Understanding Knee Avascular Necrosis: Causes, Types, and Treatment Options.
Avascular necrosis (AVN), also known as osteonecrosis of the knee, is a progressive and debilitating knee disease where the subchondral bone loses its vascular supply, causing a portion of the bone to die. This can lead to subchondral collapse, resulting in severe erosive degenerative arthritis. Initially believed to primarily affect the medial femoral condyle, researchers now recognize three distinct types: Spontaneous AVN, Secondary AVN, and Post-arthroscopic AVN.
Idiopathic Osteonecrosis
Idiopathic or Spontaneous osteonecrosis has an unknown cause, with theories including arterial supply interruption, capillary occlusion, interosseous capillary tamponade, or vessel wall injury. There is some controversy surrounding its prevalence, with suggestions that it occurs more frequently after age 50 and is more common in females, affecting nearly three times more females than males. Spontaneous AVN is commonly observed in the epiphyseal region, particularly in the medial or lateral tibial plateau and femoral condyles. It has also been associated with du corgi la insufficiency fractures.
Secondary avascular necrosis may affect both femoral condyles, causing multiple lesions in the epiphysis, metaphysis, and diaphysis of the bone. Typically seen in individuals under 45, it may be bilateral in over 80% of cases. Risk factors for secondary AVN include radiation, chemotherapy, and trauma, as well as medical disorders such as myeloproliferative diseases and sickle cell disease. There is an indirect correlation with corticosteroid use, although conflicting data makes it comparable to the inconsistent relationship observed with alcohol use.
Notably, not all patients on high-dose corticosteroids develop AVN, similar to the variability observed in alcohol-related risk factors. Avascular necrosis occurs in only 10% of patients on high-dose corticosteroids and even less frequently in the general population that abuses alcohol.
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