Tissue Integration of Calcium Phosphate Compound after Subchondroplasty: 4-Year Follow-Up in a 76-Year-Old Female Patient (original) (raw)
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Subchondroplasty for treating bone marrow lesions in osteoarthritic knee – initial experience
Al-Azhar International Medical Journal (Print), 2022
Background: Osteoarthritis is a condition that impacts all of the tissues in a joint. Evidence suggests that the subchondral bone is the most important component in both pain genesis and disease progression Aim of the study: Prospective outcome research to see how effective is subchondroplasty surgery at relieving pain and improving knee function in patients having osteoarthritis-related bone marrow lesions of the knee. Patients and Methods: The study included 30 patients between the ages of 40 and 75 who had been suffering from atraumatic knee pain for at least three months, had failed conservative treatment for at least three months, had BML on MRI imaging in a loading area, and had localized pain in the BML area. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and visual analog scale (VAS) pain scores have been acquired preoperatively, at 2 weeks, 3 months, 6 months, and 12 months after surgery. Under fluoroscopic guidance, subchondroplasty was conducted by injecting nanocrystal hydroxyapatite cement into the bone marrow lesion's location. Results: Following a one-year follow-up, the WOMAC scores improved considerably, from 62.03+-11.19 to 21.83 +-8.18 (p < 0.001). All of the patients' pain, stiffness, and physical functions improved significantly. Furthermore, after surgery, the mean VAS values showed a considerable improvement. At the end of the year, the patient improved from 6.98 +-1.16 to 1.81 +-1.00 (p < 0.01), which is highly statistically significant. Conclusion: Subchondroplasty is a promising approach for treating osteoarthritis-related bone marrow lesions of the knee, providing significant pain relief and functional results with low rates of complications in the short term results.
Subchondroplasty for treating bone marrow lesions in the knee – initial experience
Revista Brasileira De Ortopedia, 2017
Objective: To evaluate the use of subchondroplasty in the treatment of bone marrow lesions in an initial series of five cases. Methods: The study included patients aged between 40 and 75 years old, with pain in the knee for at least six months, associated with high-signal MRI lesion on T2 sequences, on the tibia or femur. Patients were assessed using the visual analog pain scale and the KOOS score, one week before surgery and one, three, six, 12, and 24 weeks after the procedure. Subchondroplasty was performed with a technique developed for filling the area of the bone marrow lesion with a calcium phosphate bone substitute. Results: The filling was performed on the medial femoral condyle in four patients and medial tibial plateau in one case. The assessment by the KOOS score presented a preoperative
Bone marrow lesions in the knee: early results of patients treated with subcondroplasty
2020
Introduction: Subchondroplasty is a percutaneous procedure in which calcium phosphate is injected inside BMLs (Bone Marrow Lesions) area under fluoroscopic guidance. The main aim of the present cohort study is to evaluate the effects of subchondroplasty associated to knee arthroscopy in reducing pain and improving in knee function in patients suffering from BMLs located on femoral condyles or tibial plateau. Methods: 30 patients (mean age 65.4 years) were evaluated pre-operatively and at 6 and 12 months after surgery. Numeric pain Rating Scale (NRS), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), International Knee Documentation Committee (IKDC) were evaluated. Secondarily, edema healing and bone structure were controlled at follow-up by x-ray and MRI. Results: An improvement in all evaluated scores was found at 6 months after surgery compared to the baseline. NRS changed from a mean value of 7 to 1 at 6 months and to 0.86 at 1 year...
Clinical Orthopaedics & Related Research, 2015
Background Injury to subchondral bone is associated with knee pain and osteoarthritis (OA). A percutaneous calcium phosphate injection is a novel approach in which subchondral bone marrow edema lesions are percutaneously injected with calcium phosphate. In theory, calcium phosphate provides structural support while it is gradually replaced by bone. However, little clinical evidence supports the efficacy of percutaneous calcium phosphate injections. Questions/purposes We asked: (1) Does percutaneous calcium phosphate injection improve validated patient-reported outcome measures? (2) What proportion of patients experience failure of treatment (defined as a low score on the Tegner Lysholm Knee Scoring Scale)? (3) Is there a
Treatment of subchondral insufficiency fracture of the knee by subchondroplasty
Annals of Joint, 2020
Background: Subchondral insufficiency fracture greatly impacts the quality of life of patients, causes much pain, and has the potential to rapidly progress to degeneration of the knee. Application of a calcium phosphate bone graft to the subchondral insufficiency fracture area has emerged as a relevant therapeutic approach to improve symptoms and avoid the occurrence of bone collapse. The aim of the present study was to evaluate subchondroplasty of the knee regarding its applicability and results in terms of function improvement and prevention of evolution of joint degeneration. Methods: Eleven 40-to 75-year-old patients with pain of the knee for at least 6 months who were diagnosed with subchondral insufficiency fracture. The diagnosis was established based on clinical assessment and MRI. The typical abnormality observed on MRI was a high signal intensity bone marrow lesion adjacent to low signal intensity cortical thickening on T2-weighted. Patients with articular surface collapse or osteoarthrosis with a Kellgren-Lawrence grade higher than 3 were excluded. Patients were assessed based on a pain visual analogue scale (VAS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) score. Results: The KOOS score for function increased from 43.0 (35.1-48.2) before surgery to 89.9 (89.3-94.0) [median (interquartile range), P=0.0033] after surgery, and the VAS score decreased from 9 [7-10] to 1 [0-3] [median (interquartile range), P=0.0032]. Conclusions: Subchondroplasty was shown to be safe, applicable, and efficacious for improvement of pain and the KOOS score for subchondral insufficiency fractures of the knee.
