Bisphosphonates or prostacyclin in the treatment of bone-marrow oedema syndrome of the knee and foot
Department of Orthopaedic Surgery, University Hospital of Regensburg, Bad Abbach, Germany, .Rheumatology International (Impact Factor: 1.52). 11/2012; 33(6). DOI: 10.1007/s00296-012-2584-0
Bone-marrow oedema (BME) represents a reversible but mostly painful increase in interstitial fluid. The exact pathogenetic processes still remain unknown. Treatment options are mainly symptomatic with core decompression as golden standard leading to immediate pain relieve. Recently, it has been shown that intravenous prostacyclin and bisphosphonates are useful in achieving a reduction in BME with a considerable improvement in the accompanying symptoms. We compared the outcome of both intravenously applied prostacyclin (Ilomedin(®), 10 patients) and bisphosphonate (Bondronat(®), 10 patients) in treatment of BME of the knee and foot. We could find a significant improvement of WOMAC score, SF-36 score and VAS 3 months and 1 year after therapeutic intervention in both the prostacyclin and the bisphosphonate group. Concerning the MRI scans in both groups, we found a distinct reduction of BME in 47 % and a complete regression in 40 %. Comparing both groups, the improvement of the scores was greater in the prostacyclin group than in the bisphosphonate group; the difference, however, was not significant. Intravenous bisphosphonates as well as prostacyclin are of efficient therapeutic benefit in treatment of BME with a quicker and greater effect of prostacyclin.
Article: Das Knochenmarködemsyndrom (KMÖS)[Show abstract] [Hide abstract]
ABSTRACT: Beim Knochenmarködem (KMÖ) handelt es sich um eine pathologische Vermehrung der interstitiellen Flüssigkeit im Knochen mit unspezifischem Erscheinungsbild im Magnetresonanztomogramm (MRT). Unterschieden werden das traumatische, das atraumatische, oft ischämische, das reaktive und das mechanische KMÖ. Das schmerzhafte KMÖS wird uneinheitlich als eigene Entität oder als reversibles Vorstadium der Osteonekrose (ON) betrachtet. Die Gefahr seines Übergangs in eine ON mit Gelenkdestruktion ist immer gegeben. Am häufigsten sind das Hüft-, Knie- und obere Sprunggelenk betroffen. Diagnostische Methode der Wahl ist das MRT. Je nach Ätiologie ist eine konservative oder operative Therapie zu diskutieren. Das KMÖS wird primär konservativ behandelt. Die Infusion von Prostazyklin oder Bisphosphonaten stellt eine gute Option für viele KMÖ dar. Etabliertes Verfahren ist die sog. „core decompression“. Beim ischämischen KMÖ sowie im Frühstadium einer ON könnte eine Kombination beider Verfahren von Vorteil sein.Der Orthopäde 03/2013; 42(3). DOI:10.1007/s00132-012-2053-1 · 0.36 Impact Factor
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ABSTRACT: Bone marrow oedema (BMO) is a multifactorial condition. The conservative treatment options include immobilisation of the affected region and systemic intravenous iloprost therapy. Whereas many studies confirm the positive effect of iloprost therapy in larger joints, e.g. knee and hip, there have been few studies of BMO in smaller areas such as the ankle joint or midfoot. The purpose of this study is to show that treatment with iloprost leads to positive long-term outcomes for BMO of the foot and ankle. Twenty-three patients with BMO of the ankle joint or midfoot, Association Research Circulation Osseous (ARCO) stages 1-2, were included in this study. A questionnaire was used to record the Ankle-hindfoot, Kaikkonen, SF-36 and VAS scores before and after iloprost therapy. In addition, all patients underwent MRI for radiological follow-up monitoring 3 months after treatment. A significant improvement in function based on the ankle-hindfoot and Kaikkonen scale was demonstrated after iloprost therapy. In 22 patients, follow-up MRI after 3 months showed complete regression of the oedema. Based on the positive results of our study, we recommend treatment with iloprost for BMO of the upper ankle joint and foot at ARCO stages 1-2.European Journal of Orthopaedic Surgery & Traumatology 09/2013; 24(8). DOI:10.1007/s00590-013-1320-0 · 0.18 Impact Factor
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ABSTRACT: Introduction The goal of this retrospective study was to evaluate the safety and efficacy of ibandronate for bone marrow oedema (BMO) syndrome and stress fracture cases, and to demonstrate an additional field of therapeutic importance–the high-performance athlete. Patients and Methods This retrospective study included twenty-five high-performance athletes. Sixty per cent of the athletes were European soccer players and 40.0% other high-class international athletes (3 women and 22 men with an average age of 25.0 ± 4.2), with BMO of the lower trunk or extremity diagnosed by magnetic resonance imaging (MRI). The treatment regimen consisted of high-dose vitamin D supplementation and intravenous ibandronate therapy. Results The time between the onset of pain and proper diagnosis of BMO was 106.3 ± 104.1 days. Excellent pain reduction (pain at rest and under strain) and improved mobility was reported within the first two weeks after the first ibandronate administration by sixteen patients (64%). The time from first treatment until return to competition (RTC) was on average 102.6 ± 65.2 days in total. If the time from onset of pain until diagnosis was within 40 days, the RTC was significantly reduced (p ≤ 0.05) to almost 50% (63.8 ± 48.1 days) when compared to the athletes with later diagnosis (124.4 ± 63.2 days). Conclusions The here-applied therapy regimen of intravenous BPs application and vitamin D supplementation in BMO syndrome has a beneficial effect for high-performance athletes. An early diagnosis and rapid treatment start can reduce the RTC significantly. An optimal bone metabolism with sufficient daily calcium and vitamin D intake is crucial and should not only be strived for the professional but also for the recreational athlete.Injury 06/2014; 45(6). DOI:10.1016/j.injury.2014.01.023 · 2.14 Impact Factor
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