scholarly journals Calcium phosphate injection of symptomatic bone marrow lesions of the knee: what is the current clinical evidence?

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
D. S. Angadi ◽  
D. Edwards ◽  
J. T. K. Melton
Keyword(s):  
Bone Marrow ◽  
Calcium Phosphate ◽  
Clinical Outcomes ◽  
Clinical Decision Making ◽  
Short Form ◽  
Case Reports ◽  
Objective Assessment ◽  
Weight Bearing ◽  
Bone Marrow Lesions ◽  
Phosphate Injection

Abstract Background Chronic bone marrow lesions (BML) in the weight-bearing portions of the knee are often associated with symptomatic degenerative arthritis resulting in pain and dysfunction. Injection of bone substitute material like calcium phosphate has been described. Whilst some studies have reported encouraging results others have shown limited benefit of this technique. Aim The aim was to collate the available evidence on the injection of calcium phosphate and systematically evaluate the results to answer the questions encountered in clinical decision making: (1) does it provide effective long-lasting pain relief to avoid further surgical intervention? (2) which factors (patient/surgical) significantly influence the outcome? and (3) does it adversely affect the outcomes of subsequent arthroplasty? Methods A literature search was performed to identify the studies describing the clinical outcomes of calcium phosphate injection for treatment of BML. We evaluated the reported clinical outcomes with respect to pain, function and complications. Isolated case reports and studies with no objective assessment of clinical outcomes were excluded. Results We noted 46 articles in the current literature of which 8 described clinical outcomes of calcium phosphate injection. Mean (plus/minus SD) score on the visual analog scale (VAS) has been reported to improve from 7.90 (± 0.38) to 2.76 (± 0.90), whereas the International Knee Documentation Committee (IKDC) score improved from 30.5 (SD not reported (NR)) to 53.0 (SD NR). Pre and post procedure Short form survey (SF-12) scores were 29.8 (SD NR) and 36.7 (SD NR), respectively. In one study, scores on the Tegner Lysholm knee scoring scale improved in 12 out of 22 patients, whereas the remainder had no change in symptoms. Extravasation of calcium phosphate into the joint was the most common complication, whereas no adverse effect has been reported on subsequent arthroplasty. Conclusion Limited data from the published studies would suggest that calcium phosphate injection of BML may potentially improve pain and function. However, no evidence is currently available to clearly identify patient/surgical factors that may influence the long-term outcomes of this procedure. Hence pragmatic, prospective studies with stratified patient cohorts and robust reporting of outcome measures are essential to improve the understanding of the indications and clinical effectiveness of this novel procedure.

Talar Avascular Necrosis After Calcium Phosphate Injection Treatment of Talar Bone Marrow Lesions

2020 ◽  
Vol 10 (2) ◽  
pp. e19.00389-e19.00389
Author(s):  
Jessica M. Kohring ◽  
Irvin Oh ◽  
Judith F. Baumhauer
Keyword(s):  
Bone Marrow ◽  
Calcium Phosphate ◽  
Avascular Necrosis ◽  
Bone Marrow Lesions ◽  
Injection Treatment ◽  
Phosphate Injection

scholarly journals Two Year Clinical Outcomes of the Subchondroplasty® Procedure for Treatment of Symptomatic Bone Marrow Lesions of the Knee

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0029
Author(s):  
Christopher Hajnik ◽  
Sam Akhavan ◽  
Douglas J. Wyland ◽  
Steven B. Cohen ◽  
Laith M. Jazrawi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Conversion Rate ◽  
Bone Substitute ◽  
Patient Reported Outcomes ◽  
Bone Substitute Material ◽  
Bone Marrow Lesions ◽  
Patient Reported ◽  
Substitute Material ◽  
One Year

