Lam King Hei Stanley, Hung Chen-Yu, Hung Andy
Department of Family Medicine, The Chinese University of Hong Kong, Hong Kong, CHN.
Physical Medicine and Rehabilitation, National Taiwan University Hospital Beihu Branch, Taipei, TWN.
Cureus. 2020 Dec 26;12(12):e12312. doi: 10.7759/cureus.12312.
The subchondral bone marrow lesion (BML) has been found to have a significant correlation with pain in osteoarthritis patients. The intraosseous injection with orthobiologics such as platelet-rich plasma (PRP) or bone marrow aspirate concentrate has shown a promising therapeutic effect on BML-related pain. Traditionally, the intraosseous injection was performed with a large caliber trocar to break into the subchondral bone under fluoroscopy guidance and the patient was usually sedated prior to the procedure. In this report, we presented a 55-year-old woman who suffered from refractory right lateral knee pain for three months. The MRI revealed a right lateral tibial plateau subchondral BML, tears of medial and lateral menisci, and a general osteoarthritic appearance. We used ultrasound (US) to guide a 21-gauge needle through a pre-existing cortical break on the Gerdy's tubercle for the intraosseous PRP injection. The contrast was confirmed to reach the subchondral bone of the lateral tibial plateau and the injection reproduced the patient's symptoms. Three weeks later, the patient had significant improvement in the visual analog scale and function. In conclusion, intraosseous injection with PRP is a possibly effective treatment for subchondral BML in knee osteoarthritis, and US can facilitate a smaller gauge needle placement without the need to sedate the patient.
已发现软骨下骨髓损伤（BML）与骨关节炎患者的疼痛显著相关。向骨内注射富含血小板血浆（PRP）或骨髓抽吸浓缩物等骨科生物制剂已显示出对BML相关疼痛有良好的治疗效果。传统上，骨内注射是在荧光透视引导下用大口径套管针穿入软骨下骨，并且在操作前通常会让患者镇静。在本报告中，我们介绍了一名55岁女性，她右侧膝关节顽固性疼痛3个月。MRI显示右侧胫骨平台外侧软骨下BML、内外侧半月板撕裂以及一般的骨关节炎表现。我们使用超声（US）引导一根21号针通过Gerdy结节处预先存在的皮质破损处进行骨内PRP注射。确认造影剂到达胫骨平台外侧的软骨下骨，且注射再现了患者的症状。三周后，患者的视觉模拟评分和功能有显著改善。总之，骨内注射PRP可能是治疗膝关节骨关节炎软骨下BML的有效方法，并且超声可便于放置较细的针，而无需让患者镇静。
