Subchondroplasty for treating bone marrow lesions in the knee – initial experience

Abstract

ObjectiveTo evaluate the use of subchondroplasty in the treatment of bone marrow lesions in an initial series of five cases.MethodsThe study included patients aged between 40 and 75 years old, with pain in the knee for at least six months, associated with high-signal MRI lesion on T2 sequences, on the tibia or femur. Patients were assessed using the visual analog pain scale and the KOOS score, one week before surgery and one, three, six, 12, and 24 weeks after the procedure. Subchondroplasty was performed with a technique developed for filling the area of the bone marrow lesion with a calcium phosphate bone substitute.ResultsThe filling was performed on the medial femoral condyle in four patients and medial tibial plateau in one case. The assessment by the KOOS score presented a preoperative average of 38.44 points and 62.7, 58.08, 57.92, 63.34, and 71.26 points with one, three, six, 12, and 24 weeks after surgery, respectively. In the evaluation by the VAS, the average was 7.8 points preoperatively and 2.8, 3, 2.8, 1.8, and 0.6 points over the same periods. All patients were able to ambulate without additional support, on the first day after the procedure. One patient had a minimal graft dislocation to the soft tissue, with local pain, which resolved completely after a week.ConclusionThe subchondroplasty technique provided significant improvements in the parameters of pain and functional capacity in the short-term assessment.

Subchondroplasty for the treatment of post‐traumatic bone marrow lesions of the medial femoral condyle in a pre‐clinical canine model

“…However, it is important to note that SCP‐treated knees showed relatively more functional impairment than non‐treated knees at the two early assessment time points. Similar findings have been reported in some patients receiving SCP injections in the knee who reported mild to moderate pain in the initial time period after treatment . This initial impairment may have been exacerbated in dogs in the present study due to the perceived overfill and extravasation of the injectate, and attention to this factor is important for further preclinical study and clinical application of SCP treatment.…”

“…The beneficial outcomes associated with SCP treatment noted in the present study are similar to clinical outcomes in 66 patients treated with SCP for BMLs by Cohen et al who reported significantly less pain and better function based on visual analog scale (VAS) and International Knee Documentation Committee (IKDC) assessments, respectively, through 2 years after treatment. Similarly, Bonadio et al demonstrated significantly improved outcomes for pain and function assessed by VAS and IKDC, respectively, in a series of five patients who underwent SCP for BMLs and were followed through 6 months after treatment. In another study evaluating the effect of SCP on outcomes in patients with knee BMLs, Chatterjee et al reported significant improvements in Knee Injury and Osteoarthritis Outcome Scores (KOOS) and Tegner‐Lysholm Knee Scoring in a non‐matched cohort of 22 patients with advanced knee OA who underwent SCP and were followed through 6 months after treatment.…”

Enhanced Subchondroplasty Treatment for Post‐Traumatic Cartilage and Subchondral Bone Marrow Lesions in a Canine Model

“…Beneficial clinical outcomes associated with SCP treatment for BMLs including significantly less pain and improved functional scores through 2 years after treatment have been reported. 19,24 There are currently no studies evaluating PRP or BMC treatment of BMLs. However, there are studies that have looked at intraosseous (IO) injection of PRP in patients with more advanced knee OA.…”

“…While SCP has reported clinical benefits in treating subchondral bone pathology and can be considered an orthobiologic, it has been associated with significant morbidity when used at higher volumes, and alone, does not fully address the current gap in treatment . As such, combination therapy to include other orthobiologics with CaP bone void filler may be beneficial.…”

“…18,22,23 While SCP has reported clinical benefits in treating subchondral bone pathology and can be considered an orthobiologic, it has been associated with significant morbidity when used at higher volumes, and alone, does not fully address the current gap in treatment. 21,[24][25][26] As such, combination therapy to include other orthobiologics with CaP bone void filler may be beneficial. The two primary candidates for combination therapy are platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMC) based on their safety profiles, regulatory compliance, and known biologic effects on bone.…”