Objectives: Bone Marrow Lesions (BML) are a common finding on knee MRI. In the knee, BML have a strong correlation to patient-reported pain, function, joint deterioration and rapid progression to TKR. Histologic analyses of BML have demonstrated findings consistent with fracture and bony remodeling of the trabeculae. The Subchondroplasty (SCP®) Procedure aims to treat the bone defects present in the BML by percutaneously filling them with a bone substitute material, designed to flow through intact bone, harden at body temperature and then heal through natural bone turnover. Previous retrospective, single-center case series have demonstrated improvements in patient-reported outcomes. The purpose of this prospective, multi-center study is to evaluate the 2-year clinical and radiographic outcomes of patients with BML of the knee treated with the Subchondroplasty Procedure. Methods: Seventy patients were treated between 2012 and 2017 for BML of the tibial plateau and/or femoral condyle. Self-drilling cannulas were inserted into the BML using arthroscopic and fluoroscopic guidance, then injected with AccuFill® Bone Substitute Material. All patients also underwent arthroscopy to aid in targeting the underlying bony lesion and address intra-articular pathology. MRIs and radiographs were obtained pre-operatively, at 6, 12 and 24 months, with additional radiographs collected at 6 weeks and 3 months. Patient-reported outcomes, including VAS pain, IKDC and KOOS were collected pre-operatively, 2 and 6 weeks, and 3, 6, 12 and 24 months post-operatively. Results: Seventy patients (36 males and 34 females), average age 57 were consented and enrolled in the study. Preoperative K-L grade included 1.4% Grade 0, 2.9% Grade 1, 27.1% Grade 2, 55.7% Grade 3 and 7.1% Grade 4. Fifty eight tibial plateaus and 41 femoral condyles were treated (29 bipolar lesions treated). VAS Pain scores improved from a mean of 6.2/10 pre-op to 2.9/10 at 1 year. IKDC scores improved from mean 33.9 pre-op to 61.3 at 1 year. KOOS scores improved from baseline to 1 year (Fig. 1) with mean KOOS Pain from 45.8 to 73.9, ADL 52.9 to 79.2, Symptoms 49.7 to 71.9, Sports 21.2 to 49.9 and Quality of Life 18.1 to 52.3. All patient-reported outcomes showed statistically significant improvement at one year. Two year outcomes collected to date appear to follow the same trend. The last study subject is due to return in January 2019 at which point the final 2 year analysis will be completed. Six patients (8.6%) converted to arthroplasty (1 UKA and 5 TKA) at one year. To date, the 24 month conversion rate is 16.1% out of 62 subjects. The final conversion rate for 24 months will be calculated after the final subject returns. Radiographs and MRIs demonstrated good incorporation of the AccuFill material through 12 months with evidence of early remodeling and a lack of OA progression in the majority of subjects. Twenty-four month MRIs demonstrate continued remodeling of the AccuFill material. Conclusion: This study presents statistically and clinically-meaningful evidence of improvements in clinical outcomes following Subchondroplasty procedure for BML of the knee. The low conversion rate suggests this less-invasive procedure may delay the need for knee arthroplasty. MR imaging demonstrates good incorporation of the BSM and evidence of remodeling and reduction in material volume over time. [Figure: see text][Table: see text]

Gelatinous Degeneration of the Bone Marrow: Two Case Reports Showing Different Hematological Features and Clinical Outcomes

2007 ◽  
Vol 118 (3) ◽  
pp. 165-166 ◽  
Author(s):  
Pasquale Niscola ◽  
Luca Maurillo ◽  
Massimiliano Palombi ◽  
Stefano Fratoni ◽  
Alessio Pio Perrotti ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Case Reports

scholarly journals Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis

2018 ◽  
Vol 53 (20) ◽  
pp. 1268-1278 ◽  
Author(s):  
Adam G Culvenor ◽  
Britt Elin Øiestad ◽  
Harvi F Hart ◽  
Joshua J Stefanik ◽  
Ali Guermazi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Marrow ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Meniscal Tear ◽  
Clinical Decision ◽  
Cartilage Defects ◽  
Meniscal Tears ◽  
Bone Marrow Lesions ◽  
Mri Features

BackgroundKnee MRI is increasingly used to inform clinical management. Features associated with osteoarthritis are often present in asymptomatic uninjured knees; however, the estimated prevalence varies substantially between studies. We performed a systematic review with meta-analysis to provide summary estimates of the prevalence of MRI features of osteoarthritis in asymptomatic uninjured knees.MethodsWe searched six electronic databases for studies reporting MRI osteoarthritis feature prevalence (ie, cartilage defects, meniscal tears, bone marrow lesions and osteophytes) in asymptomatic uninjured knees. Summary estimates were calculated using random-effects meta-analysis (and stratified by mean age: <40 vs ≥40 years). Meta-regression explored heterogeneity.ResultsWe included 63 studies (5397 knees of 4751 adults). The overall pooled prevalence of cartilage defects was 24% (95% CI 15% to 34%) and meniscal tears was 10% (7% to 13%), with significantly higher prevalence with age: cartilage defect <40 years 11% (6%to 17%) and ≥40 years 43% (29% to 57%); meniscal tear <40 years 4% (2% to 7%) and ≥40 years 19% (13% to 26%). The overall pooled estimate of bone marrow lesions and osteophytes was 18% (12% to 24%) and 25% (14% to 38%), respectively, with prevalence of osteophytes (but not bone marrow lesions) increasing with age. Significant associations were found between prevalence estimates and MRI sequences used, physical activity, radiographic osteoarthritis and risk of bias.ConclusionsSummary estimates of MRI osteoarthritis feature prevalence among asymptomatic uninjured knees were 4%–14% in adults aged <40 years to 19%–43% in adults ≥40 years. These imaging findings should be interpreted in the context of clinical presentations and considered in clinical decision-making.

