Evaluation of Correlation Between Bone Marrow Edema Like Lesions and the Articular Elements Pathology Involved in Knee Osteoarthritis Using Magnetic Resonance Imaging

Background: Bone marrow edema-like lesions (BMLs) is a kind of bone disease due to excessive stress in the joints. The abnormal joint stress may be caused by pathological changes of the knee joint. Therefore, assessment of the relationship between the pathological state of the knee joints and BMLs is helpful to understand the pathological process of osteoarthritis (OA). Objective: To investigate pathogenic factors that are related to BMLs in osteoarthritic knee, by assessing the interrelationship between subregional BMLs and pathology of the interarticular structures. Methods: MRI and standard radiographs of the knees were obtained in 281 patients with OA. Articular cartilage morphology, meniscal degeneration, ligament integrity, and the presence of a joint effusion were assessed on MRI and were graded by a semi-quantitative method, the Whole Organ MRI Score (WORMS). Univariate and multivariate logistic regression analyses were used to evaluate the associations between BMLs in tibio-femoral compartments of the knee with the presence of pathology in the intra-articular elements of each compartment. Results: A total of 333 BMLs was found in 207 of 281 patients. The WORMS for cartilage, menisci and osteophytes were significantly higher in OA patients who had BMLs than those without BMLs. In univariable analysis, cartilage defects, meniscal pathology, ligament lesions and osteophates were all correlated with BMLs in various extent. However, when considering all the factors together using multivariate logistic regression analysis, only cartilage defects and meniscus lesions were significantly associated with BMLs in the ipsi-compartment. Conclusion: The presence of BMLs is associated with multiple factors in knee of OA patients. Cartilage defects appear to be the strongest correlating factor.