Summary

Subchondroplasty along with therapeutic arthroscopy is a minimally invasive and a safe procedure which provides pain relief, improve functional outcomes, and delay the need for knee arthroplasty.

Abstract

Background

Symptomatic bone marrow lesion seen in degenerative knee accelerates the progression of osteoarthritis and increase the likelihood of joint replacement surgery. Subchondroplasty procedure has been used as an adjunct to knee arthroscopy for the management of symptomatic bone marrow lesions. The bone substitute stimulates bone remodelling which improves the mechanical property and prevent disease progression.

Objectives
To assess the effectiveness of subchondroplasty in reducing pain and functional outcomes of patients with bone marrow lesions performed in a single centre.

Study Design & Methods
This is a retrospective study from 1st January 2018 till 31st July 2021. Preoperative Magnetic Resonance Imaging is used to determine the size and location of bone marrow lesions. Calcium phosphate bone substitute is injected under fluoroscopic guidance followed by therapeutic knee arthroscopy. Patients were followed up one year post operatively. Visual Analog Score (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score are used for assessment.

Results

82 patients underwent Subchondroplasty from 2018 to 2020. VAS improved from 6.6 ±0.9 preoperatively to 5.3±0.9 at 1 month follow up (p<0.001). VAS score further improved to 3.8±1.0 at 6 month follow up (P<0.05) and 1.9±1.0 at 12 months follow up (P<0.001). Meanwhile, WOMAC score improved from 40.0±4.6 preoperatively to 24.6±3.9 at 1 month follow up (P<0.05). Scores further improved to 19.1±4.2 at 6 month follow up (P= 0.005) and 11.9±4.9 at 12 months follow up. (P<0.005). Out of 82 patients, two (2.5%) patients required total knee replacement within 12 months.