scholarly journals Evaluation and Management of Subchondral Calcium Phosphate Injection Technique to Treat Bone Marrow Lesion

Cartilage ◽  
2018 ◽  
Vol 10 (4) ◽  
pp. 395-401 ◽  
Author(s):  
Diego Costa Astur ◽  
Eduardo Vasconcelos de Freitas ◽  
Pedro Barreira Cabral ◽  
Caio Carvalho Morais ◽  
Bruno Silveira Pavei ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Calcium Phosphate ◽  
Femoral Condyle ◽  
Bone Marrow Lesion ◽  
Functional Improvement ◽  
Injection Technique ◽  
Pain Complaint ◽  
Total Knee ◽  
Phosphate Injection ◽  
Phosphate Treatment

Purpose This study aimed to compile available data in medical literature about subchondral calcium phosphate injection, comparing results obtained with this technique, as well as indications, complications, and other important factors in treatment of bone marrow lesions. Designs A literature review using PubMed and Medline database in order to identify works with terms “subchondral calcium phosphate injection,” “ subchondroplasty®,” “bone marrow lesion,” and “knee.” Eight relevant articles were found. Results A total of 164 patients with bone marrow lesion mainly on femoral condyle and tibial plateau recovered with significant functional improvement of knee after subchondral calcium phosphate treatment. Although 25% of them still had some type of pain complaint, they also showed improvement. There were few complications reported and return to activities occurred after 3 months on average. Conclusions Few studies evaluate the result of using subchondral calcium phosphate injection technique. However, all presented favorable results regarding pain and improvement of knee function. In addition, within 2 years, there was a 70% reduction in conversion to total knee arthroplasty in patients with previous surgical indication who choose calcium phosphate treatment.

scholarly journals Enhanced angiogenesis and increased bone turnover characterize bone marrow lesions in osteoarthritis at the base of the thumb

2018 ◽  
Vol 7 (6) ◽  
pp. 406-413 ◽  
Author(s):  
M. Shabestari ◽  
N. J. Kise ◽  
M. A. Landin ◽  
S. Sesseng ◽  
J. C. Hellund ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Turnover ◽  
Weight Bearing ◽  
Histological Changes ◽  
Trabecular Thickness ◽  
Bone Marrow Lesions ◽  
Dynamic Histomorphometry ◽  
Water Signal ◽  
Femoral Heads ◽  
Tissue Changes

ObjectivesLittle is known about tissue changes underlying bone marrow lesions (BMLs) in non-weight-bearing joints with osteoarthritis (OA). Our aim was to characterize BMLs in OA of the hand using dynamic histomorphometry. We therefore quantified bone turnover and angiogenesis in subchondral bone at the base of the thumb, and compared the findings with control bone from hip OA.MethodsPatients with OA at the base of the thumb, or the hip, underwent preoperative MRI to assess BMLs, and tetracycline labelling to determine bone turnover. Three groups were compared: trapezium bones removed by trapeziectomy from patients with thumb base OA (n = 20); femoral heads with (n = 24); and those without (n = 9) BMLs obtained from patients with hip OA who underwent total hip arthroplasty.ResultsAll trapezium bones demonstrated MRI-defined BMLs. Compared with femoral heads without BMLs, the trapezia demonstrated significantly higher bone turnover (mean sd 0.2 (0.1) versus 0.01 (0.01) µm3/µm2/day), mineralizing surface (18.5% (13.1) versus 1.4% (1.3)) and vascularity (5.2% (1.1) versus 1.2% (0.6)). Femoral heads with BMLs exhibited higher bone turnover (0.3 (0.2) versus 0.2 (0.1) µm3/µm2/day), a higher mineralization rate (26.6% (10.6) versus 18.6% (11.9)) and greater trabecular thickness (301.3 µm (108) versus 163.6 µm (24.8)) than the trapezia.ConclusionBone turnover and angiogenesis were enhanced in BMLs of both the thumb base and hip OA, of which the latter exhibited the highest bone turnover. Thus, the increase in bone turnover in weight-bearing joints like the hip may be more pronounced than less mechanically loaded osteoarthritic joints demonstrating BMLs. The histological changes observed may explain the water signal from BMLs on MRI. Cite this article: M. Shabestari, N. J. Kise, M. A. Landin, S. Sesseng, J. C. Hellund, J. E. Reseland, E. F. Eriksen, I. K. Haugen. Enhanced angiogenesis and increased bone turnover characterize bone marrow lesions in osteoarthritis at the base of the thumb. Bone Joint Res 2018;7:406–413. DOI: 10.1302/2046-3758.76.BJR-2017-0083.R3.

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