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n.1.See Spunk.
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Ligamentous examination of the affected knee is typically normal in cases of SPONK.
With the majority of affected patients being elderly females with osteoporotic bone, some investigators believe that SPONK develops as a consequence of microfractures occurring in weak subchondral bone secondary to minor trauma.
Evaluation of the coagulation profiles of patients affected with SPONK is necessary to determine whether this mechanism is present in the pathogenesis of the disease.
22-24) Case series have identified medial meniscal tears in 50% to 78% of patients of patients with SPONK with a recent series by Robertson and colleagues (24) noting that tears, specifically in the area of the meniscal root, coexisted with spontaneous osteoncecrosis in 24 of their 30 patients (80%).
Stage V SPONK includes continued subchondral collapse with the development of associated secondary degenerative changes.
1,8,27) In many of the early studies of SPONK, the area of the lesion within the condyle was used to predict which cases would progress to severe degenerative arthritis.
Some investigators suggest using gadolinium enhanced MRI in the evaluation of cases of SPONK.
The intense pain associated with the acute phase of SPONK may last up to 6 weeks at which point the extent of the patients' symptoms divides them into two main groups.
4,5,34,35) Cases of persistent or worsening symptoms after knee arthroscopy need to be considered for the possibility of an evolving osteonecrosis lesion; a diagnosis that needs to be distinguished from SPONK, bone marrow edema syndrome, and recurrent meniscal tear.
Most investigators report using a period of 4 to 6 weeks following the development of symptoms as sufficient time for radiographic evidence of SPONK to be present.
By 3 months postoperatively, the extent of edema typically decreases and MRI findings in cases of ONPK are similar to those seen in cases of SPONK with T1 imaging showing a discrete low signal area surrounded by an area of intermediate signal intensity.
In contrast to the correlation of clinical course and prognosis with the size of the lesion in SPONK, this correlation has been less reliable in cases of ONPK.