Diagnostic performance of dual-energy CT in detecting bone marrow edema in lower limb joint injuries: a meta-analysis.

OBJECTIVE: We aimed to evaluate the diagnostic performance of dual-energy computed tomography (DECT) in detecting bone marrow edema (BME) in patients with lower limb joint injuries. METHODS: A thorough literature search was conducted across the PubMed, Embase, and Web of Science databases to identify relevant studies up to April 2024. Studies examining the diagnostic performance of DECT in detecting BME in lower limb joint injuries patients were included. Sensitivity and specificity were evaluated using the inverse variance method and transformed via the Freeman-Tukey double arcsine transformation. Furthermore, the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was utilized to evaluate the methodological quality of the included studies. RESULTS: This meta-analysis included 17 articles involving 625 patients. The pooled sensitivity, specificity, and AUC for DECT in detecting BME in lower limb joint injuries patients were 0.82 (95 % CI: 0.76-0.87), 0.95 (95 % CI: 0.92-0.97), and 0.95 (95 % CI: 0.93-0.97), respectively. The pooled sensitivity of DECT for detecting BME in knee, hip, and ankle joint injuries was 0.80, 0.84, and 0.80, with no significant difference among these joints (P = 0.55). The pooled specificity for knee, hip, and ankle injuries was 0.95, 0.97, and 0.89. Specificity differed significantly among the joints (P < 0.01), with the highest specificity in hip injuries. CONCLUSIONS: Our meta-analysis indicates that DECT demonstrates high diagnostic performance in detecting BME in patients with lower limb joint injuries, with the highest specificity observed in hip joint injuries. To validate these findings, further larger prospective studies are necessary.

The Impact of Age and Gender on Anterior Cruciate Ligament Injuries and Associated Knee Lesions: A Retrospective Study.

OBJECTIVES: This study aimed to evaluate the anterior cruciate ligament (ACL)-associated lesions in knee sports injuries in magnetic resonance imaging (MRI) and the effect of genders and ages on the patterns of the associated lesions in Arar, Northern Border region, Saudi Arabia. METHODS: This retrospective cohort study enrolled MRI of knee sports injuries with diagnosed ACL lesions during the period from January 2018 to December 2023 in Prince Abdulaziz Bin Musaed Hospital and Alkhibrah Health Center in Arar. RESULTS: A total of 505 knee MRI images were enrolled in the study. There were 104 (20.5%) females and 401 (79.5%) males with an average age of 34.5 years (range: 10-85 years) in this study. ACL lesions were reported in 191 (37.8%) cases. ACL was reported to be associated with other knee lesions in 185 (96.8%) cases. Joint effusion and posterior horn medial meniscus (PHMM) lesions were the most associated lesions found in 112 (58.9%) and 108 (56.5%) cases, respectively. Aging was found to significantly increase the incidence of PHMM and joint effusion associated with ACL tears, with estimated relative risks of 1.4 and 1.5 (odds ratio: 2.19 and 2.6), respectively. Also, the female gender was found to significantly increase the incidence of PHMM and associated ligament injuries with estimated relative risks of 1.5 and 4.1 (odds ratio: 3.6 and 5.1), respectively. CONCLUSION: Tears of ACL are prevalent patterns of knee sports injuries with different types of associated injuries, which can be affected by the ages and genders of the patients.

Bone marrow edema in children: chronic nonbacterial osteomyelitis and its mimickers.

Bone marrow is a highly cellular tissue undergoing significant developmental and physiologic changes with age. Indeed, with maturation from pediatric to the adult age there is a progressive, centrifugal conversion from red to yellow bone marrow. Histological characteristics of bone marrow are reflected in MR image signal. MR is therefore extremely sensitive in detecting pathological changes which are mostly characterized by increased free water causing high signal intensity on T2. Among the numerous diseases causing bone marrow edema in children chronic nonbacterial osteomyelitis (CNO) certainly has to be mentioned. This idiopathic inflammatory disorder is characterized by nonspecific migrating symptoms like skeletal pain with phases of exacerbations and relapses with alternating acute and chronic MR signs and it is often a diagnosis of exclusion. Hence, with bone marrow edema, various features at imaging should be considered to differentiate malignancies such as osseous lymphoma, osteosarcoma, and Ewing's sarcoma as well as benign lesions like osteomyelitis, post-traumatic, or post-treatment bone marrow edema. The aim of this review is to recall the main characteristics of CNO and provide an overview of its main mimickers highlighting similarities and differences.

