Abstract
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 A systematic review was undertaken of published and unpublished or grey literature databases from their inception until 1st August 2012.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 and homogenisation.
Keywords: Osteoarthritis, bone marrow oedema, bone marrow lesions.
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