Subchondroplasty

Knee pain is frequently experienced by many people. If the pain becomes severe, disrupts daily routines, or is accompanied by swelling, redness, or warmth, it’s recommended to see a doctor.

At Complete Orthopedics, we have a team specializing in knee issues that offers a range of treatments for knee pain, including surgery if needed. We operate in six hospitals across New York City and Long Island, providing top-notch surgical and orthopedic care. Appointments with our surgeons can be made online or over the phone.

Learn about common causes of knee pain and investigate the treatments available, including situations that may require surgical intervention.

Overview

Subchondroplasty is the procedure in which the bone adjacent to the cartilage is drilled for decompression and filled with bone cement or paste with osteoconductive properties. It is done in patients who present with pain around the knee and are found to have a stress reaction (sometimes called a fracture) underneath the articular cartilage. These patients may or may not have a history of fall, accident, injury or twisting of the knee. They may also have joint line tenderness secondary to pathology inside the knee like a meniscal tear.

These patients are initially treated conservatively with antiinflammatory medications, ice, elevation and compression. If they are not relieved with conservative means, advance imaging including x-ray and MRI may be needed. If the patients show evidence of a bone marrow lesion (BML) or bone marrow edema (BME) on an MRI, then these patients may be a candidate for subchondroplasty.

A bone marrow lesion or a bone marrow edema adjacent to the cartilage of the knee joint is typically seen as a cloudy white area on the T2 and STIR sequence of the MRI. It represents stress reaction and edema in the area. It is symbolic for stress fracture localized to the bone underlying the cartilage. When these stress fracture type lesions are not able to heal with conservative means then invasive procedure like subchondroplasty may be needed.

Arthroscopic image showing articular cartilage damage.

Arthroscopic image showing articular cartilage damage.

The reason for nonhealing of these lesions may be increased pressure in the area due to the edema, which is taken care by drilling a hole and letting it to decompress. The hole is filled up with bone cement or paste to support and allow healing. Research and evidence have shown that these bone marrow lesions are the strong predictor of knee arthroplasty within three years of presentation.

Further research has also shown that subchondroplasty was able to delay and defer knee replacement in such patients. The procedure hence not only takes care of the pain and disability due to the pathology, but also helps in delaying or preventing the need for a knee replacement surgery in the future.

Procedure

This surgery is done in an outpatient setting. It is usually combined with arthroscopic examination of the knee, which helps to look inside the knee and take care of any pathologies, which may or may not be diagnosed on the MRI which include meniscal tear or cartilage lesions. It also helps in preventing complications of subchondroplasty, that is extravasation of the material into the joint.

Subchondroplasty is done under x-ray imaging control in the operating room. The patients usually will have two to four stitches after the procedure. The patients are sent home the same day within a couple of hours after procedure. They will require the need for assistive device like crutches for ambulation for 3-4 weeks.

They are sent home with pain medications and asked to follow within a week with the surgeon. They are asked to elevate and ice and use pain medications as directed to take care of the pain and swelling in the knee joint. The patients are allowed to ambulate as well as do activities of daily living as tolerated.

They are usually seen in one week and physical therapy for the knee is started at that time. It may take up to 8-10 weeks to heal completely.

IntraOsseous Bioplasty (Arthrex)

Bioplasty is a variation in which a wider decompression is done and the drill hole is filled with biologic material in the form of Platelet rich Plasma (PRP) mixed with Demineralized Bone Matrix (DBM). Both procedures have shown good results in carefully selected patients and help in preventing rapid deterioration of the joint and delay or prevent joint replacement surgery.

 

Patient Selection and Considerations

Ideal candidates for subchondroplasty are those who have persistent pain associated with BMLs, have not responded sufficiently to conservative treatments, and are not immediate candidates for total knee replacement. The presence of a BML in patients with osteoarthritis is a predictor of more rapid progression to more severe joint issues, making early intervention crucial. 

 

Clinical Evidence and Outcomes

Studies have shown that subchondroplasty can lead to significant improvements in pain and function for patients with knee osteoarthritis. For example, patients have reported substantial relief from pain and enhanced mobility post-surgery. This improvement is reflected in higher scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS) and lower scores on the Visual Analogue Scale (VAS) for pain, indicating successful outcomes both in terms of pain management and functional performance.

 

Summary

Subchondroplasty or IntraOsseous Bioplasty is a viable and evidence-based procedure which helps not only giving pain relief, but also in delaying or preventing knee replacement.

Do you have more questions? 

What exactly is subchondroplasty?

Subchondroplasty is a minimally invasive surgical procedure that involves the injection of a bone substitute, typically calcium phosphate, into the subchondral bone where bone marrow lesions (BMLs) are present. This technique aims to stabilize the bone, alleviate pain, and prevent further deterioration of the joint.

Who are the ideal candidates for subchondroplasty?

Ideal candidates for subchondroplasty include patients with persistent knee pain due to osteoarthritis, who exhibit bone marrow lesions on MRI, and have not responded adequately to conservative treatment methods. Patients should not be immediate candidates for total knee replacement.

