Spontaneous osteonecrosis of knee
Classic history and presentation: Sudden onset of severe knee pain and effusion in an elderly woman with a history of osteopenia / osteoporosis. The knee pain is unilateral in > 99% of cases and confined to the medial compartment in approximately 95% of cases.
Prevalence: The exact prevalence is unknown. SONK is likely underdiagnosed. Many patients with end-stage osteoarthritis may have had occult SONK that went undiagnosed and progressed to outright osteoarthritis. In patients older than 50 years and older than 65 years with acute medial compartment knee pain, the incidence of SONK is 3.4% and 9.4%, respectively.
- Age – Patients are most likely older than 60 years.
- Sex / gender – SONK is 3 times more common in women.
Pathophysiology: The exact pathophysiology of SONK is unknown. It may represent a subchondral insufficiency fracture, but others believe it is caused by a meniscal root tear.
Grade / classification system:
- Knee symptoms with normal radiographs.
- Flattening of the weight-bearing surface and subchondral radiolucencies surrounded by osteosclerosis of the affected condyle.
- Extension of radiolucencies with subchondral collapse.
- Degenerative phase with osteosclerosis and osteophyte formation surrounding the condyle.
M87.859 – Other osteonecrosis, unspecified femur
449816009 – Avascular necrosis of femoral condyle
- Secondary osteonecrosis of the knee – usually seen in patients older than 55 and commonly bilateral; associated with corticosteroid use, alcohol use, and renal disease
- Osteochondritis dissecans – lateral aspect of medial femoral condyle in adolescents
- Occult fracture – no osteonecrosis on MRI, history of trauma
- Distal femoral fracture
- Tibial plateau fracture
- Tibial eminence fracture
- Septic arthritis
- Ligamentous tear – anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL)
- Meniscal tear