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. 2021 Jan 19;23(1):35.
doi: 10.1186/s13075-021-02422-0.

Association of subchondral bone marrow lesion localization with weight-bearing pain in people with knee osteoarthritis: data from the Osteoarthritis Initiative

Koji Aso  1   2 , Seyed Mohsen Shahtaheri  3 , Daniel F McWilliams  3 , David A Walsh  3
Affiliations

Association of subchondral bone marrow lesion localization with weight-bearing pain in people with knee osteoarthritis: data from the Osteoarthritis Initiative

Koji Aso et al. Arthritis Res Ther. .

Abstract

Background: Subchondral bone marrow lesions (BMLs) detected on MRI in knee osteoarthritis (OA) are associated with knee pain. The prevalence and progression of subchondral BMLs are increased by mechanical knee load. However, associations of subchondral BML location with weight-bearing knee pain are currently unknown. In this study, we aim to demonstrate associations of subchondral BML location and size with weight-bearing knee pain in knee OA.

Methods: We analyzed 1412 and 582 varus knees from cross-sectional and longitudinal Osteoarthritis Initiative datasets, respectively. BML scores were semi-quantitatively analyzed with the MRI Osteoarthritis Knee Score for 4 subchondral regions (median and lateral femorotibial, medial and lateral patellofemoral) and subspinous region. Weight-bearing and non-weight-bearing pain scores were derived from WOMAC pain items. Correlation and negative binomial regression models were used for analysis of associations between the BML scores and pain at baseline and changes in the BML scores and changes in pain after 24-month follow-up.

Results: Greater BML scores at medial femorotibial and lateral patellofemoral compartments were associated with greater weight-bearing pain scores, and statistical significance was retained after adjusting for BML scores at the other 4 joint compartments and other OA features, as well as for non-weight-bearing pain, age, sex, and body mass index (BMI) (medial femorotibial; B = 0.08, p = 0.02. patellofemoral; B = 0.13, p = 0.01). Subanalysis revealed that greater medial femorotibial BML scores were associated with greater pain on walking and standing (B = 0.11, p = 0.01, and B = 0.10, p = 0.04, respectively). Lateral patellofemoral BML scores were associated with pain on climbing, respectively (B = 0.14, p = 0.02). Increases or decreases over 24 months in BML score in the medial femorotibial compartment were significantly associated with increases or decreases in weight-bearing pain severity after adjusting for non-weight-bearing pain, age, sex, baseline weight-bearing pain, BMI, and BML at the other 4 joint compartments (B = 0.10, p = 0.01).

Conclusions: Subchondral BML size at the medial femorotibial joint compartment was specifically associated with the severity and the change in weight-bearing pain, independent of non-weight-bearing pain, in knee OA. Specific associations of weight-bearing pain with subchondral BMLs in weight-bearing compartments of the knee indicate that BMLs in subchondral bone contribute to biomechanically induced OA pain.

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Conflict of interest statement

D.A. Walsh: Grants from Versus Arthritis, while the study was being conducted; grants from Pfizer Ltd., other from Pfizer Ltd., personal fees from GlaxoSmithKline, outside the submitted work.

D. F. McWilliams: grants from Pfizer Ltd.

The remaining authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Subject selection from OAI database. n, number of participants included in the analysis
Fig. 2
Fig. 2
Delineation of subregional divisions for BML scoring. For BML scoring, the knee was divided into 4 articular sub-regions (medial and lateral femorotibial, and medial and lateral patellofemoral compartment) and subspinous region based on MOAKS; MFT, median femorotibial compartment; LFT, lateral femorotibial compartment; PF, patellofemoral compartment; S, subspinous region
See this image and copyright information in PMC

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