Our ankle and knee joints are covered by articular cartilage, which is a smooth, white tissue covering the ends of bones where they come into contact with one another, to enable the bones to glide over each other with very little friction.
Subchondroplasty means ‘surgical repair below the cartilage’ and is a minimally invasive surgical procedure that can be done for painful bone marrow lesions beneath joint cartilages.
Bone marrow lesions (BMLs) are swelling and fluid collection (edema) in the bone marrow just below joint cartilages (subchondral region), that is detected on Magnetic Resonance Imaging (MRI). They reflect a healing response surrounding a microfracture within the subchondral bone. They are typically found in the knee or ankle joints. One of the commonest causes is osteoarthritis, or ‘wear and tear’ arthritis, which occurs with ageing and use. Other common causes of BMLs are trauma, insufficiency fractures and stress fractures.
BMLs can be a source of significant pain and functional impairment, and when left untreated, these microfractures in the subchondral bone may weaken the bone and cause fractures of the joint cartilage, collapse of the articular surfaces in the joint and progression of arthritis.
Your orthopaedic doctor will normally recommend conservative treatment options first such as resting the affected leg through use of joint braces and crutches. You will be prescribed analgesia to relieve the pain. Physiotherapy may also help by teaching you how to off-load weight from the affected leg. Some BMLs, especially those associated with bone impaction and bleeding caused by trauma, are reversible and resolve in approximately 2 to 4 months.
However, if there is persistent and worsening pain, a surgical procedure such as the minimally invasive subchondroplasty may be recommended.
Subchondroplasty is a minimally-invasive surgery that can help relieve pain arising from bone marrow lesions. The procedure targets subchondral bone defects by injecting Bone Substitute Material (BSM) into the area of bone edema via a special needle under fluoroscopic (X-ray) guidance.
BSM is an artificial mineral compound that hardens quickly when injected and mimics properties of cancellous bone. The goal is to improve the structural quality of the affected subchondral bone to prevent further bone collapse and progression of arthritis. As the bone heals, the BSM is absorbed and completely replaced by the new bone itself.
Subchondroplasty treatment is a minimally invasive procedure and the risk is relatively low.
The subchondroplasty treatment can be done under local or general anaesthesia, and post procedure pain is usually minimal.
Patients can be discharged on the same day after the procedure and allowed to ambulate. You may feel pain in the affected area for the first few days post-surgery, and analgesics will be prescribed. If you undergo concomitant meniscus or ligament repair at the same time, crutches and physiotherapy may also be prescribed to aid your recovery.
No, it is not. However, it is a bridging treatment option between conservative therapies and more invasive open surgeries such as partial and total joint replacement. By repairing the underlying damage, it may offer good relief from symptoms of pain and mobility limitation in the joint that can last weeks to months. The efficacy of the procedure varies from person to person, depending on the original condition of the joint. However, some patients may still end up requiring total joint replacement in the future.
Contact Precision Orthopaedics for a consultation to see if your joint symptoms are arising from BMLs, and if you may be a candidate for subchondroplasty treatment for joint pain relief.
Dr Seng Chusheng is a Consultant Orthopaedic Surgeon with specialised expertise in minimally invasive foot and ankle surgery, sports and reconstructive surgery, as well as treatment for orthopaedic trauma. Dr Seng holds an MBBS and MMed (Orthopaedic Surgery) from the National University of Singapore, and is a Fellow of the Royal College of Surgeons of Edinburgh, UK (Orthopaedic Surgery).
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