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. 2023 May 16;11(5):23259671231163528.
doi: 10.1177/23259671231163528. eCollection 2023 May.

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

Pietro Randelli  1   2   3 , Riccardo Compagnoni  1   4 , Paolo Ferrua  1   2 , Martina Ricci  1 , Luca La Verde  1   5 , Ahmed Farid Mekky  1   6 , Annalisa De Silvestri  7 , Alessandra Menon  1   2   3
Affiliations

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

Pietro Randelli et al. Orthop J Sports Med. .

Abstract

Background: Bone marrow lesions (BMLs) are common subchondral defects revealed by magnetic resonance imaging (MRI) in patients with osteoarthritis, often associated with pain and functional limitation. Subchondroplasty (SCP) is a relatively new technique in which bone substitute material (BSM) is injected inside BML areas to provide structural support to the subchondral bone, preventing its collapse and reducing pain.

Purpose/hypothesis: The purpose of this study was to characterize changes in pain, functional and radiological outcomes, conversion to knee replacement, and complications after SCP. We hypothesized that ≥70% of patients would achieve a reduction in pain of ≥4 points on a numeric rating scale (NRS) at a 6-month follow-up after SCP.

Study design: Case series; Level of evidence, 4.

Methods: Patients with symptomatic knee BMLs who underwent SCP were prospectively evaluated preoperatively and at 1, 6, 12, and 24 months postoperatively. Functional outcomes were measured with the NRS for pain, Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and International Knee Documentation Committee (IKDC) scores. Radiographs and MRI were performed preoperatively and at 6- and 12-month follow-ups to verify edema healing and changes in bone structure.

Results: A total of 50 patients were included in the study. The mean follow-up was 26 months (24-30 months). Compared with preoperative values, the mean NRS score decreased at every follow-up point (P < .0001 for all) and the IKDC, WOMAC, and KSS scores improved significantly at 6- and 12-month follow-ups. At 6 months postoperatively, 27 patients (54%) registered a reduction on the NRS of ≥4 points. Postoperative MRI revealed a hypointense zone surrounded by a hyperintense signal at the injection site. Standard radiography showed osteoarthritis grade worsening in 4 (8%) patients. Knee replacement was performed in 11 patients -in 7 patients due to the worsening or persistence of disabling symptoms and in 4 patients due to the progression of osteoarthritis. The leakage of BSM occurred in 6 patients without any clinical consequences during the study period.

Conclusion: About half of the study patients achieved a reduction in the NRS of 4 points at the 6-month follow-up after SCP.

Registration: NCT04905394 (ClinicalTrials.gov identifier).

Keywords: bone marrow lesions; early osteoarthritis; knee; subchondroplasty.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: P.R. has received consulting fees from DePuy, IBSA Group, Medacta, Microport, and Olympus and nonconsulting fees from B. Braun, LIMA, and Zimmer Biomet. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Subchondroplasty procedure. (A) Preparation of bone substitute. (B) Fenestrated cannula. (C-E) Insertion of cannulas and injection of bone substitute under fluoroscopic guidance.
Figure 2.
Figure 2.
Flow diagram of the study. TKA, total knee arthroplasty; UKA, unicompartmental knee arthroplasty.
Figure 3.
Figure 3.
Clinical and functional outcomes at 1-, 6-, 12-, and 24-month follow ups. Error bars show the SEM. IKDC, International Knee Documentation Committee subjective score; KSS, Knee Society Score; NRS, numeric rating scale; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index. Statistically significant differences compared with the preoperative value are presented as follows: *P < .05; *** P < .001; **** P < .0001.
See this image and copyright information in PMC

References

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