved from 44 to 85 points after one month, and to 95 points after three months. At that time, the marrow showed normal signals. Without additional intervention the patient was able to resume normal activities.