Steroid Injections of Hip and Knee May Damage Joints (IMAGE)
Caption
Subchondral insufficiency fracture in a 69-year-old woman who presented with acutely worsening knee pain without known trauma. (a) Anteroposterior radiograph of the right knee shows possible medial compartment joint space narrowing (arrows) without osteophytes. There are no signs of osteonecrosis or subchondral insufficiency fracture. (b) Coronal intermediate-weighted fat-suppressed MRI obtained at the same time as a shows a subchondral insufficiency fracture of the medial femoral condyle, without collapse of the articular surface (arrow). In addition, there is marked femoral and tibial bone marrow edema (*). This patient was not treated with conservative measures (ie, switch to non-weight-bearing activity) and received an intra-articular corticosteroid injection. (c) Eleven months later, she returned with continued right knee pain. Repeat anteroposterior radiograph of the right knee shows collapse of the medial femoral condyle articular surface (arrows). (d) Coronal intermediate-weighted MRI acquired at the same time as c demonstrates deformity of the articular surface (short arrow) of the medial femoral condyle in the area of a previously noted subchondral insufficiency fracture (long arrow). In addition, there is marked bone marrow edema (*).
Credit
Radiological Society of North America
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