scholarly journals Ultrasound-Assisted Intraosseous Injection of Platelet-Rich Plasma for a Patient With Tibial Plateau Subchondral Bone Marrow Lesion: A Case Presentation and Technical Illustration

Cureus ◽  
2020 ◽  
Author(s):  
King Hei Stanley Lam ◽  
Chen-Yu Hung ◽  
Andy Hung
Keyword(s):  
Bone Marrow ◽  
Subchondral Bone ◽  
Tibial Plateau ◽  
Platelet Rich Plasma ◽  
Bone Marrow Lesion ◽  
Case Presentation ◽  
Intraosseous Injection ◽  
Ultrasound Assisted ◽  
Technical Illustration

Preoperative Tibial Subchondral Bone Marrow Lesion Patterns and Associations With Outcomes After Isolated Meniscus Allograft Transplantation

2018 ◽  
Vol 46 (5) ◽  
pp. 1175-1184 ◽  
Author(s):  
Bryan M. Saltzman ◽  
Eric J. Cotter ◽  
Jeffrey P. Stephens ◽  
Gregory L. Cvetanovich ◽  
Brett Madden ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Subchondral Bone ◽  
Negative Correlation ◽  
Rating Scale ◽  
Bone Marrow Lesion ◽  
Womac Pain ◽  
Meniscus Allograft Transplantation ◽  
Meniscus Allograft ◽  
Mri Scans ◽  
Activity Rating

Background: The association between preoperative tibial subchondral bone marrow lesion (BML) patterns and outcomes after isolated meniscus allograft transplantation (MAT) are unknown. Purpose: To determine (1) if a superior classification means exists (ie, high interrater reliability [IRR]) for grading tibial subchondral BML before isolated MAT and (2) whether quality and/or severity of preoperative tibial subchondral BML patterns was associated with clinical outcomes and/or failure rates after isolated MAT. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who underwent isolated MAT with a single surgeon between October 2006 and February 2017 were identified. Three means were evaluated to quantify the degree of subchondral BML in the affected tibial-sided compartment: Welsch et al, based on maximum diameter of the lesion; Costa-Paz et al, based on appearance and location of the lesion; and Filardo et al, based on severity of findings. IRR was generated and compared among the 3 classifications. The preoperative magnetic resonance imaging (MRI) subchondral BML grading scheme with the highest IRR was then used to assess for associations with postoperative outcomes for those patients with >2-year follow-up, per a Spearman correlation matrix with each reviewer’s grades. Results: In total, 60 MRI scans were available for subchondral BML grading. Grader 1 identified the presence of subchondral BML in the tibia of the affected compartment in 40 (66.7%) of the available MRI scans, as compared with 38 (63.3%) for grader 2. The calculated IRRs with the Welsch et al and Costa-Paz et al classifications were rated “strong/almost perfect” agreement. A significant correlation was demonstrated between grader 1 with the Welsch et al grading scheme and outcome measures of KOOS pain (Knee injury and Osteoarthritis Outcome Score; negative correlation, P = .05), WOMAC pain (Western Ontario and McMaster Universities Osteoarthritis Index; positive correlation, P = .026), and Marx Activity Rating Scale (negative correlation, P = .019). A significant correlation was demonstrated between grader 2 with the Costa-Paz et al grading scheme and postoperative satisfaction (positive correlation, P = .018). There were no significant differences in survivorship based on gradings. Conclusion: Nearly two-thirds of patients who undergo isolated MAT have subchondral BML on preoperative MRI. Our findings suggest that increasing BML size (Welsch et al) is correlated with worse postoperative pain measures (KOOS pain, WOMAC pain) and worse activity ratings (Marx Activity Rating Scale). Additionally, increasing disruption or depression of the normal contour of the cortical surface, with or without lesion contiguity with the subjacent articular surface (Costa-Paz et al), is correlated with greater postoperative satisfaction.

scholarly journals The Treatment of Bone Marrow Lesions Associated with Advanced Knee Osteoarthritis: Comparing Intraosseous and Intraarticular Injections with Bone Marrow Concentrate and Platelet Products

