Prospective Evaluation of Clinical Outcomes of the Subchondroplasty® Procedure for Treatment of Symptomatic Bone Marrow Lesions of the Knee.

IF 1.6 4区 医学 Q3 ORTHOPEDICS
Steven B Cohen, Christopher Hajnik, Gregory L Loren, Sam Akhavan, Patrick J DeMeo, Douglas J Wyland, Thomas Youm, Laith M Jazrawi, Robert J Daley, Jack Farr, Patrick Reischling, Jennifer Woodell-May
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引用次数: 0

Abstract

Introduction: Bone Marrow Lesions (BMLs) have a strong correlation to patient reported pain, functional limitations, joint deterioration, and rapid progression to total knee arthroplasty. The Subchondroplasty® (SCP) Procedure uses AccuFill®, a calcium phosphate bone substitute material (BSM), to treat bone defects such as microtrabecular fractures and BML.

Methods: This observational, prospective, multicenter, cohort study evaluated the effect of the SCP Procedure at two-year follow-up for 70 patients with knee BML. Under arthroscopic and fluoroscopic guidance, the BML was injected with AccuFill®. Patient reported outcomes, including Visual Analog Scale (VAS) pain, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and modified Knee Society Score (mKSS) were collected through 24 months postoperatively. Radiographs and magnetic resonance images (MRI) were performed at baseline and up to 24 months post-operatively. Patient selection was not limited based on degree of osteoarthritis (OA) as determined radiologically by Kellgren-Lawrence (K-L) grade. For a subset of subjects, patient reported outcomes were collected up to five years including pain evaluation, patient knee global assessment, and satisfaction with the procedure.

Results: Pre-operative radiographs indicated moderate to severe osteoarthritis (K-L grades 2-4) in 65 subjects (92.8%). Significant improvements (p<0.0001) in mean VAS Pain, IKDC, mKSS and KOOS scores were observed compared with baseline. Kaplan-Meier survivorship free from conversion to knee arthroplasty was 76.2% at two years. The subset of subjects followed for five years demonstrated low pain scores and high procedure satisfaction.

Conclusion: This study presents statistically significant and clinically meaningful evidence of improvement in clinical outcomes following SCP for BMLs of the knee after two years. The survivorship rate from arthroplasty at two years was 76.2%. SCP for BMLs can relieve pain with a minimally invasive procedure and may delay the need for knee arthroplasty.

前瞻性评估用于治疗膝关节症状性骨髓病变的 Subchondroplasty® 程序的临床疗效。
简介:骨髓病变(BMLs)与患者报告的疼痛、功能受限、关节退化以及迅速发展为全膝关节置换术密切相关。Subchondroplasty® (SCP) 手术使用磷酸钙骨替代材料(BSM)AccuFill® 治疗骨缺损,如微小兔骨骨折和骨髓病变:这项观察性、前瞻性、多中心、队列研究评估了 SCP 程序对 70 名膝关节 BML 患者两年随访的效果。在关节镜和透视引导下,BML 被注入 AccuFill®。在术后 24 个月内收集了患者报告的结果,包括视觉模拟量表 (VAS) 疼痛、膝关节损伤和骨关节炎结果评分 (KOOS)、国际膝关节文献委员会 (IKDC) 和改良膝关节社会评分 (mKSS)。在基线期和术后 24 个月内,对患者进行了射线照相和磁共振成像(MRI)检查。根据 Kellgren-Lawrence (K-L)分级放射学确定的骨关节炎(OA)程度,患者的选择不受限制。对部分受试者进行了长达五年的患者报告结果收集,包括疼痛评估、患者膝关节整体评估以及对手术的满意度:结果:65 名受试者(92.8%)的术前X光片显示患有中度至重度骨关节炎(K-L 2-4 级)。结果:65 名受试者(92.8%)的术前X光片显示有中度和重度骨关节炎(K-L 2-4 级):这项研究提供了具有统计学意义和临床意义的证据,证明SCP治疗膝关节BML两年后临床效果有所改善。关节置换术两年后的存活率为 76.2%。SCP治疗BML可通过微创手术缓解疼痛,并可推迟膝关节置换术的时间。
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来源期刊
CiteScore
4.50
自引率
5.90%
发文量
139
期刊介绍: The Journal of Knee Surgery covers a range of issues relating to the orthopaedic techniques of arthroscopy, arthroplasty, and reconstructive surgery of the knee joint. In addition to original peer-review articles, this periodical provides details on emerging surgical techniques, as well as reviews and special focus sections. Topics of interest include cruciate ligament repair and reconstruction, bone grafting, cartilage regeneration, and magnetic resonance imaging.
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