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DOI: 10.1055/s-0039-1700568
Subchondroplasty for Bone Marrow Lesions in the Arthritic Knee Results in Pain Relief and Improvement in Function
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Abstract
Subchondroplasty is a relatively new joint preserving procedure, which involves the localized injection of calcium pyrophosphate bone substitute into the bone marrow lesion. The advent of magnetic resonance imaging (MRI) has greatly facilitated the identification of these bone marrow lesions. We investigated the clinical efficacy of subchondroplasty in the treatment of symptomatic bone marrow lesions in the knee, including knees with preexisting osteoarthritis. This study comprised of 12 patients whose knees were evaluated with standard radiographs and MRI to identify and localize the bone marrow lesions. They then underwent subchondroplasty under intraoperative radiographic guidance. Preoperative and postoperative visual analog scale (VAS) pain scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and Knee Injury and Arthritis Outcome Scores (KOOS) were obtained. VAS scores improved significantly from 7.5 ± 1.8 before surgery to 5.2 ± 2.7 after surgery. This further improved to 2.1 ± 2.4 at the one-year follow-up. KOOS scores improved significantly from 38.5 ± 17.0 before surgery to 73.2 ± 19.0 at the one-year follow-up. WOMAC scores improved significantly from 47.8 ± 20.5 before surgery to 14.3 ± 13.2 at the one-year follow-up. Subchondroplasty offers an effective way to treat subchondral bone marrow lesions in the arthritic knee, resulting in improvement in symptoms and early return to activity. Long-term studies are required to evaluate if these benefits can last. This is a Level II study.
Keywords
bone marrow lesion - subchondroplasty - osteoarthritis - knee pain - calcium phosphate bone substitutePublikationsverlauf
Eingereicht: 07. Dezember 2019
Angenommen: 18. September 2019
Artikel online veröffentlicht:
21. November 2019
© 2019. Thieme. All rights reserved.
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References
- 1 Wuchu F, Weber A, Yan C, Wen C. BMI-related subchondral bone microstructural changes in knee osteoarthritis: overloading or metabolic disturbance?. Osteoarthritis Cartilage 2019; 27: S356-S357
- 2 Holzer LA, Kastner N, Leithner A, Holzer G. Microstructural analysis of subchondral bone in knee osteoarthritis. Osteoarthritis Cartilage 2016; 24: S279
- 3 Burnett WD, Kontulainen SA, McLennan CE. et al. Knee osteoarthritis patients with more subchondral cysts have altered tibial subchondral bone mineral density. BMC Musculoskelet Disord 2019; 20 (01) 14
- 4 Pathria MN, Chung CB, Resnick DL. Acute and stress-related injuries of bone and cartilage: pertinent anatomy, basic biomechanics, and imaging perspective. Radiology 2016; 280 (01) 21-38
- 5 Grässel S, Aszódi A. Cartilage: Volume 2: Pathophysiology. Switzerland: Springer; 2017
- 6 Sanchez-Adams J, Leddy HA, McNulty AL, O'Conor CJ, Guilak F. The mechanobiology of articular cartilage: bearing the burden of osteoarthritis. Curr Rheumatol Rep 2014; 16 (10) 451
- 7 Muratovic D, Cicuttini F, Wluka A. et al. Bone marrow lesions detected by specific combination of MRI sequences are associated with severity of osteochondral degeneration. Arthritis Res Ther 2016; 18: 54
- 8 Sofat N. Drilling down to the bone: evaluating bone marrow lesions in osteoarthritis. Eur Med J 2018; 3 (04) 103-110
- 9 Eriksen EF. Treatment of bone marrow lesions (bone marrow edema). Bonekey Rep 2015; 4: 755
- 10 Yoo JY, O'Malley MJ, Matsen Ko LJ, Cohen SB, Sharkey PF. Knee arthroplasty after subchondroplasty: early results, complications, and technical challenges. J Arthroplasty 2016; 31 (10) 2188-2192
- 11 Rebolledo BJ, Smith KM, Dragoo JL. Hitting the mark: optimizing the use of calcium phosphate injections for the treatment of bone marrow lesions of the proximal tibia and distal femur. Arthrosc Tech 2018; 7 (10) e1013-e1018
- 12 Holzer LA. Subchondral bone: an emerging target for treatment of osteoarthritis. J Rheum Dis Treat 2015; 1 (01) DOI: 10.23937/2469-5726/1510001.