2021 ◽  
pp. E279-E288
Author(s):  
Ehren Dodson
Keyword(s):  
Bone Marrow ◽  
Knee Osteoarthritis ◽  
Patient Reported Outcomes ◽  
Platelet Rich Plasma ◽  
Intraarticular Injection ◽  
Bone Marrow Concentrate ◽  
Bone Marrow Lesions ◽  
Treatment Groups ◽  
Patient Reported ◽  
Intraosseous Injection

Background: Bone marrow lesions are a radiographic indication of bony pathology closely associated with advanced osteoarthritis of the adjacent joint. Injection of autologous orthobiologic products, including bone marrow concentrate and platelet-rich plasma, have demonstrated safety and efficacy in treating both advanced osteoarthritis (via intraarticular injection) and associated bone marrow lesions (via intraosseous injection). The relative efficacy of intraarticular versus intraosseous injection of orthobiologics has not been evaluated at the present time. Objectives: The objective was to evaluate differences in orthobiologic bone marrow lesions treatment, either as a collateral result of intraarticular injection with bone marrow concentrate and platelet products alone, or intraosseous plus intraarticular injection as measured by patient reported outcomes. Study Design: This study employed a prospective case-matched cohort design. Setting: This study took place at a single outpatient interventional orthopedic pain clinic. Methods: Using data from a prospective orthobiologic treatment registry of knee patients, a population of knee osteoarthritis with bone marrow lesions patients who had undergone only intraarticular knee injections of bone marrow concentrate and platelets (for symptomatic advanced osteoarthritis) were age, gender, and disease severity case-matched to a series of advanced osteoarthritis and bone marrow lesions patients who underwent intraosseous plus intraarticular injections. Self-reported patient outcomes for Numeric Pain Scale, International Knee Documentation Committee, lower extremity functional scale, and a modified single assessment numeric evaluation were compared between the 2 treatment groups. Results: Eighty patients were included, 40 in each group. Although pain and functional outcome scores were significantly improved in both treatment groups, there was no statistically significant differences in patient reported outcomes based on the type of treatment. Limitations: There are several limitations to this study, including multiple providers performing the injections, varying onset of symptoms to treatment, and additional injections after their initial treatment, that were not controlled. In addition, increasing the sample size may be beneficial as well, particularly with the large bone marrow lesions group, which did suggest possible improvement with intraosseous plus intraarticular over the intraarticular, although was not statistically significant in our sample. Limited data availability for this cohort as well as some missing data are other limitations to consider. Conclusion: Treating knee bone marrow lesions with intraosseous bone marrow concentrate and platelet products did not affect patient reported outcomes. Key words: Intraosseous, intraarticular, bone marrow concentrate, bone marrow lesion, bone marrow edema, knee osteoarthritis, platelet-rich plasma, injection

scholarly journals Intraosseous Injection of Autologous Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma for Treatment of Knee Osteoarthritis

2021 ◽  
Vol 27 (4) ◽  
pp. 69-81
Author(s):  
Dmitriy A. Malanin ◽  
Vladimir D. Sikilinda ◽  
Andrei I. Gorbatenko ◽  
Maxim V. Demeshchenko ◽  
Il’ya A. Suchilin ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspirate ◽  
Rating Scale ◽  
Platelet Rich Plasma ◽  
Autologous Bone Marrow ◽  
Bone Marrow Aspirate Concentrate ◽  
Knee Oa ◽  
Intraosseous Injection ◽  
Autologous Bone

