Atraumatic Medullary Osteonecrosis of the Tibia and Femur Treated With Intraosseous Orthobiologics

Osteonecrosis (ON) is a painful condition involving bony cell death with resultant architectural collapse. This report discusses the case of a 50-year-old Caucasian female who presented to an outpatient musculoskeletal clinic with severe chronic left knee pain. She had a history of ulcerative colitis and resultant chronic corticosteroid exposure with subsequent development of knee ON. She was treated with an intraosseous autologous bone marrow concentrate (BMC), demineralized bone matrix (DBM), and platelet-rich plasma (PRP) injection. At 11 months post-injection, she demonstrated a significant improvement in pain scores, mobility, activity, and decreased narcotic use. Intraosseous orthobiologic injection for the treatment of knee ON is a promising procedure with a reasonable safety profile that warrants further study as an alternative to surgical intervention.