MR appearance of SONK-like subchondral abnormalities in the adult knee: SONK redefined

Skeletal Radiology
R Richard Ramnath, Susan V Kattapuram

Abstract

To investigate the MR characteristics of SONK-like (spontaneous osteonecrosis of the knee) subchondral abnormalities in the adult atraumatic knee and to recategorize these patients into two subgroups: a subacute to chronic process associated with osteoarthritis and an acute process associated with insufficiency fractures. We retrospectively examined the knee MRIs of 39 patients with non-specific interpretations of osteochondral abnormalities. There were a total of 52 subchondral lesions without any known traumatic event and no prior surgery. All lesions evaluated had MR features previously ascribed to SONK. Several MR characteristics were then assessed: presence or absence of a line, size, zonal location, T1 and T2 signal, associated marrow edema, associated ipsilateral meniscal tear, and associated ipsilateral cartilage defects. The abnormalities with linear components (insufficiency fractures) tended to be larger (P<0.01) and were associated with a severe amount of marrow edema (P<0.0001) consistent with an acute process. The non-linear abnormalities were more associated with cartilage defects (P=0.01) and less marrow edema consistent with osteoarthritis and a subacute to chronic process. This association of SONK-like abnorma...Continue Reading

Citations

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