The aim of the study was to determine the effectiveness of autologous bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) intraosseous injection in the treatment of patients with knee OA stages II-III. Materials and Methods. The multicenter randomized study involved 40 patients (27 women, 13 men, average age 67.07.8 years, BMI 32.74.8, duration of disease 17.33.7 months) with knee OA of stages II-III according to the Kellgren-Lawrence (K-L) classification. Patients of the main (BMAC group) group (n = 19) underwent a single intraosseous injection of BMAC, in the comparison group (n = 21) a PRP injection (PRP group). The results were evaluated after 1, 3, 6, 12 months with the verbal rating scale (VRS), VAS, Leken and WOMAC scales. Results. Comparison of the results in the groups on the VRS showed that at an earlier time (3 and 6 months), the preferences of patients were in favor of the treatment of BMAC (65% and 55% positive reviews) before PRP (55% and 45% positive reviews), whereas after 12 months the differences were insignificant. Analysis of VAS indicators in patients of both groups indicated a more pronounced decrease in the severity of pain syndrome after BMAC intraosseous injection. The analysis of the Leken scale indicators showed in favor of BMAC throughout the entire observation period, the differences were most pronounced in the first 3 months of observation. The ratio of the values of the WOMAC index in both patients groups indicated statistically significant differences that persisted in all periods of follow-up, the increase in indicators occurred to a lesser extent after the introduction of BMAC compared with PRP. Conclusion. A single intraosseous BMAC injection has an advantage over a similar PRP injection in terms of pain, knee function and physical activity of patients at all follow-up periods. Both methods of treatment are equally safe.

scholarly journals INTRA ARTICULAR PLATELET RICH PLASMA'S FUNCTIONAL OUTCOME IN EARLY KNEE OSTEOARTHRITIS

2021 ◽  
Vol 10 (4) ◽  
pp. 3262-3265
Author(s):  
Saurabh Ponde
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Knee Osteoarthritis ◽  
Subchondral Bone ◽  
Marrow Transplantation ◽  
Structural Changes ◽  
Platelet Rich Plasma ◽  
Low Grade ◽  
Synovial Joint ◽  
Pre Treatment

Knee osteoarthritis (KOA) is a low-grade, functional inflammatory disease that causes functional impairment and dysfunction. Obesity and age are two of the main risk factors, with costs ranging from 1.0% to 2.5% of gross domestic product. KOA was previously thought to be an autoimmune disease; however, the growing body of data shows that two well-connected parts of the synovial joint, the subchondral bone (SB) and the synovial membrane (SM), are directly involved in the degeneration of articular cartilage (AC). Intra-articular delivery is the most common way to get platelet-rich plasma (PRP) into AC, SM, and synovial fluid (SF), and has been shown to be safe and effective in reducing pain and increasing joint function in patients with mild KOA. SB, on the other hand, deals with structural changes in people with severe KOA, including gradual subchondral bone marrow transplantation by fibro neurovascular mesenchyme tissue, bone marrow transplantation, bone marrow lesions (BMLs), osteophytes, sclerosis, and stiffness of SB. Intrusion into PRP is not enough to reach SB in this situation, reducing its effectiveness. This is an upcoming study that followed 50 knees for about six months. At one-month intervals, two intra-articular injections were given. Outcome was measured using the WOMAC and Visual Analogue Scale (VAS) before and after the second injection, and at 1, 3 and 6 months following the second injection. All scores improved significantly over time compared to pre-treatment rates (p 0.001). The baseline VAS score was 7.62, which decreased significantly to 3.56 at the end of the study (pain reduction by 48 percent). PRP injections in the knees help to treat osteoarthritis of grade I and II. The results of the study showed a significant decrease in symptoms in people aged 40 to 60 years.

scholarly journals Evaluation and Management of Osteochondral Lesions of the Talus

Cartilage ◽  
2016 ◽  
Vol 8 (1) ◽  
pp. 19-30 ◽  
Author(s):  
Christopher A. Looze ◽  
Jason Capo ◽  
Michael K. Ryan ◽  
John P. Begly ◽  
Cary Chapman ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Subchondral Bone ◽  
Hyaline Cartilage ◽  
Platelet Rich Plasma ◽  
Pediatric Population ◽  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Ankle Sprains ◽  
Bone Marrow Stimulation ◽  
Chondrocyte Implantation

