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The 6 patients followed up at 15.1, 7.5, 3.9, 2.25, 2, and 1 year, respectively. None progressed to joint collapse or severe osteoarthritis. Four became and remained asymptomatic at 2-, 3.9-, 7.5-, and 15.1-year follow-up, respectively. A fifth patient did not progress to collapse or severe osteoarthritis but had residual pain at 2.25-year follow-up. The sixth patient had no symptomatic benefit on enoxaparin but improved on rivaroxaban at 1-year follow-up. Two patients had recurrences of knee pain 1 and 4 years after their initial treatment with enoxaparin. One resolved after a second course of enoxaparin, and the other, with a second recurrence 1 year after the second course, resolved after a third course. Pretreatment, all 6 patients required canes, crutches, or wheelchairs, but after enoxaparin, no patient required them, and walking was unrestricted. Thrombophilia-hypofibrinolysis contributes to the pathogenesis of knee osteonecrosis. Thrombophilic-hypofibrinolytic patients with stage II knee osteonecrosis treated with enoxaparin have had no collapse or progression to severe osteoarthritis, and most have had resolution of pain and restoration of full function. This represents a major improvement compared with the natural history of untreated spontaneous knee osteonecrosis.<\/jats:p>","DOI":"10.3928\/01477447-20140924-59","type":"journal-article","created":{"date-parts":[[2014,10,1]],"date-time":"2014-10-01T18:06:21Z","timestamp":1412186781000},"source":"Crossref","is-referenced-by-count":18,"title":["Medical Treatment of Osteonecrosis of the Knee Associated With Thrombophilia-Hypofibrinolysis"],"prefix":"10.3928","volume":"37","author":[{"given":"Charles J.","family":"Glueck","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard A.","family":"Freiberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ping","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2308","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20130327-08"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1354\/vp.40-4-345"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1297-319X(02)00391-3"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199173020-00007"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0463.2002.100304.x"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2613.1998.00063.x"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2006.01.025"},{"key":"e_1_3_1_9_2","first-page":"171","volume-title":"Ischemia and Necrosis of Bone","author":"Ficat P","year":"1980","unstructured":"Ficat P. 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