A review of bone marrow lesions in the arthritic knee and description of a technique for treatment

Gobbi, Alberto; Dallo, Ignacio; Frank, Rachel M.; Bradsell, Hannah; Sáenz, Ivan; Murrel, William D.

doi:10.1016/j.jcjp.2021.100021

Cited by 6 publications

(3 citation statements)

References 68 publications

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“…The small dowels of autologous bone are injected into the affected area to fill the intertrabecular space, thereby inducing improved bone remodeling and delivering additional supportive and biologically active tissue to the subchondral lesion [35].…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Cell-Based Therapy for Symptomatic Bone Marrow Lesions of the Knee: A Prospective Clinical Study at 1 Year

Dallo

D’Ambrosi

Szwedowski

et al. 2022

Stem Cells and Development

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Bone marrow lesions (BMLs) are typical findings in magnetic resonance imaging present in different pathologies, such as spontaneous insufficiency fractures, osteonecrosis, transient BML syndromes, osteoarthritis, and trauma. The etiology and evolution of BMLs in multiple conditions remain unclear.There is still no gold standard protocol for the treatment of symptomatic BMLs in the knee. The biologic augmentation by Osteo Core Plasty™ is a new treatment modality showing promising results reducing pain with the aim to stop the progression of the disease. The purpose of this prospective study is to report the clinical outcomes and safety of Osteo Core Plasty for the treatment of symptomatic BMLs in the knee. Fifteen patients with symptomatic BMLs of the knee treated with the Osteo Core Plasty technique were included and followed prospectively for a minimum of 12 months. Each patient was evaluated before the surgery and respectively at 6 and 12 months using the Tegner Score, Marx Score, the International Knee Documentation Committee, the Knee Injury and Osteoarthritis Outcome Score divided in pain, activity daily living and quality of life subscale, and the Visual Analog Scale for pain. All clinical scores except Tegner and Marx score showed an overall statistically significant improvement through the entire follow-up (P < 0.05) and a significant improvement (P < 0.05) between each follow-up period (T0 vs. T1; T0 vs. T2; T1 vs. T2). No complications were reported. These preliminary results confirm that biological subchondral bone augmentation by Osteo Core Plasty technique is a safe and effective minimally invasive treatment option for symptomatic BMLs in the knee at 1-year follow-up. There is still a need for high-quality randomized controlled trials studies and systematic reviews in the future to enhance further treatment strategies in preventing or treating BMLs of the knee.MSCs, several aspects, such as the amount of aspirate, need further exploration. Bone autograft augmentation can deliver structural support and biologically active tissue to the subchondral lesion.Recent research has focused on using biologic therapeutics to help maintain and improve cartilage health [12][13][14][15]. However, treatment options for subchondral bone are limited. Osteo Core Plasty is a new, minimally invasive procedure for treating subchondral pathologies that has the potential to prevent the progression of OA [16].This study aimed to analyze the subchondral bone treatment with biologic Osteo Core Plasty™ in patients with symptomatic BMLs of the knee, including Subchondral Insufficiency Fracture of the knee (SIFK), Spontaneous Osteonecrosis of the knee (SONK), and early stages of knee OA. We hypothesize that the Osteo Core Plasty technique could be a safe and effective minimally invasive technique to treat the knee's BMLs, reporting pain relief and improving clinical outcomes at shortterm follow-up. MATERIALS AND METHODS Study designBetween December 2017 and January 2020, 15 patients with symptomatic BMLs of the knee, treated wit...

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Cell-Based Therapy for Symptomatic Bone Marrow Lesions of the Knee: A Prospective Clinical Study at 1 Year

Dallo

D’Ambrosi

Szwedowski

et al. 2022

Stem Cells and Development

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“…Prior studies have shown that some OA features only detectable by MRI, including bone marrow lesions (BMLs) play a role in structural OA incidence and progression and may be present before cartilage damage occurs [6][7][8] . BMLs are associated with knee pain and meniscal damage and extrusion 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of Evaluation Metrics of Deep Learning for Imbalanced Imaging Data in Osteoarthritis Studies

