Cohen Steven B, Hajnik Christopher, Loren Gregory J, Akhavan Sam, DeMeo Patrick J, Wyland Douglas J, Youm Thomas, Jazrawi Laith M, Daley Robert J, Farr Jack, Reischling Patrick, Woodell-May Jennifer E
Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
CORE Orthopaedic Medical Center, Orthopaedic Surgeons, Encinitas, California.
J Knee Surg. 2025 May;38(6):290-299. doi: 10.1055/a-2501-0910. Epub 2024 Dec 12.
Bone marrow lesions (BMLs) have a strong correlation to patient-reported pain, functional limitations, joint deterioration, and rapid progression to total knee arthroplasty. The Subchondroplasty (SCP) procedure uses AccuFill, a calcium phosphate bone substitute material (BSM), to treat bone defects such as microtrabecular fractures and BML. This observational, prospective, multicenter, cohort study evaluated the effect of the SCP procedure at the 2-year follow-up for 70 patients with knee BML. Under arthroscopic and fluoroscopic guidance, the BML was injected with AccuFill. Patient-reported outcomes, including Visual Analog Scale (VAS) pain, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and modified Knee Society Score (mKSS) were collected through 24 months postoperatively. Radiographs and magnetic resonance imaging (MRI) were performed at baseline and up to 24 months postoperatively. Patient selection was not limited based on the degree of osteoarthritis (OA) as determined radiologically by the Kellgren-Lawrence (K-L) grade. For a subset of patients, patient-reported outcomes were collected up to 5 years including pain evaluation, patient knee global assessment, and satisfaction with the procedure. Preoperative radiographs indicated moderate to severe OA (K-L grades 2-4) in 65 patients (92.8%). Significant improvements ( < 0.0001) in mean VAS pain, IKDC, mKSS, and KOOS scores were observed compared with baseline. Kaplan-Meier survivorship free from conversion to knee arthroplasty was 76.2% at 2 years. The subset of patients followed for 5 years demonstrated low pain scores and high procedure satisfaction. This study presents statistically significant and clinically meaningful evidence of improvement in clinical outcomes following SCP for BMLs of the knee after 2 years. The survivorship rate from arthroplasty at 2 years was 76.2%. SCP for BMLs can relieve pain with a minimally invasive procedure and may delay the need for knee arthroplasty. REGISTRATION: NCT01621893 (ClinicalTrials.gov). LEVEL OF EVIDENCE: Level II, Prospective Cohort Therapeutic Study.
骨髓损伤（BMLs）与患者报告的疼痛、功能受限、关节退变以及全膝关节置换术的快速进展密切相关。软骨下成形术（SCP）使用磷酸钙骨替代材料（BSM）AccuFill来治疗诸如微小梁骨折和BML等骨缺损。这项观察性、前瞻性、多中心队列研究评估了SCP手术对70例膝关节BML患者随访2年的效果。在关节镜和荧光镜引导下，向BML内注射AccuFill。通过术后24个月收集患者报告的结果，包括视觉模拟量表（VAS）疼痛评分、膝关节损伤和骨关节炎结局评分（KOOS）、国际膝关节文献委员会（IKDC）评分以及改良膝关节协会评分（mKSS）。在基线和术后长达24个月时进行X线片和磁共振成像（MRI）检查。患者选择不受通过Kellgren-Lawrence（K-L）分级影像学确定的骨关节炎（OA）程度限制。对于一部分患者，收集长达5年的患者报告结果，包括疼痛评估、患者膝关节整体评估以及对手术的满意度。术前X线片显示65例患者（92.8%）有中度至重度OA（K-L分级2-4级）。与基线相比，平均VAS疼痛评分、IKDC评分、mKSS评分和KOOS评分有显著改善（<0.0001）。2年时未转换为膝关节置换术的Kaplan-Meier生存率为76.2%。随访5年的患者亚组显示疼痛评分低且手术满意度高。本研究提供了统计学上显著且具有临床意义的证据，证明SCP治疗膝关节BMLs术后2年临床结局有所改善。2年时关节置换术的生存率为76.2%。SCP治疗BMLs可通过微创手术缓解疼痛，并可能延迟膝关节置换术的需求。注册：NCT01621893（ClinicalTrials.gov）。证据水平：II级，前瞻性队列治疗研究。
