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MRI-Demonstrated Outcome of Subchondral Stress Fractures of the Knee After Treatment with Iloprost or Tramadol: Observations in 14 Patients

Mayerhoefer, Marius E MD*; Kramer, Josef MD; Breitenseher, Martin J MD*‡; Norden, Cornelia MD§; Vakil-Adli, Anosheh MD; Hofmann, Siegfried MD**; Meizer, Roland MD††; Siedentop, Harald§; Landsiedl, Franz MD††; Aigner, Nicolas MD††

Clinical Journal of Sport Medicine: July 2008 - Volume 18 - Issue 4 - p 358-362
doi: 10.1097/JSM.0b013e31817f3e1c
Brief Report

Objective: To investigate the outcome of subchondral stress fractures (SSF) of the knee after treatment with the prostacyclin analogue Iloprost or the opioid analgesic Tramadol.

Design: Case series/retrospective review.

Setting: Tertiary care center.

Patients: Fourteen patients with at least a single subchondral stress fracture of the knee, surrounded by bone marrow edema, visible on T1-weighted and short tau inversion recovery magnetic resonance images.

Interventions: Nine patients had been treated with oral Iloprost (group 1; 11 SSF) and 5 patients with Tramadol (group 2; 5 SSF) for 4 weeks in the course of a double-blind, randomized clinical trial. MR images were obtained at baseline (1 day before the start of treatment), after 3 months, and after 1 year.

Main Outcome Variables: SSF volumes and their rates of change between baseline and follow-up examinations, as determined on T1-weighted images by computer-assisted quantification.

Results: After three months, the SSF volumes had decreased by a median of 42.2% in group 1 and increased by a median of 2.2% in group 2 (P = 0.008). After 1 year, the median decrease in SSF volumes was 100.0% in group 1 and 65.7% in group 2 (P = 0.017).

Conclusion: This small case series suggests that healing of SSF is more pronounced after Iloprost treatment.

From the *Department of Radiology, Medical University of Vienna/Vienna General Hospital, Vienna, Austria; †Institute of CT and MRI Diagnostics Schillerpark, Linz, Austria; ‡Institute of Radiology, Waldviertelklinikum Horn, Horn, Austria; §Bayer Schering Pharma AG, Specialized Therapeutics, Berlin, Germany; ¶Department of Orthopaedics, Hospital of the Sisters of Charity Linz, Linz, Austria; **Department of Orthopaedics, LKH Stolzalpe, Stolzalpe, Austria; and ††First Orthopaedic Department, Orthopaedic Hospital Speising, Vienna, Austria.

Submitted for publication September 5, 2007; accepted May 8, 2008.

Reprints: Marius E. Mayerhoefer, MD, Department of Radiology, Vienna General Hospital (AKH) Waehringer Guertel 18-20, 1090 Vienna, Austria (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.