Subchondroplasty

What are Bone Marrow Lesions?

Knee osteoarthritis (OA) is a common form of arthritis that causes joint pain and stiffness. It is a progressive disease in which the joint cartilage gradually wears away, leading to disability.

Bone marrow lesions or BMLs are strong predictors of osteoarthritic cartilage damage. They are visible on an MRI but not on a regular X-ray. BMLs are sites of chronic inflammation of subchondral bone. They lie below the bone surface within the marrow and are accompanied by swelling and fluid collection (edema). BMLs are associated with subchondral defects, insufficiency fractures, and stress fractures.

Treatments for Bone Marrow Lesions

Conservative treatments for BMLs include pain medications, knee braces, crutches, and physical therapy. However, long-lasting (chronic) BMLs that do not heal by themselves will require treatment. Those with chronic BMLs have faster cartilage destruction and are more likely to require a total knee replacement earlier.

What is Subchondroplasty?

Subchondroplasty is a minimally invasive procedure that is performed to specifically repair chronic BMLs by filling them with a bone substitute material. The bone substitute is then slowly resorbed and replaced with healthy bone, repairing the bone defect. Subchondroplasty also resolves the associated edema. Subchondroplasty may be performed alone or along with other arthroscopic procedures.

Ideal Candidates for Subchondroplasty

Subchondroplasty is indicated if BMLs is the primary source of pain in the knee. However, subchondroplasty is contraindicated if your BMI is more than 40 or you have severe malalignment of the knee joint.

Subchondroplasty Procedure

The whole subchondroplasty procedure is performed under fluoroscopy to accurately target chronic BMLs. Fluoroscopy provides your surgeon with intraoperative real-time X-ray images of the surgical area to guide the surgeon.

Subchondroplasty is performed under general anesthesia.
A semi-circular reference frame is placed relative to your tibia or shinbone. This allows your surgeon to target the internal subchondral location of BML from a range of trajectories. A pin is inserted through the skin to the bone under fluoroscopic imaging using this semi-circular frame.
A cannulated drill is then used to advance the pin to the desired depth in the bone.
The semi-circular guide is then removed leaving only the pin.
A cannula is placed over the pin and is slid into the bone until it is firmly in place.
The Luer lock of the delivery syringe filled with the bone substitute is attached to the back of the cannula.
The bone substitute is then injected into the bone by applying steady pressure. The delivery syringe is then detached. If more bone substitute is required, an additional filled syringe may be attached to the same cannula and injected until the desired volume is reached.
A trocar is inserted into the delivery cannula to push the left over bone substitute into the bone.
The cannula is then removed.
Finally, proper placing of the bone substitute is confirmed using the fluoroscopic imaging and the incision is closed.

After Subchondroplasty Procedure

Some pain and discomfort in the operated area are usually experienced for 1-2 days after the procedure. Pain medications will be prescribed to manage it. Crutches will be recommended for 1-2 weeks after the surgery to reduce weight-bearing on the operated leg. Physical therapy will also be recommended to regain strength and mobility in the knee.

Advantages of Subchondroplasty

Subchondroplasty is a minimally invasive procedure with the following advantages:

It is an outpatient procedure. The patient is usually discharged on the same day after the surgery.
It leads to faster recovery and quicker return to normal activities.
It does not hinder total knee replacement if required in the future.