Surgical Treatment of Bone Marrow Lesion Associated with Recurrent Plantar Fasciitis: A Case Report Describing an Innovative Technique Using Subchondroplasty ®

Bernhard, Kaitlyn; Ng, Alan; Kruse, Dustin; Stone, Paul A.

doi:10.1053/j.jfas.2017.11.012

Cited by 15 publications

(8 citation statements)

References 22 publications

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“…13,14 Despite these advantages, subchondroplasty is a relatively new procedure with a paucity of data published on the efficacy of treatment. Besides the study done by the surgeon who developed the technique, [13][14][15] and a few small case series reports and studies from other authors with preliminary results, [16][17][18][19][20][21] not much is known about the efficacy of this procedure.Most of the patients with bone marrow lesions also have concomitant degenerative changes of the cartilage. The…”

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confidence: 99%

Subchondroplasty for Bone Marrow Lesions in the Arthritic Knee Results in Pain Relief and Improvement in Function

Chua

Kang

et al. 2019

J Knee Surg

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Subchondroplasty is a relatively new joint preserving procedure, which involves the localized injection of calcium pyrophosphate bone substitute into the bone marrow lesion. The advent of magnetic resonance imaging (MRI) has greatly facilitated the identification of these bone marrow lesions. We investigated the clinical efficacy of subchondroplasty in the treatment of symptomatic bone marrow lesions in the knee, including knees with preexisting osteoarthritis. This study comprised of 12 patients whose knees were evaluated with standard radiographs and MRI to identify and localize the bone marrow lesions. They then underwent subchondroplasty under intraoperative radiographic guidance. Preoperative and postoperative visual analog scale (VAS) pain scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and Knee Injury and Arthritis Outcome Scores (KOOS) were obtained. VAS scores improved significantly from 7.5 ± 1.8 before surgery to 5.2 ± 2.7 after surgery. This further improved to 2.1 ± 2.4 at the one-year follow-up. KOOS scores improved significantly from 38.5 ± 17.0 before surgery to 73.2 ± 19.0 at the one-year follow-up. WOMAC scores improved significantly from 47.8 ± 20.5 before surgery to 14.3 ± 13.2 at the one-year follow-up. Subchondroplasty offers an effective way to treat subchondral bone marrow lesions in the arthritic knee, resulting in improvement in symptoms and early return to activity. Long-term studies are required to evaluate if these benefits can last. This is a Level II study.

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confidence: 99%

Subchondroplasty for Bone Marrow Lesions in the Arthritic Knee Results in Pain Relief and Improvement in Function

Chua

Kang

et al. 2019

J Knee Surg

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“…Finally, Bernhard and colleagues previously described the use of subchondral stabilization of the calcaneus in a patient with concomitant refractory plantar fasciitis. 14 Although the authors' experience was positive, this report was limited to only a single patient's experience. 14 Our ndings should be interpreted within the context of the study.…”

Section: Discussionmentioning

confidence: 92%

“…14 Although the authors' experience was positive, this report was limited to only a single patient's experience. 14 Our ndings should be interpreted within the context of the study. First, we do not have a comparison group with which to compare/contrast our ndings.…”

Section: Discussionmentioning

confidence: 92%

Initial Experience with Subchondral Stabilization for Bone Marrow Lesions of the Midfoot and Forefoot

