2025 ISAKOS Biennial Congress ePoster
Patient-Specific Guides For Subchondroplasty Of The Knee: Short-Term Clinical Outcomes
Andrea Pratobevera, MD, Carate Brianza, Lombardia ITALY
Marcello Motta, MD, Brescia ITALY
Giulio Vittone, MD ITALY
Maristella Francesca Saccomanno, MD, PhD, Brescia ITALY
Sofia Ravo, MD, Brescia ITALY
Giuseppe Milano, Prof., Brescia, BS ITALY
Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia, ITALY
FDA Status Not Applicable
Summary
Subchondroplasty with BMAC using patient-specific guides offers precise, targeted treatment for knee bone marrow edema, demonstrating promising short-term clinical and radiological outcomes.
ePosters will be available shortly before Congress
Abstract
Objectives: Subchondroplasty is a recently introduced procedure for the treatment of bone marrow edema (BME), particularly in the knee, where biological matrices like bone marrow aspirate concentrate (BMAC) are gaining importance as infiltrative substances due to their regenerative and immunomodulatory properties. The identification of BME through intra-operative fluoroscopy and its proper infiltration can be challenging for the surgeon, since diagnosis is made by magnetic resonance imaging (MRI), which is the gold standard.
This study aimed to evaluate the short-term clinical and radiological outcomes of knee BME treated with BMAC using patient-specific (PS) guides. The hypothesis was that PS guides would enable more precise management of BME, reduce intraoperative radiation exposure, and result in favorable clinical outcomes and post-operative MRI findings.
Methods
This retrospective study included patients with knee BME treated with BMAC infiltration using PS guides between December 2021 and April 2024. Eligible patients had pre-operative MRI-confirmed ARCO (Association Research Circulation Osseous) stage 1-3 BME and had not responded to at least three months of conservative treatment. PS guides were developed based on the 3D-reconstruction of MRI images. The bone marrow aspirate was obtained with a dedicated kit. BMAC were then injected in the center of each BME lesion through the PS guides.
Follow-up MRI was performed three months after subchondroplasty. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) for pain and the Knee Injury and Osteoarthritis Outcome Score (KOOS). An intention-to-treat analysis was used to assess eventual conversions to knee replacement.
Results
Ten consecutive patients (8 males and 2 females) were included. The mean age at the time of treatment was 62.9 + 10 years. BME was located on the femur in 3 cases, on the tibia in 3 cases, and on both sides in 4. The severity of the lesion was ARCO stage 3 in 2 cases, stage 2 in 4, and stage 3 in 4. The mean follow-up was 11.6 ± 6.0 months. One patient with ARCO stage 1 BME in the medial femoral condyle and medial tibial plateau progressed to total knee arthroplasty 10 months post-subchondroplasty. All the other patients showed radiological resolution of BME. The mean VAS score was 2.5 ± 2.2. KOOS results showed a mean pain score of 84.3 ± 15.3, other symptoms score of 79.7 ± 16.6, activities score of 69.8 ± 29.8, sports score of 67.1 ± 26, quality of life score of 73.9 ± 28.3.
Conclusions
Subchondroplasty with BMAC can be considered a safe and encouraging procedure for the treatment of knee BME. The use of PS guides allows an accurate and targeted treatment of bone marrow lesions, optimizing the procedure and preserving soft tissues with less intraoperative radiation exposure.