How is subchondroplasty performed?

The procedure is performed under fluoroscopic guidance to ensure accurate placement of the injection. A mixture of a solid and fluid bone substitute is injected through a cannula into the affected area, filling the lesions and supporting the bone’s natural healing process.

What are the risks associated with subchondroplasty?

As with any surgical procedure, subchondroplasty carries risks such as infection, bleeding, and reaction to anesthesia. Specific to this procedure, there is a risk of the injected material leaking or migrating, and potential for an inflammatory response to the bone substitute.

How long is the recovery period after subchondroplasty?

Recovery varies but typically patients can return to normal activities within a few weeks. Pain and mobility improvement can be noticed as early as a few days post-operation, although full benefits might take several weeks to manifest.

Is subchondroplasty covered by health insurance?

Coverage can vary depending on the patient’s health insurance plan and the specific indications for the procedure. It’s important to consult with the insurance provider prior to the procedure to understand coverage details.

Can subchondroplasty be repeated if symptoms persist?

Yes, the procedure can be repeated, but the necessity for this would depend on the individual patient’s response to the initial treatment and progression of underlying conditions such as osteoarthritis.

What are the success rates of subchondroplasty?

Success rates vary, but studies generally report significant improvements in pain and function. Many patients experience relief from symptoms and improved quality of life following the procedure.

What alternatives are there to subchondroplasty?

Alternatives to subchondroplasty include conservative treatments like physical therapy and medications, as well as more invasive procedures like osteotomy or total knee replacement, depending on the severity of the condition.

What are bone marrow lesions?

Bone marrow lesions are areas within the bone that show up on an MRI as regions of increased fluid. They are often associated with pain and are indicative of changes in the bone that could lead to further joint deterioration.

How does subchondroplasty impact future knee surgeries?

Subchondroplasty does not typically affect the outcomes of future knee surgeries such as total knee replacement. It can serve as a bridge therapy, potentially delaying the need for more invasive surgeries

What type of anesthesia is used during subchondroplasty?

The procedure can be performed under local anesthesia, regional anesthesia, or general anesthesia, depending on the extent of the procedure and the patient’s needs.

How is subchondroplasty different from standard bone grafting?

Unlike traditional bone grafting, subchondroplasty specifically targets subchondral bone lesions using a minimally invasive approach and injects a flowable bone substitute rather than solid graft material.

What symptoms indicate the need for subchondroplasty?

Symptoms such as persistent knee pain, swelling, and decreased mobility, especially in patients with osteoarthritis and visible bone marrow lesions on MRI, may indicate the need for subchondroplasty.

Can subchondroplasty be performed on other joints besides the knee?

While it is most commonly performed on the knee, subchondroplasty can also be applied to other joints experiencing similar issues, such as the hip or ankle, though these applications are less common.

What is the long-term efficacy of subchondroply?

The long-term efficacy of subchondroplasty appears promising based on current research. Patients often report sustained improvement in pain and function, with effects lasting for several years. However, the long-term success also depends on the progression of the underlying joint condition, like osteoarthritis.

Does subchondroplasty prevent the need for knee replacement?

While subchondroplasty can delay the need for knee replacement by alleviating symptoms and stabilizing the joint, it does not cure the underlying osteoarthritis. For some patients, knee replacement may still be necessary in the future.

Are there age restrictions for undergoing subchondroplasty?

There are no strict age restrictions, but the procedure is typically recommended for middle-aged and older adults who suffer from bone marrow lesions due to osteoarthritis or other degenerative joint diseases.

What postoperative care is required after subchondroplasty?

Postoperative care typically involves pain management, gradual weight-bearing activities, and physical therapy to restore mobility and strengthen the joint.

How quickly can I return to normal activities after subchondroplasty?

Most patients are able to resume light activities within a few days and return to more normal levels of activity within several weeks, depending on the individual’s health status and the specifics of their procedure.

What are the signs of complications after subchondroplasty?

Signs of potential complications include excessive pain, swelling, redness, or drainage at the injection site, and fever. Any of these symptoms should prompt immediate consultation with a healthcare provider.

How does the injected bone substitute integrate with my own bone?

The calcium phosphate bone substitute gradually integrates with the surrounding bone tissue through a process called osteointegration, helping to restore the strength and structure of the subchondral bone.

Can subchondroplasty be done alongside other knee surgeries?

Yes, subchondroplasty can be performed in conjunction with other procedures such as arthroscopy to address additional joint issues like cartilage damage.

What is the success rate of subchondroplasty in younger patients?

While there is limited data specifically on younger patients, those without advanced degenerative changes tend to respond well to subchondroplasty, with good improvement in pain and function.

Is there a preferred season or time of year to undergo subchondroplasty?

There is no preferred season for undergoing subchondroplasty. The decision should be based on the patient’s clinical needs, lifestyle, and the advice of their orthopedic surgeon.

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.