{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T19:02:27Z","timestamp":1789844547320,"version":"4.0.1"},"reference-count":107,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T00:00:00Z","timestamp":1743724800000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Bone marrow lesions (BMLs) of the knee are a common magnetic resonance imaging finding and are present in a wide range of pathologies, including traumatic contusions and fractures, following cartilage surgery alterations, osteoarthritis, transient BMLs syndromes, subchondral insufficiency fractures of the knee and spontaneous osteonecrosis of the knee. Regardless of their aetiology, clinical management may prove challenging. This review focuses on the conservative treatment approaches to manage patients affected by knee BML, thanks to the contribution of field experts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Experts from around the globe were involved in performing a review on the most used conservative treatment strategies to address BMLs, trying to summarize the available evidence from the most popular first\u2010line treatments while documenting their applications and results for the different BML aetiologies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Positive results were documented for unloading knee braces, external shockwave therapy, hyperbaric oxygen therapy, pulsed electromagnetic fields therapy and bisphosphonates. Nonetheless, the analysis of the scientific literature documented a scarce number of publications specifically addressing the knee joint, with even less evidence when it comes to the results for the different aetiologies of BMLs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The management of BMLs is challenging, and many factors influence clinical and radiological outcomes. This paper summarized the evidence on conservative treatments for knee BMLs. Although showing promising results, conservative options still need to be fully investigated. Open questions to be addressed concern treatment duration, BML stage and overlapping with concomitant therapies. Further studies are needed to identify the best first\u2010line conservative approach or treatment combination based on each BML aetiology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level V: expert opinion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70151","type":"journal-article","created":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T13:45:49Z","timestamp":1743860749000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Conservative treatments of bone marrow lesions"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6352-9671","authenticated-orcid":false,"given":"Luca","family":"Andriolo","sequence":"first","affiliation":[{"name":"Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9550-5412","authenticated-orcid":false,"given":"Alessandro","family":"Sangiorgio","sequence":"additional","affiliation":[{"name":"Service of Orthopaedics and Traumatology, Department of Surgery EOC Lugano Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Berruto","sequence":"additional","affiliation":[{"name":"U.O.C. 1st Orthopedic Clinic, ASST Gaetano Pini\u2010CTO Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8612-4842","authenticated-orcid":false,"given":"Henning","family":"Madry","sequence":"additional","affiliation":[{"name":"Center of Experimental Orthopaedics Saarland University Homburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9341-7187","authenticated-orcid":false,"given":"Giuseppe M.","family":"Peretti","sequence":"additional","affiliation":[{"name":"E.U.O.R.R. Unit, Department of Biomedical Sciences for Health, IRCCS Orthopedic Institute Galeazzi University \u201cLa Statale\u201d Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8644-0909","authenticated-orcid":false,"given":"Massimo","family":"Varenna","sequence":"additional","affiliation":[{"name":"Bone Diseases Unit, Department of Rheumatology and Medical Sciences ASST Gaetano Pini\u2010CTO Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9793-594X","authenticated-orcid":false,"given":"Beer","family":"Yiftah","sequence":"additional","affiliation":[{"name":"Shamir Medical Center Be'er Ya'akov Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2941-1407","authenticated-orcid":false,"given":"Stefano","family":"Zaffagnini","sequence":"additional","affiliation":[{"name":"Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8136-0977","authenticated-orcid":false,"given":"Giuseppe","family":"Filardo","sequence":"additional","affiliation":[{"name":"Service of Orthopaedics and Traumatology, Department of Surgery EOC Lugano Switzerland"},{"name":"Faculty of Biomedical Sciences Universit\u00e0 della Svizzera Italiana Lugano Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,4]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.5650040215"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-198912000-00022"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0952-3278(94)90103-1"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1663-5"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jeo2.70071"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00774-009-0038-x"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2021.03.029"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-198909000-00027"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2022.11.003"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/ng0697-174"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar3103"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.artd.2018.02.010"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/14756366.2018.1485149"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1115\/1.4044818"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02576396"},{"key":"e_1_2_14_17_1","article-title":"Pulsed electromagnetic field stimulation of bone healing and joint preservation: cellular mechanisms of skeletal response","volume":"4","author":"Cadossi R","year":"2020","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-207681"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-206376"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.4236\/jbise.2014.75028"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42358-022-00253-4"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2011.06.003"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-014-2991-5"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2015.11.030"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0072714"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.150053"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/0090-6980(91)90028-E"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00914313"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2022.06.003"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2012.08.020"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-4089-y"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopha.2007.03.001"},{"key":"e_1_2_14_33_1","first-page":"3","article-title":"A 2003 update of bone physiology and Wolff's Law for clinicians","volume":"74","author":"Frost HM.","year":"2004","journal-title":"Angle