Anomalous intraosseous venous drainage with bone edema and periosteal reaction: A rare entity to be aware of.

Varicose veins are associated with conditions that impair venous return, such as pregnancy, physical inactivity, valve failure and post-thrombotic syndrome. We report the case of a 50-year-old female patient with history of intermittent calf pain, worsening with prolonged standing posture. She had no previous medical history of either lower extremity trauma or infection. Physical examination showed medial pretibial soft tissue swelling. CT and MRI showed images suggestive of anomalous intraosseous venous drainage with associated bone edema and periosteal reaction. Knowledge of this rare entity is fundamental for proper patient management.

Characterization of bone marrow edema patterns among patients with Segond fracture in the setting of acute anterior cruciate ligament injury: A comparative MRI study.

PURPOSE: The purpose of this study is to investigate the anatomic distribution of bone marrow edema on MRI among patients who sustained a Segond fracture compared to those with an isolated ACL tear. METHODS: A retrospective cohort study was performed of patients aged 18-40 years old who presented with an acute isolated ACL tear between January 2012 and May 2022. Two blinded readers reviewed all knee MRIs to assess bone marrow edema using the Whole-Organ Magnetic Resonance Imaging Score and the area of each sub-compartment was scored. RESULTS: There were 522 patients in the final analysis, of which 28 patients (5.4%) were identified to have a Segond fracture. The Segond group demonstrated significantly greater rates of WORMS grades 2 and 3 in the central lateral femoral condyle, as well as the anterior, central, and posterior lateral tibial plateau. Furthermore, the Segond group demonstrated significantly greater rates of WORMS grades 2 and 3 in the central medial femoral condyle and the anterior medial tibial plateau. Bone edema at the central lateral femoral condyle (R = 0.034, p = 0.019) and central tibial plateau (R = 0.093, p = 0.033) were significantly correlated with lateral meniscus tears, while the edema in the posterior medial femoral condyle was correlated with medial meniscus tears (R = 0.127, p = 0.004). CONCLUSION: Patients who present with ACL tear and a concomitant Segond fracture demonstrate significantly more extensive bone marrow edema in both the medial and lateral compartments of the knee compared to patients with an isolated ACL tear.

Echo-planar DWI variants: A comparative study in vertebral marrow pathology.

PURPOSE: Single-shot echo-planar imaging (ss-EPI) has limited application in vertebral column imaging due to numerous artifacts. Therefore, we aimed to compare readout-segmented echo-planar imaging (rs-EPI) to ss-EPI and assess its value in the differential diagnosis of vertebral infectious, tumoral infiltrative, and degenerative disorders. MATERIALS AND METHODS: Sixty-six adult patients with spondylodiscitis (SD, n = 26), tumoral infiltration (TI, n = 20), or Modic type I degeneration (DE, n = 20) findings on spinal magnetic resonance imaging (MRI) included in this retrospective study. Two radiologists scored images for quality on a 4-point scale (image resolution, degree of geometric distortion, lesion selectivity, and diagnostic reliability) and measured signal intensity (SI), apparent diffusion coefficient (ADC), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). DE and SD groups also united to form the benign group. RESULTS: In all groups, rs-EPI performed better than ss-EPI in image quality, SNR, and CNR (p < .05). The difference between mean pathological ADC (ADCP) in the two sequences was statistically significant (p < .05). There was no significant difference between the groups in terms of ADCP in rs-EPI (p = .229), unlike ss-EPI (p = .025). Pathological SI (SIP) and CNR in rs-EPI were significantly higher in the malignant group than benign group (p = .002, p < .001). In rs-EPI, no significant difference was found between malignant and benign groups' ADCP (p = .13). CONCLUSION: The rs-EPI is a diffusion-weighted imaging (DWI) method with higher image quality that diminishes motion-induced phase errors and increases resolution through phase corrections. However, the distinction of malignant and benign vertebral bone marrow pathologies is unsatisfactory for rs-EPI compared with ss-EPI.

Bone marrow edema detection for diagnostic support of axial spondyloarthritis using MRI.

