Centeno-Schultz Clinic, Broomfield, CO; Regenexx, LLC, Des Moines, IA.
Centeno-Schultz Clinic, Broomfield, CO.
Pain Physician. 2021 May;24(3):E279-E288.
Bone marrow lesions are a radiographic indication of bony pathology closely associated with advanced osteoarthritis of the adjacent joint. Injection of autologous orthobiologic products, including bone marrow concentrate and platelet-rich plasma, have demonstrated safety and efficacy in treating both advanced osteoarthritis (via intraarticular injection) and associated bone marrow lesions (via intraosseous injection). The relative efficacy of intraarticular versus intraosseous injection of orthobiologics has not been evaluated at the present time.
The objective was to evaluate differences in orthobiologic bone marrow lesions treatment, either as a collateral result of intraarticular injection with bone marrow concentrate and platelet products alone, or intraosseous plus intraarticular injection as measured by patient reported outcomes.
This study employed a prospective case-matched cohort design.
This study took place at a single outpatient interventional orthopedic pain clinic.
Using data from a prospective orthobiologic treatment registry of knee patients, a population of knee osteoarthritis with bone marrow lesions patients who had undergone only intraarticular knee injections of bone marrow concentrate and platelets (for symptomatic advanced osteoarthritis) were age, gender, and disease severity case-matched to a series of advanced osteoarthritis and bone marrow lesions patients who underwent intraosseous plus intraarticular injections. Self-reported patient outcomes for Numeric Pain Scale, International Knee Documentation Committee, lower extremity functional scale, and a modified single assessment numeric evaluation were compared between the 2 treatment groups.
Eighty patients were included, 40 in each group. Although pain and functional outcome scores were significantly improved in both treatment groups, there was no statistically significant differences in patient reported outcomes based on the type of treatment.
There are several limitations to this study, including multiple providers performing the injections, varying onset of symptoms to treatment, and additional injections after their initial treatment, that were not controlled. In addition, increasing the sample size may be beneficial as well, particularly with the large bone marrow lesions group, which did suggest possible improvement with intraosseous plus intraarticular over the intraarticular, although was not statistically significant in our sample. Limited data availability for this cohort as well as some missing data are other limitations to consider.
Treating knee bone marrow lesions with intraosseous bone marrow concentrate and platelet products did not affect patient reported outcomes.
骨髓病变是骨病理学的影像学指征，与邻近关节的晚期骨关节炎密切相关。自体同源生物制品（包括骨髓浓缩物和富含血小板的血浆）的注射已被证明在治疗晚期骨关节炎（通过关节内注射）和相关骨髓病变（通过骨内注射）方面是安全有效的。目前尚未评估关节内与骨内注射同源生物制品的相对疗效。
评估同源生物骨髓病变治疗的差异，无论是作为单独使用骨髓浓缩物和血小板产品进行关节内注射的附带结果，还是作为骨内加关节内注射的结果，通过患者报告的结果进行评估。
本研究采用前瞻性病例匹配队列设计。
本研究在一家单门诊介入矫形疼痛诊所进行。
利用膝关节患者前瞻性同源生物治疗登记处的数据，对仅接受关节内膝关节注射骨髓浓缩物和血小板（用于治疗有症状的晚期骨关节炎）的膝关节骨关节炎伴骨髓病变患者进行年龄、性别和疾病严重程度的病例匹配，以匹配一系列接受骨内加关节内注射的晚期骨关节炎和骨髓病变患者。比较两组患者的数字疼痛量表、国际膝关节文献委员会、下肢功能量表和改良单一评估数字评估的自我报告患者结果。
共纳入 80 例患者，每组 40 例。尽管两组患者的疼痛和功能结果评分均显著改善，但基于治疗类型，患者报告的结果无统计学差异。
本研究存在多种局限性，包括多个提供者进行注射、症状出现到治疗的时间不同以及初始治疗后的额外注射，这些都未得到控制。此外，增加样本量可能也会有所帮助，特别是对于较大的骨髓病变组，虽然在我们的样本中没有统计学意义，但可能表明骨内加关节内注射优于关节内注射。该队列的有限数据可用性以及一些缺失数据也是需要考虑的其他限制。
用骨内骨髓浓缩物和富含血小板的产品治疗膝关节骨髓病变不会影响患者的报告结果。