Orthod"},{"key":"e_1_2_14_34_1","doi-asserted-by":"publisher","DOI":"10.1143\/JPSJ.12.1158"},{"key":"e_1_2_14_35_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0033543"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-199243060-00008"},{"key":"e_1_2_14_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10856-014-5331-0"},{"key":"e_1_2_14_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e13116"},{"key":"e_1_2_14_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-021-02484-5"},{"key":"e_1_2_14_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfma.2019.05.024"},{"key":"e_1_2_14_41_1","doi-asserted-by":"publisher","DOI":"10.1096\/fj.10-157370"},{"key":"e_1_2_14_42_1","doi-asserted-by":"publisher","DOI":"10.1053\/joca.2002.0801"},{"key":"e_1_2_14_43_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200101000-00008"},{"key":"e_1_2_14_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar2526"},{"key":"e_1_2_14_45_1","first-page":"6","article-title":"Osteonecrosis of the knee: review","volume":"3","author":"Karim AR","year":"2015","journal-title":"Ann Transl Med"},{"key":"e_1_2_14_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9290(94)00159-2"},{"key":"e_1_2_14_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-011-1713-8"},{"key":"e_1_2_14_48_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-4113-2"},{"key":"e_1_2_14_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-06228-6"},{"key":"e_1_2_14_50_1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20150305-57"},{"key":"e_1_2_14_51_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.170.1.9423603"},{"key":"e_1_2_14_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2021.115979"},{"key":"e_1_2_14_53_1","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5413.45319"},{"key":"e_1_2_14_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2023.03.006"},{"key":"e_1_2_14_55_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.79.13.4180"},{"key":"e_1_2_14_56_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-010-1054-z"},{"key":"e_1_2_14_57_1","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.1.000044"},{"key":"e_1_2_14_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2012.11.011"},{"key":"e_1_2_14_59_1","doi-asserted-by":"publisher","DOI":"10.7547\/8750-7315-105.1.27"},{"key":"e_1_2_14_60_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.00536"},{"key":"e_1_2_14_61_1","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0b013e31817f3e1c"},{"key":"e_1_2_14_62_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kem172"},{"key":"e_1_2_14_63_1","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2020.604860"},{"key":"e_1_2_14_64_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-010-1053-0"},{"key":"e_1_2_14_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2019.07.004"},{"key":"e_1_2_14_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2018.01.012"},{"key":"e_1_2_14_67_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2012.06.008"},{"key":"e_1_2_14_68_1","doi-asserted-by":"publisher","DOI":"10.22203\/eCM.v025a21"},{"key":"e_1_2_14_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2013.01.008"},{"key":"e_1_2_14_70_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511430376"},{"key":"e_1_2_14_71_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000033498"},{"key":"e_1_2_14_72_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-022-06584-8"},{"key":"e_1_2_14_73_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.19.00381"},{"key":"e_1_2_14_74_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-019-05792-w"},{"key":"e_1_2_14_75_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.85B3.13237"},{"key":"e_1_2_14_76_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1740931"},{"key":"e_1_2_14_77_1","doi-asserted-by":"publisher","DOI":"10.1002\/jeo2.12098"},{"key":"e_1_2_14_78_1","doi-asserted-by":"publisher","DOI":"10.1159\/000452836"},{"key":"e_1_2_14_79_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-019-03245-6"},{"key":"e_1_2_14_80_1","doi-asserted-by":"publisher","DOI":"10.1634\/stemcells.20-6-530"},{"key":"e_1_2_14_81_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199304000-00009"},{"key":"e_1_2_14_82_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actbio.2012.11.008"},{"key":"e_1_2_14_83_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-014-3305-x"},{"key":"e_1_2_14_84_1","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12253"},{"key":"e_1_2_14_85_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keq286"},{"key":"e_1_2_14_86_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-857X(05)70119-8"},{"key":"e_1_2_14_87_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.82B5.0820724"},{"key":"e_1_2_14_88_1","first-page":"189","article-title":"Hyperbaric oxygen therapy in the treatment of osteonecrosis of the femoral head: a review of the current literature","volume":"43","author":"Uzun G","year":"2016","journal-title":"Undersea Hyperb Med"},{"key":"e_1_2_14_89_1","first-page":"690","article-title":"Is there a difference in outcome between two types of valgus unloading braces? A randomized controlled trial","volume":"83","author":"Egmond N","year":"2017","journal-title":"Acta Orthop Belg"},{"key":"e_1_2_14_90_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ket370"},{"key":"e_1_2_14_91_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kes312"},{"key":"e_1_2_14_92_1","doi-asserted-by":"publisher","DOI":"10.1177\/1759720X211014020"},{"key":"e_1_2_14_93_1","doi-asserted-by":"publisher","DOI":"10.1177\/1759720X221142274"},{"key":"e_1_2_14_94_1","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(02)00812-8"},{"key":"e_1_2_14_95_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kev123"},{"key":"e_1_2_14_96_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-011-1534-9"},{"key":"e_1_2_14_97_1","doi-asserted-by":"publisher","DOI":"10.7150\/ijms.17469"},{"key":"e_1_2_14_98_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-157-9-201211060-00007"},{"key":"e_1_2_14_99_1","doi-asserted-by":"publisher","DOI":"10.22203\/eCM.v029a20"},{"key":"e_1_2_14_100_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200006000-00013"},{"key":"e_1_2_14_101_1","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(199912)42:12<2719::AID-ANR31>3.0.CO;2-X"},{"key":"e_1_2_14_102_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2006.10.012"},{"key":"e_1_2_14_103_1","first-page":"2630","article-title":"Combination of cells\u2010based therapy with apelin\u201013 and hyperbaric oxygen efficiently promote neovascularization in ischemic animal model","volume":"23","author":"Yu M","year":"2019","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"e_1_2_14_104_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.131904"},{"key":"e_1_2_14_105_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-207673"},{"key":"e_1_2_14_106_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.30148"},{"key":"e_1_2_14_107_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-020-02159-7"},{"key":"e_1_2_14_108_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocarto.2021.100183"}],"container-title":["Journal of Experimental Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jeo2.70151","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jeo2.70151","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jeo2.70151","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:21:40Z","timestamp":1789842100000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/jeo2.70151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":107,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1002\/jeo2.70151"],"URL":"https:\/\/doi.org\/10.1002\/jeo2.70151","archive":["Portico"],"relation":{},"ISSN":["2197-1153","2197-1153"],"issn-type":[{"value":"2197-1153","type":"print"},{"value":"2197-1153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]},"assertion":[{"value":"2024-10-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70151"}}