PURPOSE: This study proposes a process for detecting slices with bone marrow edema (BME), a typical finding of axSpA, using MRI scans as the input. This process does not require manual input of ROIs and provides the results of the judgment of the presence or absence of BME on a slice and the location of edema as the rationale for the judgment. METHODS: First, the signal intensity of the MRI scans of the sacroiliac joint was normalized to reduce the variation in signal values between scans. Next, slices containing synovial joints were extracted using a slice selection network. Finally, the BME slice detection network determines the presence or absence of the BME in each slice and outputs the location of the BME. RESULTS: The proposed method was applied to 86 MRI scans collected from 15 hospitals in Japan. The results showed that the average absolute error of the slice selection process was 1.49 slices for the misalignment between the upper and lower slices of the synovial joint range. The accuracy, sensitivity, and specificity of the BME slice detection network were 0.905, 0.532, and 0.974, respectively. CONCLUSION: This paper proposes a process to detect the slice with BME and its location as the rationale of the judgment from an MRI scan and shows its effectiveness using 86 MRI scans. In the future, we plan to develop a process for detecting other findings such as bone erosion from MR scans, followed by the development of a diagnostic support system.

Foot and Ankle MRI Findings in Asymptomatic Professional Ballet Dancers.

Background: Previous research in sport populations has demonstrated that abnormal magnetic resonance imaging (MRI) findings may be present in individuals without symptoms or known pathology. Extending this understanding to ballet, particularly in relation to the foot and ankle, is important to guide medical advice given to dancers. Purpose: To assess foot and ankle MRI scans in asymptomatic ballet dancers focusing on bone marrow edema and the posterior ankle and to investigate whether these MRI findings would become symptomatic within 1 year. Study Design: Case series; Level of evidence, 4. Methods: In total, 31 healthy dancers (62 feet/ankles; 15 male and 16 female; age, 26.5 ± 4.3 years) who were dancing in full capacity were recruited from an elite professional ballet company. Orthogonal 3-plane short tau inversion recovery imaging of both feet and ankles was obtained using 3T MRI and the images were reviewed using a standardized evaluation form by 2 musculoskeletal radiologists. Injuries in the company were recorded and positive MRI findings were assessed for correlation with any injuries requiring medical attention during the subsequent 12 months. Results: A total of 51 (82%) of the 62 feet and ankles had ≥1 area of bone marrow edema. The most common locations of bone marrow edema were the talus (n = 41; 66%), followed by first metatarsal (n = 14; 23%). Os trigonum and Stieda process were seen in 5 (8%) and 8 (13%) ankles, respectively. Among them, 2 os trigona showed bone marrow edema. Fluid in the anterior and posterior talocrural joints and the subtalar joint was observed in 48%, 63%, and 63% of these joints, respectively. Fluid around foot and ankle tendons was observed, with the most prevalent being the flexor hallucis longus tendon (n = 13; 21%). Two dancers who had positive findings on their MRI subsequently developed symptoms during the next 12 months. Conclusion: Positive MRI findings are commonplace in the foot and ankle of asymptomatic professional ballet dancers. The majority do not result in the development of symptoms requiring medical attention within 12 months. Careful interpretation of MRI findings with the dancer's clinical picture is required before recommending activity modification or further intervention.

Occult femoral fracture: Be aware of dual energy computed tomography.

A 74-year-old man was admitted to our emergency department following minor trauma. Plain radiographs and standard computed tomography (CT) scans revealed no signs of fractures. Subsequently, virtual noncalcium (VNCa) images were reconstructed, showing a linear area of bone marrow edema (BME) resembling a femoral neck fracture. Magnetic resonance imaging (MRI) was performed to confirm the presence of BME and an associated intraspongious fracture. In an emergency setting, dual-energy CT (DECT) and VNCa images can successfully identify occult femoral fractures, especially in patients with mild symptoms and minor trauma, thereby preventing misdiagnosis.

A comprehensive MRI analysis of osteoid osteomas in patients with diverse radiological features across various regions.

