Subchondroplasty in the Treatment of Bone Marrow Lesions of the Knee: Preliminary Experience on First 15 Patients

Abstract

Purpose The aim of this prospective study was to assess the effectiveness in terms of pain relief and functional improvement of the Subchondroplasty procedure in the treatment of osteoarthritis-related bone marrow lesions (BMLs) of the knee.

Methods The study included first 15 consecutive patients undergone to Subchondroplasty procedure for the treatment of chronic degenerative BMLs in which previous conservative treatment have failed. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Knee Injury and Osteoarthritis Outcome Scores (KOOS), and visual analog scale (VAS) pain scores were obtained preoperatively and at 1, 6, and 12 months of follow-up.

Results WOMAC scores significantly improved from 39.7 ± 20.2 before surgery to 26.8 ± 16.1 at the 1-month follow-up (p = 0.045). A further significant improvement to 15.5 ± 12.7 (p = 0.02) and to 8.6 ± 3.1 (p < 0.01) was obtained both at 6-month and at 1-year follow-up. KOOS scores improved significantly from 47.5 ± 16.6 before surgery to 65.4 ± 14.9 at 1 month (p = 0.013) and to 80.4 ± 15.1 at 6-month follow-up (p = 0.01). A further improvement to 85.6 ± 15.1 was recorded 1 year postoperatively, although nonsignificant. VAS score showed a significant improvement from 55.8 ± 20.5 preoperatively to 36.2 ± 16.9 at 1 month (p = 0.008) and to 18.2 ± 17.3 at 6-month follow-up (p = 0.005). This further improved to 12.8 ± 17.9 at 1-year follow-up, although not significantly.

Conclusion Subchondroplasty procedure represents a safe and valid surgical option in the treatment of osteoarthritis-related BMLs of the knee, providing an improvement in terms of pain relief and functional recovery. Longer studies are required to evaluate how long these improvements may last.

Level of Evidence Therapeutic case-series, Level IV study.

Keywords

bone marrow lesions - subchondroplasty - knee osteoarthritis - calcium phosphate bone substitute

