The Efficacy of Subchondroplasty for the Treatment of Knee Pain Associated with Bone Marrow Lesions

Abstract

CONTEXT CONTEXT Symptomatic bone marrow lesions on MRI in patients with knee osteoarthritis are strongly associated with progressive deterioration of the joint and an increased risk of progression requiring joint replacement surgery. This study evaluates the efficacy of knee arthroscopy with adjunctive subchondroplasty (i.e. cartilage stabilization) to improve self-rated visual analog scale (VAS) pain scores, rate of conversion to arthroplasty, and patient satisfaction levels. METHODS METHODS A retrospective chart review and phone survey was performed on 12 patients who had undergone knee arthroscopy with adjunctive subchondroplasty for knee pain associated with chronic subchondral bone marrow lesions on MRI. Follow-up for the 12 patients was 36 months on average (range of 12 to 51 months), self-reported paired preoperative and postoperative VAS scores were analyzed in addition to rate of conversion to arthroplasty and patient satisfaction. RESULTS RESULTS The results demonstrated statistically significant reductions in mean preoperative VAS scores versus six-week postoperative VAS scores from 7.58 to 1.83 (p < 0.001) in addition to significant reductions in mean preoperative VAS scores to final postoperative VAS scores from 7.58 to 1.60 (p < 0.001). There was no statistically significant association (p > 0.05) with patients' demographic and clinical data (e.g., age, height, weight, BMI, length of symptoms) and rate of revision to total arthroplasty after receiving the arthroscopic subchondroplasty procedure. Out of the 12 patients, two (16.7%) patients went on to conversion to total knee arthroplasty. CONCLUSIONS CONCLUSIONS In this series, knee arthroscopy with adjunctive subchondroplasty for the treatment of osteoarthritis with symptomatic bone marrow lesions was associated with clinically significant improvements in VAS pain scores. Furthermore, patients who underwent subchondroplasty had a low rate (16.7%) of conversion to total knee arthroplasty at 36-month follow-up.

Efficacy of Subchondroplasty in the Treatment of Pain Associated With Bone Marrow Lesions in the Osteoarthritic Knee

“…SCP failed in 11 patients who required knee replacement within the follow-up period (6 patients, total knee replacement; 5 patients, unicompartmental knee replacement). The failure rate observed in this study was 22.9%, which is in agreement with other studies 5 , 14 – 16 in the literature whose failure rates ranged between 12.5% and 30%. Early failures during the first 6 months of the follow-up (8 patients) occurred in patients with relatively high-grade OA.…”

“…This is in accordance with available evidence reporting a mean improvement of pain on a visual analog scale of 4.3 to 7.2 points. 2 , 4 , 5 , 7 , 14 – 16 , 19 At 2 years after surgery, 26 patients (52%) showed target pain reduction, indicating a continuity of the obtained results.…”

“…The sample-size calculation and 6-month evaluation point were determined based on previous studies. 4 , 5 , 14 , 16 With a sample size of 50, a confidence interval of about 10% would be obtained if the prevalence of success—defined as patients with a 4-point reduction in the 6-month NRS score—was 72%, indicating a high precision of the estimates.…”

Evaluation of a modified subchondroplasty technique in an equine full-thickness cartilage defect model: a pilot study

“…29,32,41,42 Compared to baseline, improvement in visual analog scale scores may not be seen until 6 weeks postoperatively. 43 All horses exhibited bilateral increases in the measured lameness parameters compared to baseline, similar to previous findings for the established defect model used in this study. 16 A subchondral drill tract was associated with at least 1 defect per stifle, and treatments 1 and 3 were never administered in the same stifle.…”

Treatment of Subchondral Bone Marrow Edema with Intralesional Viscous Bone Cement in a Young, Active Patient

“…BME has been shown to be a precursor to osteoarthritis (OA), particularly in individuals older than 40 years [2][3][4][5] . The use of intralesional bone cement in this population has grown in popularity because of growing availability and excellent clinical results for reducing the pain and disability associated with these lesions 1,[6][7][8][9] . However, BME is also seen in younger individuals in response to ACL, meniscal, or other ligamentous injuries, yet there is a paucity of literature on treating BME in younger patients.…”