Magnetic resonance imaging of subchondral insufficiency fractures of the lower limb

Subchondral insufficiency fracture (SIF) is a non-traumatic condition that has historically been associated with elderly, osteoporotic women and patients with systemic conditions. There has been much work done to determine the pathogenesis of SIF, which has previously been regarded as idiopathic, rapid-progressive osteoarthritis or osteonecrosis of the hip, spontaneous osteonecrosis of the knee (SONK), osteochondral defect (OCD) of the talus and adult-onset Freiberg infraction of the metatarsal head. Early diagnosis and management are crucial to prevent subchondral collapse, secondary osteonecrosis and early-onset osteoarthritis. Magnetic resonance imaging (MRI) plays an important role in the diagnosis of SIF, which is often inconspicuous on initial radiographs. In this article, the authors provide an update on the role of MRI in identifying key imaging features of SIF in various joints of the lower limb to aid in its correct diagnosis.