Knee osteoarthritis (OA) presents as a prevalent form of arthritis characterized by joint pain and stiffness, often progressing to disability as the joint cartilage gradually deteriorates.
One significant indicator of osteoarthritic cartilage damage is the presence of bone marrow lesions (BMLs), detectable through MRI but not conventional X-rays. BMLs signify chronic inflammation of subchondral bone beneath the joint surface, often accompanied by swelling and fluid accumulation (edema). Chronic BMLs, if left untreated, may hasten cartilage destruction and increase the likelihood of requiring total knee replacement.
Conservative management options for BMLs include pain medications, knee braces, crutches, and physical therapy. However, chronic BMLs resistant to self-healing necessitate intervention.
Subchondroplasty emerges as a minimally invasive procedure targeting chronic BMLs by filling them with a bone substitute material. This technique aids in bone defect repair as the substitute gradually resorbs, promoting healthy bone formation while resolving associated edema. Subchondroplasty may be conducted independently or alongside other arthroscopic procedures.

Ideal Candidates and Procedure Overview

Patients experiencing knee pain primarily attributed to BMLs may benefit from subchondroplasty, except those with a BMI exceeding 40 or severe knee joint malalignment.
The procedure is conducted under fluoroscopy to precisely target chronic BMLs, providing real-time X-ray images for surgical guidance. Preceding the procedure, BMLs are identified via T2 Fat Suppressed MRI.

During Subchondroplasty:

  • General anesthesia is administered to the patient.
  • A semi-circular reference frame is positioned relative to the patient’s tibia, aiding in targeting BMLs.
  • A pin is inserted through the skin to the bone under fluoroscopic guidance.
  • A cannulated drill is utilized to advance the pin to the desired depth.
  • The bone substitute is injected through a cannula into the bone, adjusting volume as necessary.
  • A trocar aids in pushing the bone substitute into place.
  • Proper positioning is confirmed via fluoroscopic imaging before closing the incision.

Post-Procedure Care and Advantages

Following subchondroplasty, patients may experience discomfort for 1-2 days, managed with prescribed pain medications. Crutches are recommended for 1-2 weeks to alleviate weight-bearing on the operated leg, accompanied by physical therapy to restore knee strength and mobility.

Subchondroplasty boasts several advantages:

  • It is an outpatient procedure, facilitating same-day discharge.
  • Recovery is swift, allowing a quicker return to normal activities.
  • It does not impede future total knee replacement if necessary.
By understanding the nuances of knee osteoarthritis and the benefits of subchondroplasty, patients and healthcare providers can collaboratively explore treatment options to enhance knee function and quality of life.
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