BACKGROUND: Magnetic resonance imaging (MRI), which does not involve ionizing radiation, is the preferred imaging modality for diagnosing osteoid osteoma (OO), an ailment more common in children and young adults. PURPOSE: This study aims to perform a literature review and delineate the MRI findings of OO lesions in patients exhibiting varying radiological features across different regions. MATERIALS AND METHODS: A retrospective study included 63 patients diagnosed with OO through MRI, assessed independently by two blinded radiologists using both standard and dynamic contrast-enhanced MRI techniques. After excluding 7 patients with prior biopsy, surgery, or RFA, the study included 56 patients with 57 lesions. RESULTS: Of 57 lesions evaluated, 50 were in long, and 7 in flat bones. One patient presented with two separate nidi within the intertrochanteric region. Most of the lesions, 49 (86%), were extra-articular, while 8 (14%) were intra-articular. The nidus was intracortical in 45 (78.9%) patients, intramedullary in 5 (8.8%), subperiosteal in 5 (8.8%), and endosteal in 2 (3.5%). Average nidus diameter was 7.02 ± 2.64 mm (3-12.6 mm). Central nidal calcification was present in 68.4% (n = 39) cases. Contrast enhancement was intense at 90.5%, moderate at 9.5%. Reactive sclerosis around the nidus was severe (50.9%), moderate (22.8%), and mild (26.3%). Bone marrow edema was severe (70.2%), moderate (14.0%), and mild (15.8%). Soft tissue edema was identified in 77.2% of all lesions. CONCLUSION: To minimize delays in diagnosis and treatment, radiologists should become acquainted with the typical OO MRI findings and the atypical MRI findings that might be mistaken for other conditions.

No Significant Differences between Bisphosphonates and Placebo for the Treatment of Bone Marrow Lesions of the Knee: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objectives: The purpose of the present systematic review and meta-analysis is to summarize the current evidence on the role of bisphosphonates in the treatment of knee bone marrow lesions (BMLs), to understand whether they are truly effective in improving symptoms and restoring the subchondral bone status at imaging evaluation. Methods: A literature search was carried out on PubMed, Cochrane, and Google Scholar databases in accordance with the PRISMA guidelines. Potential risk of bias was evaluated using the Cochrane Risk of Bias 2 tool for randomized controlled trials (RCTs) and the ROBINS-I tool for non-randomized studies. Results: A total of 15 studies were included in the present systematic review and meta-analysis. Seven studies were RCTs, two were prospective cohort studies, three were retrospective, and three were case series. Our meta-analysis revealed that bisphosphonates did not significantly improve clinical scores or reduce BML size compared to placebo. Accordingly, the rate of adverse events was also non-significantly higher among bisphosphonate users versus placebo users. Conclusions: The main finding of the present meta-analysis and systematic review is that bisphosphonates show neither significant benefits nor significant adverse events when compared to placebo in the treatment of BMLs of the knee. Level of Evidence: Level IV systematic review of level II-III-IV studies. Level I meta-analysis of level I studies.

Radiofrequency ablation of osteoid osteoma at the base of the coracoid process: Report of two cases.

If you encounter an unexplained case of bone marrow edema in a young patient, consider the possibility of osteoid osteoma (OO). Even in the presence of a nidus near vital structures, RFA can safely be used to treat OO.

Unsupervised Segmentation of Knee Bone Marrow Edema-like Lesions Using Conditional Generative Models.

Bone marrow edema-like lesions (BMEL) in the knee have been linked to the symptoms and progression of osteoarthritis (OA), a highly prevalent disease with profound public health implications. Manual and semi-automatic segmentations of BMELs in magnetic resonance images (MRI) have been used to quantify the significance of BMELs. However, their utilization is hampered by the labor-intensive and time-consuming nature of the process as well as by annotator bias, especially since BMELs exhibit various sizes and irregular shapes with diffuse signal that lead to poor intra- and inter-rater reliability. In this study, we propose a novel unsupervised method for fully automated segmentation of BMELs that leverages conditional diffusion models, multiple MRI sequences that have different contrast of BMELs, and anomaly detection that do not rely on costly and error-prone annotations. We also analyze BMEL segmentation annotations from multiple experts, reporting intra-/inter-rater variability and setting better benchmarks for BMEL segmentation performance.

Assessment of bone marrow edema on dual-energy CT scans in people with diabetes mellitus and suspected Charcot neuro-osteoarthropathy.