Liu¹,

Roemer

et al. 2022

Preprint

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Objective: To compare the evaluation metrics for deep learning methods in the imbalanced imaging data in osteoarthritis (OA) studies. Method: We first divided MOAKS (MRI Osteoarthritis Knee Score) grades into the presence (MOAKS > 0) and absence (MOAKS = 0) categories. Second, a deep-learning model was trained to the sagittal intermediate-weighted (IW) fat-suppressed (FS) knee MRI images with MOAKS readings from the Osteoarthritis Initiative (OAI) study to predict the presence of bone marrow lesions (BMLs). After the deep learning models were trained, we obtained probabilities of the presence of BMLs from MRI images at the sub-region (15 sub-regions), compartment, and whole-knee levels. We compared different evaluation metrics (e.g., receiver operating characteristic (ROC) and precision-recall (PR) curves) of the deep learning model in the testing data with various class ratios (presence of BMLs vs. absence of BMLs) at these three data levels to assess the performance of models. Results: We have demonstrated that the commonly used ROC curve is not sufficiently informative when evaluating the performance of deep learning models in the imbalanced data in OA studies. Conclusion: The class ratios coupled with results of ROC, PR, and Matthews correlation coefficient (MCC) should be reported in OA studies.

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“…First, we have an article by ICRS past-president Professor Alberto Gobbi and colleagues entitled "A Review of Bone Marrow Lesions in the Arthritic Knee and Description of a Technique for Treatment . " 1 In this article, the authors discuss the etiology and types of bone marrow lesions, as well as the biology and biomechanics of these lesions along with relevant anatomy. Treatment options for these difficult entities are also reviewed, including a description of the technique and benefits of a novel minimally invasive procedure to induce bone remodeling referred to as Osteo-Core-Plasty.…”

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confidence: 99%

Welcome to the third issue of JCJP!

Frank¹

2021

Journal of Cartilage & Joint Preservation

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Lisa Fortier, and help build the journal's reputation as a leading publication in joint preservation and cartilage regeneration. Given the open access nature of this journal, the ability for clinicians, researchers, and students to publish in a timely fashion in a peer-reviewed setting is seemingly unlimited. We anticipate that JCJP will have a global impact in the near term. The mission of JCJP aligns perfectly with the mission of ICRS -to advance science and education for the prevention and treatment of cartilage disease worldwide.In this issue, we have several outstanding articles from thought leaders in joint preservation from around the globe. First, we have an article by ICRS past-president Professor Alberto Gobbi and colleagues entitled "A Review of Bone Marrow Lesions in the Arthritic Knee and Description of a Technique for Treatment . " 1 In this article, the authors discuss the etiology and types of bone marrow lesions, as well as the biology and biomechanics of these lesions along with relevant anatomy. Treatment options for these difficult entities are also reviewed, including a description of the technique and benefits of a novel minimally invasive procedure to induce bone remodeling referred to as Osteo-Core-Plasty. Next, we have an article from the lab of ICRS past-president Dr. Lisa Fortier (and prior editor-in-chief) entitled "Bone marrow concentrate mesenchymal stromal cells do not correlate with nucleated cell count or colony forming units. " 2 Point-ofcare bone marrow aspirate concentrate has become a more frequently used biologic treatment for cartilage repair and osteoarthritis given its bioactive components. Measuring the concentration of mesenchymal stromal cells in bone marrow aspirate concentrate is difficult, yet critical for determining their specific influence on healing. This article describes a study in which the authors analyzed two proposed techniques, nucleated cell count and colony forming units, that more simply quantify MSC concentration as compared to advanced methods. Next, the role of adipose is discussed in an article led by Hannah Bradsell, entitled "The Essential Roles of Human Adipose Tissue: Metabolic, Thermoregulatory, Cellular, and Paracrine Effects . " 3 In this article, the authors describe the various roles of human adipose tissue, including the important functions of adipose-derived mesenchymal stromal cells, which contain several biologic properties that exhibit paracrine and immunomodulatory functions, as well as the ability to differentiate into multiple lineages, including chondrogenic and osteogenic cell lines. This article discusses the anatomy, physiology, and various roles and properties of human adipose tissue to better understand this tissue before considering it as a cellular source. The next article in this issue is led by Dr. Nguyen Huu Chien and colleagues, entitled "The Need for a Standardized Whole Leg Radiograph Guideline: The Effects of Knee Flexion, Leg Rotation, There is a high risk of developing knee osteoarthritis in patients with lower lim...

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A review of bone marrow lesions in the arthritic knee and description of a technique for treatment

Cited by 6 publications

References 68 publications

Minimally Invasive Cell-Based Therapy for Symptomatic Bone Marrow Lesions of the Knee: A Prospective Clinical Study at 1 Year

Minimally Invasive Cell-Based Therapy for Symptomatic Bone Marrow Lesions of the Knee: A Prospective Clinical Study at 1 Year

Comparison of Evaluation Metrics of Deep Learning for Imbalanced Imaging Data in Osteoarthritis Studies

Welcome to the third issue of JCJP!

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