Association of Bone Marrow Edema with Knee Pain, Mechanical Symptoms and Meniscal Tear Severity on MRI

Abstract

Knee pain and mechanical symptoms are common clinical manifestations of knee joint disorders and frequently lead to referral for MRI. MRI gives detailed assessment of the menisci, subchondral bone, ligaments, and other intra-articular structures. BME also referred to as a bone marrow lesion, is a frequent MRI finding and may reflect underlying mechanical stress or structural pathology. Meniscal abnormalities may also contribute to altered knee biomechanics, pain, and mechanical symptoms. However, the relationship between BME, clinical symptoms, and meniscal (MRI) Mangnetic Resonance imaging grade within the same patient population remains insufficiently explored.The study aimed to determine the association of BME (Bone marrow edema) with knee pain severity, mechanical symptoms, and meniscal MRI grade in patients undergoing knee MRI.Prospective cross-sectional study was conducted among 60 participants referred for knee MRI at the Department of Radiology, Services Hospital, Lahore. Clinical information including knee pain, pain severity, and mechanical symptoms such as catching, locking, giving, and clicking way was recorded using a structured data collection proforma. MRI examinations were assessed for the presence, location, and extent of BME and for meniscal abnormalities according to MRI grading. Whole Data was analyzed using Statistical SPSS version 25. Descriptive statistics were used to summarize demographic, MRI finding and clinical. Chi-square and Fisher's Exact tests were used to assess associations between categorical variables, while Spearman's rank correlation was used to assess the relationship between BME extent and meniscal MRI grade. A p-value of <0.05 was considered statistically important.The average age of participants was 45.57 ± 12.37 years, with an age range of 19–69 years. There were 29 males (48.3%) and 31 females (51.7%). BME was present in 45 participants (75.0%), while meniscal abnormalities were identified in 50 participants (83.3%). A statistically significant association was observed between BME and knee pain severity (χ² = 29.385, df = 2, p < 0.001). Severe pain was reported by 77.8% of participants with BME compared with 13.3% of those without BME. Mechanical symptoms were present in 68.9% of participants with BME compared with 33.3% without BME, demonstrating a statistically significant association (χ² = 5.926, df = 1, p = 0.015; Fisher's Exact p = 0.031). A significant positive correlation was found between BME extent and meniscal MRI grade (Spearman's ρ = 0.665, p < 0.001). The frequency of BME increased across meniscal MRI grades, from 40.0% in participants without meniscal abnormality to 96.8% in those with Grade III abnormality (χ² = 21.912, df = 3, p < 0.001).BME was a common MRI finding among patients presenting with knee pain and was significantly associated with greater pain severity, mechanical symptoms, and higher meniscal MRI grades. The increasing frequency of BME across meniscal MRI grades suggests that BME may be an important accompanying imaging finding in patients with more pronounced meniscal abnormalities. However, the cross-sectional design permits interpretation of these findings as associations only and does not establish causality.