Table of ContentsView AllTable of ContentsCausesSymptomsDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Causes
Symptoms
Diagnosis
Treatment
Bone marrow edema(BME) is when normal fattybone marrow—the spongy tissue in the center of bones—is replaced with a watery mix of fluid and blood. Also known as a bone marrow lesion, BME occurs when arthritis, an injury, or a fracture damages the normal bone structure.
While BME can occur in any bone, the legs are most often affected. Bone marrow edema in thekneejoint is especially common. Some people with BME of the knee experience no symptoms, while others have significant knee pain when standing, walking, or using stairs.
Bone marrow edema of the knee or any other bone is diagnosed usingmagnetic resonance imaging(MRI).
This article discusses what causes bone marrow edema of the knee, as well as its symptoms, diagnosis, and treatment.
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Causes of Bone Marrow Edema of the Knee
BME can result from a variety of conditions and is classified based on the underlying cause.
Fluid is more likely to accumulate in the bone marrow when there is damage to the cortical bone—the dense, solid bone that surrounds the bone marrow cavity.
Leg Injuries
BME can develop after a traumatic injury resulting infracturesof thetibia(lower leg bone) orfemur(thigh bone).
Fracturing the bones causes inflammation and swelling, which can increase fluid levels within the knee joint.The excess fluid can sometimes replace the normal fatty bone marrow inside the leg bones too.
Dislocationof the kneecaporinjuries to the cartilage (meniscus) or ligamentsof the knee can also increase the risk of developing BME in the knee.
Common Fractures of the Leg, Ankle, and Foot
Physical Changes
Mechanical or degenerative bone marrow edema results from physical changes that damage the bones that form the knee joint and underlying bone marrow.
Examples of changes includeosteoarthritisandbone stress injurieslike bone bruises.
Subchondral Bone in Osteoarthritis: What’s the Connection?
Inflammation
Conditions likerheumatoid arthritis,psoriatic arthritis, andankylosing spondylitiscan cause inflammation throughout the body, including inflammation in the joints.
This inflammation leads to the leaking of blood cells into the subchondral bone (bone underneath knee joint cartilage). This damages the bone marrow tissue, resulting ininflammatory rheumatic bone marrow edema.
Infection
Conditions likeosteomyelitisandseptic arthritiscause infections that can change the structure of healthy bone marrow, leading toseptic bone marrow edema.
Risk factors that increase the chance of developing septic bone marrow edema in the knee include:
Damaged Blood Vessels
Avascular necrosisis a condition that develops when there’s a temporary or permanent loss of blood supply to the bone. When this affects the knee joint,ischemic bone marrow edema of the kneecan occur.
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Cancer
Bone tumors can causeneoplastic bone marrow edemaas a response to the cancerous mass that gets into healthy bone tissue. Primary bone cancer (starts in the bone itself), such as osteosarcoma, chondrosarcoma, and Ewing’s sarcoma, is quite rare and primarily occurs in children.
Bone metastases (spreading of cancer cells from another location to the bone) occur more frequently in breast, lung, prostate, and kidney cancer.
How Serious Is Bone Marrow Edema?
Symptoms of Bone Marrow Edema of the Knee
Although BME itself isn’t serious, some people can experience debilitating pain that takes a serious toll on their mental and emotional well-being.
Bone marrow edema of the knee can stimulate nerve fibers that transmit pain signals. This pain often increases when standing, walking, and going up and down stairs, limiting mobility and overall function of the knee joint.
Because BME is associated with osteoarthritis in the knee and inflammatory autoimmune conditions that attack joints, additional symptoms may include:
What Is Knee Osteoarthritis?
Diagnosing Bone Marrow Edema
Diagnosis of bone marrow edema is based on the following criteria:
The presence of the following factors can help lead to a diagnosis of bone marrow edema in the knee:
Other Imaging
Computed tomography(CT) scanscan supplement MRI imaging to help determine the possible causes of bone marrow edema. A CT can reveal bone fractures, stress fractures, osteochondral lesions, osteonecrosis (death of bone cells due to lack of adequate blood supply), and bone tumors like osteoid osteoma.
While they cannot be used to diagnose bone marrow edema,dual-energy X-ray absorptiometry (DEXA) scansexamine bone mineral density levels and can be used to diagnoseosteoporosis, a risk factor for developing bone marrow edema.
Conventional X-raysdon’t have enough clarity to be able to diagnose bone marrow edema but can show osteoarthritis and avascular necrosis, both of which can also lead to bone marrow edema.
Treatment for Bone Marrow Edema of the Knee
Medications
Certain medications can be prescribed to help manage symptoms and prevent the progression of bone marrow edema. These include:
Extracorporeal Shock Wave Therapy
Extracorporeal shock wave therapy is a noninvasive procedure performed on an outpatient basis.
When Plantar Fasciitis Is So Bad You Can’t Walk
Surgery
Bone marrow edema doesn’t always require surgery. However,core decompressionmay be done to address disrupted circulation to the bone marrow, which often occurs. It is also commonly performed to manage or prevent avascular necrosis or osteonecrosis.