Matthews

Klein

Weil

et al. 2021

Preprint

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Disabling foot pain is often accompanied by MRI evidence of bone marrow edema which may represent early structural fatigue. Emerging evidence suggests subchondral stabilization with injectable calcium phosphate can alleviate pain associated with bone marrow edema in the hindfoot, ankle and knee; however, there is no data supporting its use or safety for midfoot or forefoot lesions. We identified 54 patients who underwent SS of various midfoot/forefoot osseous structures in our practice over a four-year period. All patients proved recalcitrant to standard conservative measures, and all had advanced imaging appreciating BME. VAS for pain at 1, 3, 6, and 12 months postoperatively served as the primary outcome measure. 41 patients were included with a mean age of 54.3 ± 14.9 years and mean follow up of 14.1 ± 6.9 months. Patients saw a significant decrease in VAS pain as early as 1 month postoperatively (p<0.05). Mean postoperative VAS at 12 months was 2.11 ± 2.50, and the mean reduction in VAS pain from preop to 12 months postop was -5.00 (95% CI -3.44 to -6.56, p<0.05). Fourteen patients (34%, 14/41) were pain free at 12 months. Treatment of more than one bone (unadjusted OR 6.23 [95% CI 1.39 to 27.8], P=0.017) was associated with a greater likelihood of not achieving a pain free status at 12 months. Initial experience suggests that SS was both safe and effective in our patient population. Simultaneous treatment of multiple bones should be entered into with caution, and further research on the subject is necessary. Level of Evidence: IV (Retrospective Case Series)

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“…Nowadays, the subchondroplasty technique is still proposed with, in some cases, the use of injectable CPCs for which promising clinical results were reported in both cystic-like and non-cystic-like lesions [32][33][34][35]. In this case, the use of low-diameter cannulas is needed as well as highly injectable and cohesive CPCs, given the high intra-osseous pressure needed during the injection procedure to fill the cystic-like lesion and/or diffuse into the surrounding trabecular network of the subchondral bone [36,37].…”

Section: In Vivo Implantation Of Cpcs and Their Blood Compositesmentioning

confidence: 99%

Calcium Phosphate Cements Combined with Blood as a Promising Tool for the Treatment of Bone Marrow Lesions

Limelette

Fourmestraux

Despas

et al. 2023

JFB

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The solid phase of a commercial calcium phosphate (Graftys® HBS) was combined with ovine or human blood stabilized either with sodium citrate or sodium heparin. The presence of blood delayed the setting reaction of the cement by ca. 7–15 h, depending on the nature of the blood and blood stabilizer. This phenomenon was found to be directly related to the particle size of the HBS solid phase, since prolonged grinding of the latter resulted in a shortened setting time (10–30 min). Even though ca. 10 h were necessary for the HBS blood composite to harden, its cohesion right after injection was improved when compared to the HBS reference as well as its injectability. A fibrin-based material was gradually formed in the HBS blood composite to end-up, after ca. 100 h, with a dense 3D organic network present in the intergranular space, thus affecting the microstructure of the composite. Indeed, SEM analyses of polished cross-sections showed areas of low mineral density (over 10–20 µm) spread in the whole volume of the HBS blood composite. Most importantly, when the two cement formulations were injected in the tibial subchondral cancellous bone in a bone marrow lesion ovine model, quantitative SEM analyses showed a highly significant difference between the HBS reference versus its analogue combined with blood. After a 4-month implantation, histological analyses clearly showed that the HBS blood composite underwent high resorption (remaining cement: ca. 13.1 ± 7.3%) and new bone formation (newly formed bone: 41.8 ± 14.7%). This was in sharp contrast with the case of the HBS reference for which a low resorption rate was observed (remaining cement: 79.0 ± 6.9%; newly formed bone: 8.6 ± 4.8%). This study suggested that the particular microstructure, induced by the use of blood as the HBS liquid phase, favored quicker colonization of the implant and acceleration of its replacement by newly formed bone. For this reason, the HBS blood composite might be worth considering as a potentially suitable material for subchondroplasty.

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Surgical Treatment of Bone Marrow Lesion Associated with Recurrent Plantar Fasciitis: A Case Report Describing an Innovative Technique Using Subchondroplasty ®

Cited by 15 publications

References 22 publications

Subchondroplasty for Bone Marrow Lesions in the Arthritic Knee Results in Pain Relief and Improvement in Function

Subchondroplasty for Bone Marrow Lesions in the Arthritic Knee Results in Pain Relief and Improvement in Function

Initial Experience with Subchondral Stabilization for Bone Marrow Lesions of the Midfoot and Forefoot

Calcium Phosphate Cements Combined with Blood as a Promising Tool for the Treatment of Bone Marrow Lesions

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