Publikationsverlauf

Eingereicht: 07. Februar 2020

Angenommen: 19. April 2021

Artikel online veröffentlicht:
18. Juni 2021

• References

• 1 Felson DT. An update on the pathogenesis and epidemiology of osteoarthritis. Radiol Clin North Am 2004; 42 (01) 1-9
• 2 Loeser RF, Goldring SR, Scanzello CR, Goldring MB. Osteoarthritis: a disease of the joint as an organ. Arthritis Rheum 2012; 64 (06) 1697-1707
• 3 Singh V, Oliashirazi A, Tan T, Fayyad A, Shahi A. Clinical and pathophysiologic significance of MRI identified bone marrow lesions associated with knee osteoarthritis. Arch Bone Jt Surg 2019; 7 (03) 211-219
• 4 Felson DT, Chaisson CE, Hill CL. et al. The association of bone marrow lesions with pain in knee osteoarthritis. Ann Intern Med 2001; 134 (07) 541-549
• 5 Link TM, Steinbach LS, Ghosh S. et al. Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Radiology 2003; 226 (02) 373-381
• 6 Lo GH, McAlindon TE, Niu J. et al; OAI Investigators Group. Bone marrow lesions and joint effusion are strongly and independently associated with weight-bearing pain in knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthritis Cartilage 2009; 17 (12) 1562-1569
• 7 Roemer FW, Nevitt MC, Felson DT. et al. Predictive validity of within-grade scoring of longitudinal changes of MRI-based cartilage morphology and bone marrow lesion assessment in the tibio-femoral joint--the MOST study. Osteoarthritis Cartilage 2012; 20 (11) 1391-1398
• 8 Felson DT, McLaughlin S, Goggins J. et al. Bone marrow edema and its relation to progression of knee osteoarthritis. Ann Intern Med 2003; 139 (5 Pt 1): 330-336
• 9 Tanamas SK, Wluka AE, Pelletier JP. et al. Bone marrow lesions in people with knee osteoarthritis predict progression of disease and joint replacement: a longitudinal study. Rheumatology (Oxford) 2010; 49 (12) 2413-2419
• 10 Raynauld JP, Martel-Pelletier J, Haraoui B. et al; Canadian Licofelone Study Group. Risk factors predictive of joint replacement in a 2-year multicentre clinical trial in knee osteoarthritis using MRI: results from over 6 years of observation. Ann Rheum Dis 2011; 70 (08) 1382-1388
• 11 Scher C, Craig J, Nelson F. Bone marrow edema in the knee in osteoarthrosis and association with total knee arthroplasty within a three-year follow-up. Skeletal Radiol 2008; 37 (07) 609-617
• 12 Kon E, Ronga M, Filardo G. et al. Bone marrow lesions and subchondral bone pathology of the knee. Knee Surg Sports Traumatol Arthrosc 2016; 24 (06) 1797-1814
• 13 Zanetti M, Bruder E, Romero J, Hodler J. Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. Radiology 2000; 215 (03) 835-840
• 14 Saadat E, Jobke B, Chu B. et al. Diagnostic performance of in vivo 3-T MRI for articular cartilage abnormalities in human osteoarthritic knees using histology as standard of reference. Eur Radiol 2008; 18 (10) 2292-2302
• 15 Muratovic D, Findlay DM, Cicuttini FM, Wluka AE, Lee YR, Kuliwaba JS. Bone matrix microdamage and vascular changes characterize bone marrow lesions in the subchondral bone of knee osteoarthritis. Bone 2018; 108: 193-201
• 16 Alliston T, Hernandez CJ, Findlay DM, Felson DT, Kennedy OD. Bone marrow lesions in osteoarthritis: what lies beneath. J Orthop Res 2018; 36 (07) 1818-1825
• 17 Taljanovic MS, Graham AR, Benjamin JB. et al. Bone marrow edema pattern in advanced hip osteoarthritis: quantitative assessment with magnetic resonance imaging and correlation with clinical examination, radiographic findings, and histopathology. Skeletal Radiol 2008; 37 (05) 423-431
• 18 Hunter DJ, Lavalley M, Li J. et al. Biochemical markers of bone turnover and their association with bone marrow lesions. Arthritis Res Ther 2008; 10 (04) R102
• 19 Leydet-Quilici H, Le Corroller T, Bouvier C. et al. Advanced hip osteoarthritis: magnetic resonance imaging aspects and histopathology correlations. Osteoarthritis Cartilage 2010; 18 (11) 1429-1435
• 20 Plenk Jr H, Hofmann S, Eschberger J. et al. Histomorphology and bone morphometry of the bone marrow edema syndrome of the hip. Clin Orthop Relat Res 1997; (334) 73-84
• 21 Sharkey PF, Cohen SB, Leinberry CF, Parvizi J. Subchondral bone marrow lesions associated with knee osteoarthritis. Am J Orthop 2012; 41 (09) 413-417
• 22 Cohen SB, Sharkey PF. Subchondroplasty for treating bone marrow lesions. J Knee Surg 2016; 29 (07) 555-563
• 23 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (04) 494-502
• 24 Iwano T, Kurosawa H, Tokuyama H, Hoshikawa Y. Roentgenographic and clinical findings of patellofemoral osteoarthrosis. With special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res 1990; (252) 190-197
• 25 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
• 26 Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 2003; 1: 64
• 27 Lotke PA, Abend JA, Ecker ML. The treatment of osteonecrosis of the medial femoral condyle. Clin Orthop Relat Res 1982; (171) 109-116
• 28 Yates PJ, Calder JD, Stranks GJ, Conn KS, Peppercorn D, Thomas NP. Early MRI diagnosis and non-surgical management of spontaneous osteonecrosis of the knee. Knee 2007; 14 (02) 112-116
• 29 Gobbi A, Lad D, Petrera M, Karnatzikos G. Symptomatic early osteoarthritis of the knee treated with pulsed electromagnetic fields: two-year follow-up. Cartilage 2014; 5 (02) 78-85
• 30 Marcheggiani Muccioli GM, Grassi A, Setti S. et al. Conservative treatment of spontaneous osteonecrosis of the knee in the early stage: pulsed electromagnetic fields therapy. Eur J Radiol 2013; 82 (03) 530-537
• 31 Vitali M, Naim Rodriguez N, Pedretti A. et al. Bone marrow edema syndrome of the medial femoral condyle treated with extracorporeal shock wave therapy: a clinical and MRI retrospective comparative study. Arch Phys Med Rehabil 2018; 99 (05) 873-879
• 32 Sansone V, Romeo P, Lavanga V. Extracorporeal shock wave therapy is effective in the treatment of bone marrow edema of the medial compartment of the knee: a comparative study. Med Princ Pract 2017; 26 (01) 23-29
• 33 Gao F, Sun W, Li Z. et al. Extracorporeal shock wave therapy in the treatment of primary bone marrow edema syndrome of the knee: a prospective randomised controlled study. BMC Musculoskelet Disord 2015; 16: 379
• 34 Varenna M, Zucchi F, Failoni S, Becciolini A, Berruto M. Intravenous neridronate in the treatment of acute painful knee osteoarthritis: a randomized controlled study. Rheumatology (Oxford) 2015; 54 (10) 1826-1832
• 35 Laslett LL, Doré DA, Quinn SJ. et al. Zoledronic acid reduces knee pain and bone marrow lesions over 1 year: a randomised controlled trial. Ann Rheum Dis 2012; 71 (08) 1322-1328
• 36 Bartl C, Imhoff A, Bartl R. Treatment of bone marrow edema syndrome with intravenous ibandronate. Arch Orthop Trauma Surg 2012; 132 (12) 1781-1788
• 37 Claßen T, Becker A, Landgraeber S. et al. Long-term clinical results after iloprost treatment for bone marrow edema and avascular necrosis. Orthop Rev (Pavia) 2016; 8 (01) 6150
• 38 Zippelius T, Matziolis G, Perka C, Putzier M, Strube P, Röhner E. Long-term effects of intravenous iloprost therapy in patients with bone marrow oedema of the knee joint. Acta Chir Orthop Traumatol Cech 2018; 85 (01) 17-21
• 39 Pountos I, Giannoudis PV. The role of iloprost on bone edema and osteonecrosis: safety and clinical results. Expert Opin Drug Saf 2018; 17 (03) 225-233
• 40 Cohen SB, Sharkey PF. Surgical treatment of osteoarthritis pain related to subchondral bone defects or bone marrow lesions: subchondroplasty. Tech Knee Surg 2012; 11: 170-175
• 41 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: 138
• 42 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
• 43 Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 2011; 63 (11, Suppl 11): S208-S228
• 44 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
• 45 Chua K, Kang JYB, Ng FDJ. et al. Subchondroplasty for bone marrow lesions in the arthritic knee results in pain relief and improvement in function. J Knee Surg 2021; 34 (06) 665-671
• 46 Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C. Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev 2008; (01) CD005118
• 47 Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ 2015; 350: h2747
• 48 Brignardello-Petersen R, Guyatt GH, Buchbinder R. et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open 2017; 7 (05) e016114