Sundaram Kavin, Vargas-Hernández Juan S, Sanchez Tomas Roca, Moreu Nestor Moreno, Mont Michael A, Higuera Carlos A, Piuzzi Nicolas S
Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio.
Department of Orthopaedic Surgery, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas, España.
J Knee Surg. 2019 Nov;32(11):1046-1057. doi: 10.1055/s-0039-1677792. Epub 2019 Feb 6.
Knee osteoarthritis (OA) is a highly prevalent disease and treatment options for early stages of OA are needed. Intraosseous injections of bone substitute and biologic materials have been proposed to expand the therapeutic arsenal by potentially halting OA progression and delaying the need for knee arthroplasty in patients with early/moderate-stage disease. Therefore, the goal of this study was assessed the efficacy and safety of subchondral intraosseous injection for the treatment of knee OA. A systematic review was performed on PubMed-Medline, and the Cochrane Database of systematic reviews. English and Spanish retrospective and prospective studies assessing the results of subchondral intraosseous injection of bone substitute materials and/or biologicals in human patients with knee OA, with a minimum of 6 months of follow-up were collected. A total of 1,081 potential articles were identified through our search. Six studies were included with a total of 163 patients. The mean follow-up was 18 months (range: 6-24 months). Patient reported outcomes measures (PROMs), complications, and conversion to total knee arthroplasty (TKA) were collected. All six studies showed PROMs improvement relative to baseline. Overall, the five studies reporting visual-analog scale (VAS) pain outcomes improved from a baseline mean score of 6.68 to 2.74. Also, knee injury and osteoarthritis score (KOOS), Tegner-Lysholm, and/or international knee documentation committee (IKDC) scores rose compared with baseline scores in all studies. Overall, 2.5% (4/163) of patients had a complication attributed to study-related treatment. Most patients (81%, 86/106) remained TKA-free at a 1-year follow-up. Subchondral intraosseous injections of bone substitute materials and platelet-rich plasma (PRP) suggest (1) improved PROMs of pain and functional status, (2) low complication rate, and (3) relatively low rates of conversion to TKA. However, the current studies investigating these treatments exhibited high degree of heterogeneity in both measurement of outcomes and delivery of treatment, with a high risk of bias. This procedure should not be utilized in advanced knee OA. In light of the limitations of the current literature, advising in favor or against this therapy for early to moderate knee OA is challenging.
膝关节骨关节炎（OA）是一种高度流行的疾病，需要针对OA早期阶段的治疗方案。有人提出通过骨内注射骨替代物和生物材料来扩大治疗手段，这有可能阻止OA的进展，并推迟早期/中期疾病患者进行膝关节置换术的需求。因此，本研究的目的是评估软骨下骨内注射治疗膝关节OA的疗效和安全性。我们在PubMed-Medline和Cochrane系统评价数据库上进行了系统评价。收集了英文和西班牙文的回顾性和前瞻性研究，这些研究评估了软骨下骨内注射骨替代材料和/或生物制剂对膝关节OA患者的治疗结果，且随访时间至少为6个月。通过检索，共识别出1081篇潜在文章。纳入了6项研究，共计163例患者。平均随访时间为18个月（范围：6 - 24个月）。收集了患者报告的结局指标（PROMs）、并发症以及转为全膝关节置换术（TKA）的情况。所有6项研究均显示PROMs相对于基线有所改善。总体而言，5项报告视觉模拟量表（VAS）疼痛结局的研究显示，基线平均得分从6.68改善至2.74。此外，在所有研究中，膝关节损伤和骨关节炎评分（KOOS）、Tegner-Lysholm评分和/或国际膝关节文献委员会（IKDC）评分相较于基线评分均有所提高。总体而言，2.5%（4/163）的患者出现了与研究相关治疗导致的并发症。在1年随访时，大多数患者（81%，86/106）仍未接受TKA。软骨下骨内注射骨替代材料和富血小板血浆（PRP）表明：（1）疼痛和功能状态的PROMs得到改善；（2）并发症发生率低；（3）转为TKA的比例相对较低。然而，目前研究这些治疗方法的研究在结局测量和治疗实施方面均表现出高度异质性，且存在较高的偏倚风险。该方法不适用于晚期膝关节OA。鉴于当前文献的局限性，对于早期至中期膝关节OA支持或反对这种治疗方法的建议具有挑战性。