Osteochondral lesions of the talus are common injuries that affect a wide variety of active patients. The majority of these lesions are associated with ankle sprains and fractures though several nontraumatic etiologies have also been recognized. Patients normally present with a history of prior ankle injury and/or instability. In addition to standard ankle radiographs, magnetic resonance imaging and computed tomography are used to characterize the extent of the lesion and involvement of the subchondral bone. Symptomatic nondisplaced lesions can often be treated conservatively within the pediatric population though this treatment is less successful in adults. Bone marrow stimulation techniques such as microfracture have yielded favorable results for the treatment of small (<15 mm) lesions. Osteochondral autograft can be harvested most commonly from the ipsilateral knee and carries the benefit of repairing defects with native hyaline cartilage. Osteochondral allograft transplant is reserved for large cystic lesions that lack subchondral bone integrity. Cell-based repair techniques such as autologous chondrocyte implantation and matrix-associated chondrocyte implantation have been increasingly used in an attempt to repair the lesion with hyaline cartilage though these techniques require adequate subchondral bone. Biological agents such as platelet-rich plasma and bone marrow aspirate have been more recently studied as an adjunct to operative treatment but their use remains theoretical. The present article reviews the current concepts in the evaluation and management of osteochondral lesions of the talus, with a focus on the available surgical treatment options.

Ultrapurified Alginate Gel Containing Bone Marrow Aspirate Concentrate Enhances Cartilage and Bone Regeneration on Osteochondral Defects in a Rabbit Model

2021 ◽  
pp. 036354652110141
Author(s):  
Liang Xu ◽  
Atsushi Urita ◽  
Tomohiro Onodera ◽  
Ryosuke Hishimura ◽  
Takayuki Nonoyama ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Bone Marrow ◽  
Cell Transplantation ◽  
Cartilage Repair ◽  
Subchondral Bone ◽  
Bone Repair ◽  
Bone Marrow Aspirate ◽  
Defect Group ◽  
The Other ◽  
Osteochondral Defects

Background: Ultrapurified alginate (UPAL) gel implantation has been demonstrated as effective in cartilage repair for osteochondral defects; however, cell transplantation within UPAL gels would be required to treat larger defects. Hypothesis: The combination of UPAL gel and bone marrow aspirate concentrate (BMAC) would enhance cartilage repair and subchondral bone repair for large osteochondral defects. Study Design: Controlled laboratory study. Methods: A total of 104 osteochondral defects (1 defect per knee) of 52 rabbits were randomly divided into 4 groups (26 defects per group): defects without any treatment (Defect group), defects treated using UPAL gel alone (UPAL group), defects treated using UPAL gel containing allogenic bone marrow mesenchymal stromal cells (UPAL-MSC group), and defects treated using UPAL gel containing BMAC (UPAL-BMAC group). At 4 and 16 weeks postoperatively, macroscopic and histologic evaluations and measurements of repaired subchondral bone volumes of reparative tissues were performed. Collagen orientation and mechanical properties of the reparative tissue were assessed at 16 weeks. Results: The defects in the UPAL-BMAC group were repaired with hyaline-like cartilage with well-organized collagen structures. The histologic scores at 4 weeks were significantly higher in the UPAL-BMAC group (16.9 ± 2.0) than in the Defect group (4.7 ± 1.9; P < .05), the UPAL group (10.0 ± 3.3; P < .05), and the UPAL-MSC group (12.2 ± 2.9; P < .05). At 16 weeks, the score in the UPAL-BMAC group (24.4 ± 1.7) was significantly higher than those in the Defect group (9.0 ± 3.7; P < .05), the UPAL group (14.2 ± 3.9; P < .05), and the UPAL-MSC group (16.3 ± 3.6; P < .05). At 4 and 16 weeks, the macroscopic evaluations were significantly superior in the UPAL-BMAC group compared with the other groups, and the values of repaired subchondral bone volumes in the UPAL-BMAC group were significantly higher than those in the Defect and UPAL groups. The mechanical properties of the reparative tissues were significantly better in the UPAL-BMAC group than in the other groups. Conclusion: The implantation of UPAL gel containing BMAC-enhanced hyaline-like cartilage repair and subchondral bone repair of osteochondral defects in a rabbit knee model. Clinical Relevance: These data support the potential clinical application of 1-step treatment for large osteochondral defects using biomaterial implantation with cell transplantation.

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