Subchondral Bone Augmentation for Treatment of Bone Marrow Lesions

Bone marrow lesions (BMLs) are areas of medullary fat necrosis, fibrosis, trabecular microfracture, and poor mineralization. Delayed or incomplete treatment of these lesions can result in subchondral bone impaction, collapse, and joint surface violation. They are correlated with worsening knee pain, decreased function, cartilage loss, and a nine times increased risk of required total knee arthroplasty in the future. The osteochondral unit consists of deeper cancellous bone followed by more superficial subchondral bone. Non-operative treatment centers around a period of rest in addition to oral nonsteroidal anti-inflammatory drugs (NSAIDs), braces, medical management, and physical therapy. Operative management is based on the “regenerative tissue engineering triad” that stimulates cell regeneration and functionality, growth factors and cytokines, and scaffolds to help support a regenerative environment. Intraosseous bioplasty and subchondroplasty are two commonly used subchondral bone augmentation procedures used in the treatment of bone marrow lesions. While intraosseous bioplasty (IOBP) has been utilized to treat BMLs in isolation and subchondroplasty for BMLs in the setting of osteoarthritis, both do have promising results when used in the right patient.