A Systematic Review and Meta-analysis Investigating the Association Between Bone Marrow Lesions in People with Osteoarthritis
Sherif Hosny, Chintu Gademsetty, Toby O. Smith and Caroline B. Hing
Affiliation: St Georges Hospital, London, UK.
Keywords: Osteoarthritis, bone marrow oedema, bone marrow lesions.
Osteoarthritis (OA) is a prevalent condition and the leading cause of disability in the world. Bone marrow lesions
(BMLs) are a relatively new phenomenon and their association with OA is not well understood. A systematic review
was undertaken of published and unpublished or grey literature databases from their inception until 1st August 2012. Specific
data in relation to BMLs was extracted from each study and each study underwent independent critical appraisal using
the CASP appraisal tool. Thirty two studies were deemed eligible for review, identified from a total of 148 citations.
These included a total of 8623 participants. The studies presented moderate to strong methodological quality although
many did not identify confounding factors or failed to account for them in study design. Overall BML prevalence was
found to be 55% of people with OA, with a variable natural course. BML prevalence was more common in the medial
knee compartment and was highly predictive of cartilage loss and positively associated with progression to total knee replacement.
There was however no consensus on whether BMLs effected pain and function. Presence of large BMLs was
associated with meniscal injury and severity of arthritic changes. To conclude, BML research is an emerging field. Standardised
methods of radiological quantitative and qualitative BML assessment are necessary to allow study comparison
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