- 13 Cohen SB, Sharkey PF. Surgical treatment of osteoarthritis pain related to subchondral bone defects or bone marrow lesions: subchondroplasty. Tech Knee Surg 2012; 11 (04) 170-175
- 14 Cohen SB, Sharkey PF. Subchondroplasty for treating bone marrow lesions. J Knee Surg 2016; 29 (07) 555-563
- 15 Farr J, Cohen SB. Expanding applications of the subchondroplasty procedure for the treatment of bone marrow lesions observed on magnetic resonance imaging. Oper Tech Sports Med 2013; 21 (02) 138-143
- 16 Chatterjee D, McGee A, Strauss E, Youm T, Jazrawi L. Subchondral calcium phosphate is ineffective for bone marrow edema lesions in adults with advanced osteoarthritis. Clin Orthop Relat Res 2015; 473 (07) 2334-2342
- 17 Bonadio MB, Giglio PN, Helito CP, Pécora JR, Camanho GL, Demange MK. Subchondroplasty for treating bone marrow lesions in the knee - initial experience. Rev Bras Ortop 2017; 52 (03) 325-330
- 18 Agten CA, Kaplan DJ, Jazrawi LM, Burke CJ. Subchondroplasty: what the radiologist needs to know. AJR Am J Roentgenol 2016; 207 (06) 1257-1262
- 19 Bernhard K, Ng A, Kruse D, Stone PA. Surgical treatment of bone marrow lesion associated with recurrent plantar fasciitis: a case report describing an innovative technique using Subchondroplasty® . J Foot Ankle Surg 2018; 57 (04) 811-815
- 20 Fodor P, Prejbeanu R, Predescu V. et al. Novel surgical technique for bone marrow lesion—case report. Journal of Interdisciplinary Medicine 2016; 1 (Suppl. 02) 27-30
- 21 Nevalainen MT, Sharkey PF, Cohen SB, Roedl JB, Zoga AC, Morrison WB. MRI findings of subchondroplasty of the knee: a two-case report. Clin Imaging 2016; 40 (02) 241-243
- 22 Tubach F, Ravaud P, Baron G. et al. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis 2005; 64 (01) 29-33
- 23 Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 2003; 1: 64
- 24 Bengtsson J, Möllborg J, Werner S. A study for testing the sensitivity and reliability of the Lysholm knee scoring scale. Knee Surg Sports Traumatol Arthrosc 1996; 4 (01) 27-31
- 25 Mitsou A, Vallianatos P, Piskopakis N, Maheras S. Anterior cruciate ligament reconstruction by over-the-top repair combined with popliteus tendon plasty. J Bone Joint Surg Br 1990; 72 (03) 398-404
- 26 Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. Br J Sports Med 2015; 49 (19) 1229-1235
- 27 Karuppal R. Current concepts in the articular cartilage repair and regeneration. J Orthop 2017; 14 (02) A1-A3
- 28 Nam Y, Rim YA, Lee J, Ju JH. Current therapeutic strategies for stem cell-based cartilage regeneration. Stem Cells Int 2018; 2018: 8490489
- 29 Nencini S, Ivanusic JJ. The physiology of bone pain. how much do we really know?. Front Physiol 2016; 7: 157
- 30 Mantyh PW. The neurobiology of skeletal pain. Eur J Neurosci 2014; 39 (03) 508-519
- 31 Ivanusic JJ. Molecular mechanisms that contribute to bone marrow pain. Front Neurol 2017; 8: 458
- 32 Surmenev RA, Surmeneva MA, Ivanova AA. Significance of calcium phosphate coatings for the enhancement of new bone osteogenesis--a review. Acta Biomater 2014; 10 (02) 557-579
- 33 Fernandez de Grado G, Keller L, Idoux-Gillet Y. et al. Bone substitutes: a review of their characteristics, clinical use, and perspectives for large bone defects management. J Tissue Eng 2018; 9: 2041731418776819
- 34 Gupta S, Malhotra A, Jindal R, Garg SK, Kansay R, Mittal N. Role of beta tri-calcium phosphate-based composite ceramic as bone-graft expander in Masquelet's-induced membrane technique. Indian J Orthop 2019; 53 (01) 63-69