High bone marrow edema volume may predict osteochondral allograft failure
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Key takeaways:
- Bone marrow edema volume of greater than 10 cm3 was associated with osteochondral allograft failure.
- High bone marrow edema volume was associated with lower survival rate after 3-year follow-up.
NEW ORLEANS — Bone marrow edema volume of greater than 10 cm3 may be predictive of osteochondral allograft failure, according to results presented at the Arthroscopy Association of North America Annual Meeting.
Guilherme Mathias Palhares, MD, and colleagues retrospectively analyzed data from 56 patients who underwent osteochondral allograft transplantation to determine whether diffuse bone marrow edema on 6-month MRI correlated with failure.
In his presentation, Palhares defined failure as a poor clinical outcome, including graft collapse, primary osteochondral allograft removal or revision/conversion to any kind of arthroscopy.
“MRI is a noninvasive method to evaluate the graft in preparation, and diffuse host bone marrow edema on MRI is expected during the first 3 months postoperatively,” Palhares said. “This prolonged diffuse host bone marrow edema on MRI may represent an additional host immune response to the allograft tissue.”
According to Palhares, six patients experienced failure in the study. Palhares noted patients who experienced failure had significantly higher bone marrow edema volume compared with patients who did not fail (18.49 cm3 vs. 4.66 cm3).
“The next step was to determine what would be the best cutoff value to predict failure,” Palhares said. “We found that failures around 10 cm3 had the best area under the curve, with a sensitivity of 100% and specificity around 90%.”
Palhares and colleagues categorized patients into two groups based on whether they had a bone marrow edema volume of greater than (n=12) or less than (n=44) 10 cm3.
All cases of failure occurred among patients with bone marrow edema volume of greater than 10 cm3, according to Palhares.
In addition, Kaplan Meier analysis showed that patients with bone marrow edema volume less than 10 cm3 had 100% allograft survival after 3 years follow-up, while patients with bone marrow edema volume greater than 10 cm3 had a 37.5% allograft survival after 3 years of follow-up.
“Surgeons can consider adopting this method of bone marrow edema measurement to counsel patients and identify those who may need intervention,” Palhares said.
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Palhares GM, et al. Diffuse host bone marrow edema in six-month MRI as a predictor for osteochondral allograft failure. Presented at: Arthroscopy Association of North America Annual Meeting; May 4-6, 2023; New Orleans.
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