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Histopathological examination of post-arthroscopy osteonecrosis of the knee: a scoping review
Pierangelo Za1, Giuseppe Francesco Papalia1, Luca Ambrosio1
1Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Background:
Post-arthroscopy osteonecrosis of the knee (PONK) was originally described based on magnetic resonance imaging (MRI) findings in the absence of any histopathological evidence. However, several authors have demonstrated the absence of necrosis in histological samples of patients undergoing reoperation after diagnosis of PONK. The aim of this study was to evaluate and synthesize the available literature related to the histopathological characteristics of PONK cases and to determine the appropriateness of related terminology.
Methods:
A PRISMA-compliant scoping review of PubMed, Scopus, and Cochrane was performed. Studies reporting histological analyses performed on bone samples harvested from patients with a presumptive diagnosis of PONK were included. General study characteristics, radiographic and MRI features, time elapsed between arthroscopy and histological sampling, and results of histological analysis of the bone samples were extracted.
Results:
Five articles were included, for a total of 22 patients (23 knees, mean age 63.5 years), resulting in 17 bone samples available for histological examination. The most common finding was the presence of subchondral insufficiency fractures (SIF) (94.1%), with necrosis being reported only in one case.
Conclusions:
Due to the absence of necrosis in most histopathological examinations, the term "PONK" seems inadequate to describe the corresponding clinical condition. Considering the pathological features of the analysed bone samples, SIF should be considered along with PONK when diagnosing and managing these cases until more definitive evidence becomes available.
Insights
Post-arthroscopy osteonecrosis of the knee (PONK) is often misdiagnosed, as histological analysis reveals subchondral insufficiency fractures (SIF) rather than necrosis. The term PONK may be inadequate for this condition.
Area of Science:
- Orthopedic Surgery
- Radiology
- Pathology
Background:
- Post-arthroscopy osteonecrosis of the knee (PONK) was initially described based on MRI findings without histopathological confirmation.
- Previous studies have questioned the presence of necrosis in histological samples from patients diagnosed with PONK.
Purpose of the Study:
- To evaluate and synthesize literature on the histopathological characteristics of PONK.
- To determine the appropriateness of the terminology used for PONK.
Main Methods:
- A PRISMA-compliant scoping review of PubMed, Scopus, and Cochrane databases.
- Inclusion of studies reporting histological analyses of bone samples from patients with suspected PONK.
- Extraction of study characteristics, imaging features, time to sampling, and histological results.
Main Results:
- Five articles comprising 22 patients (23 knees) were reviewed.
- Histological examination of 17 bone samples revealed subchondral insufficiency fractures (SIF) in 94.1% of cases.
- Necrosis was identified in only one patient sample.
Conclusions:
- The term PONK appears inadequate given the frequent absence of necrosis in histopathological findings.
- SIF should be considered in the diagnosis and management of these cases alongside PONK.
- Further evidence is needed for definitive diagnostic and management strategies.
