| Institution: | 1. Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, QC H3T 1J4, Canada;2. Polytechnique Montréal, 2500 Ch. de Polytechnique, Montréal, QC H3T 1J4, Canada;3. CHU Sainte-Justine, 3185 Chemin de la Côte Ste-Catherine, Montréal, QC H3T 1C5, Canada;4. Hôpital du Sacré-Cœur de Montréal (HSCM), Department of Orthopedic Surgery, 5400 boul. Gouin Ouest, Montreal, QC H4J 1C5, Canada;1. Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands;2. Department of Radiology, Martini Hospital, Groningen, The Netherlands;1. Universidade Estadual do Oeste do Paraná, Cascavel, Paraná, Brazil;2. Universidade Brasil, São Paolo, Brazil;1. Mersin University Medical School, Department of Physical and Rehabilitation Medicine, Mersin, Turkey;2. Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey;1. Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy;2. Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy;3. Engineering, Global Orthopaedics, Sydney, Australia;4. Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;5. Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA;1. Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil;2. Hospital Sírio Libanês, São Paulo, Brazil |
| Abstract: | BackgroundKnee osteoarthritis (KOA) is increasingly prevalent in North American society. The significant societal burden it represents makes it essential to promote and target new treatments in earlier phases of the disease. Among others, subchondroplasty is a newly documented technique using calcium phosphate injection targeting the osteochondral lesions preceding KOA, also known as Bone Marrow Lesions (BMLs). This article aimed to review the existing literature on clinical and radiological outcomes of subchondroplasty in the treatment of BMLs in KOA.MethodA systematic review was performed using PubMed, Embase, Medline and Cochrane Database of Systematic Reviews. Studies on calcium phosphate injections into BMLs for KOA and its clinical and radiological outcomes were screened and reviewed by independent evaluators.ResultsAfter screening, ten articles were included, totaling 540 patients. Follow-up ranged from 6 months to 7 years. Overall, the procedure showed significant functional and quality of life improvement, as well as pain relief, as shown by Patients-Reported Outcomes Measures (PROMs). There were very few complications reported, the most important being leakage of calcium phosphate outside the targeted site. Conversion rate to total knee arthroplasty (TKA) ranged from 14 % to 30 % at 2 years post-procedure. Long term radiological outcomes have been poorly documented.ConclusionsSubchondroplasty is a promising avenue for the treatment of KOA. However, quality evidence is still required before any real conclusions and practical management guidelines can be drawn. Prospective, randomized studies with a control group and a rigorous assessment of long-term clinical and radiological outcomes are recommended. |