OBJECTIVE: This study aimed to quantitatively assess the diagnostic value of bone marrow edema (BME) detection on virtual non-calcium (VNCa) images calculated from dual-energy CT (DECT) in people with diabetes mellitus and suspected Charcot neuro-osteoarthropathy (CN). MATERIALS AND METHODS: People with diabetes mellitus and suspected CN who underwent DECT of the feet (80kVp/Sn150kVp) were included retrospectively. Two blinded observers independently measured CT values on VNCa images using circular regions of interest in five locations in the midfoot (cuneiforms, cuboid and navicular) and the calcaneus of the contralateral or (if one foot was available) the ipsilateral foot. Two clinical groups were formed, one with active CN and one without active CN (no-CN), based on the clinical diagnosis. RESULTS: Thirty-two people with diabetes mellitus and suspected CN were included. Eleven had clinically active CN. The mean CT value in the midfoot was significantly higher in the CN group (-55.6 ± 18.7 HU) compared to the no-CN group (-94.4 ± 23.5 HU; p < 0.001). In the CN group, the difference in CT value between the midfoot and calcaneus was statistically significant (p = 0.003); this was not the case in the no-CN group (p = 0.357). The overall observer agreement was good for the midfoot (ICC = 0.804) and moderate for the calcaneus (ICC = 0.712). Sensitivity was 100.0% and specificity was 71.4% using a cutoff value of -87.6 HU. CONCLUSION: The detection of BME on VNCa images has a potential value in people with diabetes mellitus and suspected active CN.

Bone marrow lesions in osteoarthritis: biomarker or treatment target? A narrative review.

Osteoarthritis (OA) is a leading cause of pain, functional impairment, and disability in older adults. However, there are no effective treatments to delay and reverse OA. Magnetic resonance imaging (MRI) can assess structural abnormalities of OA by directly visualizing damage and inflammatory reactions within the tissues and detecting abnormal signals in the subchondral bone marrow region. While some studies have shown that bone marrow lesions (BMLs) are one of the early signs of the development of OA and predict structural and symptomatic progression of OA, others claimed that BMLs are prevalent in the general population and have no role in the progression of OA. In this narrative review, we screened and summarized studies with different designs that evaluated the association of BMLs with joint symptoms and structural abnormalities of OA. We also discussed whether BMLs may serve as an imaging biomarker and a treatment target for OA based on existing clinical trials.

Radiomics analysis using magnetic resonance imaging of bone marrow edema for diagnosing knee osteoarthritis.

This study aimed to develop and validate a bone marrow edema model using a magnetic resonance imaging-based radiomics nomogram for the diagnosis of osteoarthritis. Clinical and magnetic resonance imaging (MRI) data of 302 patients with and without osteoarthritis were retrospectively collected from April 2022 to October 2023 at Longhua Hospital affiliated with the Shanghai University of Traditional Chinese Medicine. The participants were randomly divided into two groups (a training group, n = 211 and a testing group, n = 91). We used logistic regression to analyze clinical characteristics and established a clinical model. Radiomics signatures were developed by extracting radiomic features from the bone marrow edema area using MRI. A nomogram was developed based on the rad-score and clinical characteristics. The diagnostic performance of the three models was compared using the receiver operating characteristic curve and Delong's test. The accuracy and clinical application value of the nomogram were evaluated using calibration curve and decision curve analysis. Clinical characteristics such as age, radiographic grading, Western Ontario and McMaster Universities Arthritis Index score, and radiological features were significantly correlated with the diagnosis of osteoarthritis. The Rad score was constructed from 11 radiological features. A clinical model was developed to diagnose osteoarthritis (training group: area under the curve [AUC], 0.819; testing group: AUC, 0.815). Radiomics models were used to effectively diagnose osteoarthritis (training group,: AUC, 0.901; testing group: AUC, 0.841). The nomogram model composed of Rad score and clinical characteristics had better diagnostic performance than a simple clinical model (training group: AUC, 0.906; testing group: AUC, 0.845; p < 0.01). Based on DCA, the nomogram model can provide better diagnostic performance in most cases. In conclusion, the MRI-bone marrow edema-based radiomics-clinical nomogram model showed good performance in diagnosing early osteoarthritis.

Dual-energy CT in musculoskeletal imaging: technical considerations and clinical applications.

Dual-energy CT stands out as a robust and innovative imaging modality, which has shown impressive advancements and increasing applications in musculoskeletal imaging. It allows to obtain detailed images with novel insights that were once the exclusive prerogative of magnetic resonance imaging. Attenuation data obtained by using different energy spectra enable to provide unique information about tissue characterization in addition to the well-established strengths of CT in the evaluation of bony structures. To understand clearly the potential of this imaging modality, radiologists must be aware of the technical complexity of this imaging tool, the different ways to acquire images and the several algorithms that can be applied in daily clinical practice and for research. Concerning musculoskeletal imaging, dual-energy CT has gained more and more space for evaluating crystal arthropathy, bone marrow edema, and soft tissue structures, including tendons and ligaments. This article aims to analyze and discuss the role of dual-energy CT in musculoskeletal imaging, exploring technical aspects, applications and clinical implications and possible perspectives of this technique.