Holes are drilled in the affected area of the bone to help relieve pressure, improve blood flow, reduce bone destruction, and reduce pain.
Treating the Underlying Cause
While these options can help treat bone marrow edema itself, additional treatment may be needed to manage its underlying cause. Examples include:
A Word From VerywellIt’s important to find the underlying cause of bone marrow edema because they can vary widely. Fortunately, bone marrow edemas can be treated to alleviate symptoms and prevent further damage.—STELLA BARD, MD, MEDICAL EXPERT BOARD
A Word From Verywell
It’s important to find the underlying cause of bone marrow edema because they can vary widely. Fortunately, bone marrow edemas can be treated to alleviate symptoms and prevent further damage.—STELLA BARD, MD, MEDICAL EXPERT BOARD
It’s important to find the underlying cause of bone marrow edema because they can vary widely. Fortunately, bone marrow edemas can be treated to alleviate symptoms and prevent further damage.
—STELLA BARD, MD, MEDICAL EXPERT BOARD
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Eriksen EF.Treatment of bone marrow lesions (bone marrow edema).Bonekey Rep. 2015 Nov 25;4:755. doi:10.1038/bonekey.2015.124Baumbach SF, Pfahler V, Bechtold-Dalla Pozza S, Feist-Pagenstert I, Fürmetz J, Baur-Melnyk A, Stumpf UC, Saller MM, Straube A, Schmidmaier R, Leipe J.How we manage bone marrow edema—an interdisciplinary approach.J Clin Med. 2020 Feb 18;9(2):551. doi:10.3390/jcm9020551American Cancer Society.Bone metastases.National Library of Medicine StatPearls.Bone marrow edema syndrome.Tarantino U, Greggi C, Cariati I, et al.Reviewing Bone Marrow Edema in Athletes: A Difficult Diagnostic and Clinical Approach.Medicina (Kaunas). 2021;57(11):1143. Published 2021 Oct 22. doi:10.3390/medicina57111143
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Eriksen EF.Treatment of bone marrow lesions (bone marrow edema).Bonekey Rep. 2015 Nov 25;4:755. doi:10.1038/bonekey.2015.124Baumbach SF, Pfahler V, Bechtold-Dalla Pozza S, Feist-Pagenstert I, Fürmetz J, Baur-Melnyk A, Stumpf UC, Saller MM, Straube A, Schmidmaier R, Leipe J.How we manage bone marrow edema—an interdisciplinary approach.J Clin Med. 2020 Feb 18;9(2):551. doi:10.3390/jcm9020551American Cancer Society.Bone metastases.National Library of Medicine StatPearls.Bone marrow edema syndrome.Tarantino U, Greggi C, Cariati I, et al.Reviewing Bone Marrow Edema in Athletes: A Difficult Diagnostic and Clinical Approach.Medicina (Kaunas). 2021;57(11):1143. Published 2021 Oct 22. doi:10.3390/medicina57111143
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Eriksen EF.Treatment of bone marrow lesions (bone marrow edema).Bonekey Rep. 2015 Nov 25;4:755. doi:10.1038/bonekey.2015.124Baumbach SF, Pfahler V, Bechtold-Dalla Pozza S, Feist-Pagenstert I, Fürmetz J, Baur-Melnyk A, Stumpf UC, Saller MM, Straube A, Schmidmaier R, Leipe J.How we manage bone marrow edema—an interdisciplinary approach.J Clin Med. 2020 Feb 18;9(2):551. doi:10.3390/jcm9020551American Cancer Society.Bone metastases.National Library of Medicine StatPearls.Bone marrow edema syndrome.Tarantino U, Greggi C, Cariati I, et al.Reviewing Bone Marrow Edema in Athletes: A Difficult Diagnostic and Clinical Approach.Medicina (Kaunas). 2021;57(11):1143. Published 2021 Oct 22. doi:10.3390/medicina57111143
Eriksen EF.Treatment of bone marrow lesions (bone marrow edema).Bonekey Rep. 2015 Nov 25;4:755. doi:10.1038/bonekey.2015.124
Baumbach SF, Pfahler V, Bechtold-Dalla Pozza S, Feist-Pagenstert I, Fürmetz J, Baur-Melnyk A, Stumpf UC, Saller MM, Straube A, Schmidmaier R, Leipe J.How we manage bone marrow edema—an interdisciplinary approach.J Clin Med. 2020 Feb 18;9(2):551. doi:10.3390/jcm9020551
American Cancer Society.Bone metastases.
National Library of Medicine StatPearls.Bone marrow edema syndrome.
Tarantino U, Greggi C, Cariati I, et al.Reviewing Bone Marrow Edema in Athletes: A Difficult Diagnostic and Clinical Approach.Medicina (Kaunas). 2021;57(11):1143. Published 2021 Oct 22. doi:10.3390/medicina57111143
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