Bone Bruising/ Bone Marrow Oedema
- This information is included as this is sometimes referred to in radiology reports. Management and referral decisions should be based on the initial clinical presentation.
- Bone bruising and the finding of bone marrow oedema on an MRI scan can be due to an acute impaction injury, recurrent trauma from overload (high-impact sports) or from pressure overload due to arthritis or meniscal damage. The increased fluid signal is from bleeding and inflammation within the trabecular bone and there may be microscopic fractures of some bony trabeculae present (although there is no unstable fracture).
- Bone marrow oedema lesions are very common in asymptomatic athletes as well as degenerate knees and their presence does not necessarily diagnose the principle problem. Some, however, can be painful and many are associated with other structural problems including (degenerate) meniscal tears and ligament injuries. For those which are painful, whilst the majority resolve within 3 months, some take over a year to settle. The pain may settle before resolution of MRI and follow up MRI is not indicated to ensure resolution.
- With an impaction injury resulting in bone bruising, the overlying hyaline surface cartilage will also be contused and can sustain permanent damaged with thinning and chondral loss over time.
- There is no treatment (medical or surgical) which has been proven to speed up the resolution of bone marrow oedema lesions and these may be a cause for persisting pain after sustaining a degenerate meniscal tear, ligament injury or a flare up of osteoarthritis.
- Similarly, there is no treatment which can prevent progressive loss of hyaline cartilage over time where an impaction injury has been sustained.