Remodelling of subchondral bone in osteoarthritis: a histomorphometric study
Journal of Clinical Pathology, 1992
Aims: To determine whether remodelling of subchondral bone in osteoarthritis is related to anatomical and mechanical factors operating on the joint surface. Methods: Ten femoral heads were examined. Patients due to have the femoral head removed because of osteoarthritis were given a double tetracycline label before surgery. The specimens were divided in three roughly equal parts, corresponding to the medial, central (weight bearing), and lateral aspects of the femoral heads. Undecalcified methylmethacrylate embedded sections were prepared. The subchondral bone was assessed for appositional bone formation by ultraviolet light microscopy, for resorptive activity by osteoclast count, and for trabecular bone volume by semiautomatic computerised image analysis. Appositional bone rate was also correlated with the presence or absence of overlying cartilage. Results: Bone density was reduced in the medial aspect of the femoral heads but there was no significant difference between the appositional bone rate or the resorptive activity in the three areas. Nor was there any correlation between appositional bone rate in the subchondral bone and the presence or absence of overlying cartilage. Conclusion: Remodelling of subchondral bone in osteoarthritis, at least in the short term, is fairly constant and is not related to weight bearing.
İstanbul Kanuni Sultan Süleyman Tıp Dergisi, 2021
Objective: The objective of this study is to compare the individual histopathological changes caused by subchondral drilling (SCD) and bone marrow injection accompanied by hyaluronic acid (HA) in rabbits with knee osteoarthritis (OA) that is stimulated by the anterior cruciate ligament transection. Method: An OA design was created in 20 New Zealand rabbits, which were then randomly divided into two groups of ten rabbits each. The first group was named as the SCD group, in which 0.3 mL bone marrow aspirate was taken from the proximal medial tibial region and injected into the same knee joint; thereafter, retrograde SCD was applied to the proximal tibial region. The second group (HA) received intra-articular injections of 0.3 mL HA oil once weekly for three weeks. The knee joints were removed nine weeks post-surgery after the animals were killed. The knee joint articular cartilage areas were examined macroscopically, and the medial femoral condyle sections were examined histopathologically. Results: Significantly better macroscopic grading results were observed in the SCD group than in the HA group (p = 0.0001). There was no significant difference in the OA cartilage histopathology (OACH) grade between the groups (p = 0.752), but the SCD group showed a significantly better OACH stage result than the HA group (p = 0.039). The total OACH score inclined to be lower in the SCD group than in the HA group (p = 0.192). Conclusion: This study demonstrated that SCD with intra-articular bone marrow injection slowed the progression of OA and protected the cartilage surface during the early stages of OA better than HA.
Osteo-core Plasty: A Minimally Invasive Approach for Subchondral Bone Marrow Lesions of the Knee
Arthroscopy Techniques, 2020
Bone marrow lesion" (BML) is a common term used to describe the presence of fluid in the bone marrow. Although various pathologies can cause BMLs seen on magnetic resonance imaging, in this Technical Note we focus on treating the lesions associated with osteoarthritis in the knee joint. The role of the subchondral bone in transferring loads within the knee joint, as well as in cartilage homeostasis, is well established. In addition, cartilage and subchondral bone are increasingly considered as an osteochondral unit, rather than as 2 separate structures. Knee osteoarthritis, along with insufficiency fracture, is one of the main indications for the treatment of painful BMLs. Nowadays, there is a growing interest in this field, and new approaches are being developed. Our technique can be defined as a surgical procedure aimed directly at pathology within the subchondral bone and is named "osteo-core plasty." It consists of 2 parts: The first is decompression of bone marrow to decrease intraosseous pressure, and the second is administration of bone marrow aspirate concentrate for better healing potential and bone autograft to deliver supportive tissue. It should be noted that the cause of BMLs must be known before this kind of treatment is performed.