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Subchondroplasty for Treating Bone Marrow Lesions.

Steven Brad Cohen1, Peter F Sharkey1

  • 1Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.

The Journal of Knee Surgery
|December 8, 2015
PubMed
Summary

Subchondroplasty, a novel procedure for bone marrow lesions (BMLs) in osteoarthritis (OA), significantly improved pain and function in patients. This joint-preserving treatment offers a promising alternative for advanced knee OA.

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Area of Science:

  • Orthopedics
  • Regenerative Medicine
  • Biomaterials

Background:

  • Bone marrow lesions (BMLs) are subchondral defects that worsen osteoarthritis (OA) prognosis, leading to severe joint degeneration and increased need for joint replacement.
  • Current joint-preserving treatments for OA pain and immobility are limited, highlighting the need for innovative therapeutic approaches.

Purpose of the Study:

  • To evaluate the effectiveness of subchondroplasty in relieving pain and improving function in patients with documented BMLs and advanced knee OA.
  • To assess the long-term outcomes of subchondroplasty combined with arthroscopic debridement for knee OA treatment.

Main Methods:

  • A retrospective study was conducted on a consecutive patient series (n=66) who underwent subchondroplasty combined with arthroscopic debridement at a single center.
  • Subchondroplasty involved injecting a calcium phosphate bone substitute into compromised subchondral bone under fluoroscopic guidance.
  • Pain and function were assessed using the visual analog scale (VAS) and the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form through 2 years postoperatively.

Main Results:

  • Patients demonstrated significant improvements in both pain and function up to 2 years after subchondroplasty with arthroscopic debridement.
  • The observed improvements in pain and function suggest a positive impact of the procedure on knee OA symptoms.
  • Compared to arthroscopic debridement alone, which showed insignificant pain relief beyond 6 months, subchondroplasty demonstrated sustained benefits.

Conclusions:

  • Subchondroplasty, when combined with arthroscopic debridement, appears to be an effective treatment for knee osteoarthritis associated with bone marrow lesions.
  • The procedure shows potential as a joint-preserving option for patients with advanced OA and BMLs, offering significant pain relief and functional improvement.
  • Further research and larger clinical trials are warranted to confirm these findings and establish subchondroplasty as a standard treatment for OA with BMLs.