Osteonecrosis (ON) is a well-known side effect of pediatric ALL therapy. However, the incidence varied greatly between studies, and the clinical relevance of radiological findings was not well understood. For a study, researchers sought to examine 256 individuals with ALL who were treated at our hospital between October 2010 and December 2016. Within the group, 41 people got ON, with a 5-year cumulative incidence of 18.5% (standard error, SE, 5.7). After censoring following stem cell transplantation (SCT) and/or recurrence, the mean (SE) 5-year cumulative incidence of ON was 12.7 (2.1)%. 

Patients above the age of ten years and those assigned to the high-risk stratum experienced a tenfold and fivefold increase in the chance of ON, respectively. The incidence of ON was more than doubled in relapsed patients, although gender, immunophenotype, and SCT had no significant influence. Magnetic resonance imaging found several lesions (median four joints implicated per patient) in all but one case, with the knee being the most afflicted joint. Lesions on convex joint surfaces progressed the most slowly, whereas most lesions on diaphyses and concave surfaces remained radiologically stable or vanished over the follow-up period. ON was common in pediatric ALL and manifested as numerous lesions. Lesions with convex surfaces were more likely to deteriorate radiologically.