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

Abstract

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...

Autologous concentrated bone marrow injection for precollapse osteonecrosis of the femoral head concurrent with contralateral total hip arthroplasty: protocol for a clinical trial

“…The incidence of collapse in the control group was 73% and that in the bone marrow graft group was 23% 3. Because the early-phase results in these reports were promising, many cell-based therapies followed and also showed promising results 4–10. The satisfactory results led to a consensus that cell-based therapy is indicated for precollapse stages to prevent femoral head collapse 11 12.…”

“…3 Because the early-phase results in these reports were promising, many cell-based therapies followed and also showed promising results. [4][5][6][7][8][9][10] The satisfactory results led to a consensus that cell-based therapy is indicated for precollapse stages to prevent femoral head collapse. 11 12 However, robust evidence supporting the preventive effect of collapse is lacking.…”