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Review
. 2020 Dec 7;7(3):401-409.
doi: 10.1093/jhps/hnaa056. eCollection 2020 Aug.

Bone marrow lesions: etiology and pathogenesis at the hip

Maria A Munsch  1 , Marc R Safran  2 , Matthew C Mai  3 , W Kelton Vasileff  1
Affiliations
Review

Bone marrow lesions: etiology and pathogenesis at the hip

Maria A Munsch et al. J Hip Preserv Surg. .

Abstract

Bone marrow lesions (BML) are painful changes in subchondral bone which can be reliably identified on magnetic resonance imaging and have been identified in patients suffering from hip osteoarthritis (OA) and related conditions. Created via repetitive microdamage at the articular surface and dysregulated subchondral healing, BML have been linked to traumatic, inflammatory, degenerative, metabolic and neoplastic processes. While BML are known to be a common pathology throughout the body, BML at the hip have not been extensively studied in comparison to those at the knee. Due to the hip's unique biomechanical architecture, function and loading, and independent risk factors leading to hip OA, hip BMLs must be independently understood. The identification of BML in the setting of a pre-osteoarthritic condition may provide a target for treatment and prevention of joint degeneration. By continuing to define and refine the relationships between BML, subchondral bone cysts and OA, prevention, diagnosis and treatment of OA could shift, leading to an improved quality of life and increased longevity of individuals' native hips.

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Figures

Fig. 1.
Fig. 1.
Anteroposterior (A) and lateral (B) X-rays of a young female patient showing evidence of femoroacetabular impingement, along with possible cyst in the femoral neck indicated by a sclerotic ring. Joint spaces appear maintained.
Fig. 2.
Fig. 2.
Sagittal fast spin echo (FSE) MRI (A) of the same female patient illustrating an example of a femoral neck psuedocyst as well as evidence of bone marrow lesion in the acetabulum. Coronal FSE MRI (B), which again shows development of femoral neck pseudocyst and BML of the acetabulum.
Fig. 3.
Fig. 3.
Coronal short T2 inversion recovery (STIR) image (A) of a young male patient demonstrating typical appearance of BML in acetabular subchondral weight-bearing bone. Coronal ion weighted fat saturated FSE MRI (B) of male patient, showing a common MRI appearance of a subchondral cyst with adjacent BML in the roof of the acetabulum.
See this image and copyright information in PMC

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