Differences in running biomechanics and tibiotalar cartilage T2 relaxation time between runners with and without asymptomatic tibial sesamoid bone marrow edema - clinical case series.

The impact of asymptomatic bone marrow edema (BME) in sesamoids on running biomechanics remains largely unknown, but exploring this relationship could aid early detection of forefoot-related injuries with cost-effective modalities. This study aimed to compare the running biomechanics of runners with asymptomatic BME in the tibial sesamoids with that of healthy controls. Four runners with asymptomatic BME in tibial sesamoids and four healthy runners participated. Lower extremity joint kinetics and kinematics were assessed along with plantar pressure while running at a self-selected speed. The T2 relaxation time of the tibiotalar cartilage was measured using MRI-derived T2 maps. Compared to the non-injured group, the injured group exhibited significantly lower plantar pressure under the hallux (p = 0.001), increased peak ankle rotation angles (p = 0.025), reduced ankle power generation (p = 0.049), and increased knee extension torque (p = 0.015). No significant differences in T2 values of the tibiotalar cartilage were observed. It appears that runners with asymptomatic BME adapted their running strategies by modifying their ankle biomechanics and reducing plantar pressure, even in the absence of pain. While the precise implications of these biomechanical alterations warrant further investigation, this study provides valuable insights into the relationship between asymptomatic BME and running biomechanics.

W-DRAG: A joint framework of WGAN with data random augmentation optimized for generative networks for bone marrow edema detection in dual energy CT.

Dual-energy computed tomography (CT) is an excellent substitute for identifying bone marrow edema in magnetic resonance imaging. However, it is rarely used in practice owing to its low contrast. To overcome this problem, we constructed a framework based on deep learning techniques to screen for diseases using axial bone images and to identify the local positions of bone lesions. To address the limited availability of labeled samples, we developed a new generative adversarial network (GAN) that extends expressions beyond conventional augmentation (CA) methods based on geometric transformations. We theoretically and experimentally determined that combining the concepts of data augmentation optimized for GAN training (DAG) and Wasserstein GAN yields a considerably stable generation of synthetic images and effectively aligns their distribution with that of real images, thereby achieving a high degree of similarity. The classification model was trained using real and synthetic samples. Consequently, the GAN technique used in the diagnostic test had an improved F1 score of approximately 7.8% compared with CA. The final F1 score was 80.24%, and the recall and precision were 84.3% and 88.7%, respectively. The results obtained using the augmented samples outperformed those obtained using pure real samples without augmentation. In addition, we adopted explainable AI techniques that leverage a class activation map (CAM) and principal component analysis to facilitate visual analysis of the network's results. The framework was designed to suggest an attention map and scattering plot to visually explain the disease predictions of the network.

Bone marrow edema of the knee: a narrative review.

Bone marrow edema (BME) is a frequent MRI finding in patients with knee pain. According to the etiology, BME of the knee can be classified into three main categories: ischemic, mechanic, and reactive. The diagnosis may be difficult, because of the specificity of symptoms and the poor radiographic findings. MRI is the gold standard, showing an area of altered signal of the bone with an high signal intensity on fat-suppressed, T2 weighted images, usually in combination with an intermediate or low signal intensity on T1 weighted images. Bone marrow edema tends to be self-limiting and, in most cases, resolves without any consequences in a varying amount of time. However, since it may evolve to complete joint destruction, early diagnosis and correct treatment are crucial to prevent the articular degeneration. Conservative therapy is the first step, with no weight-bearing for 3 to 6 weeks on the affected side, in combination with the administration of anti-inflammatory drugs or painkillers to manage symptoms. In non-responding forms and more advanced stages, minimally invasive preservative surgery can provide significant results, with subchondroplasty and core decompression being the two main procedures available. Knee arthroplasty, both total (TKA) or unicompartmental (UKA), is the only effective option when the degradation of cartilage is diffuse and in patients with subchondral bone collapse.