Subchondroplasty:
Knee repair, not knee replacement

Watch the video of Dr. Marc Pietropaoli discussing the Subchondroplasty knee repair procedure during a segment on Bridge Street (Channel 9 WSYR).

Knee Repair vs. Knee Replacement:

Unlike traditional “knee replacement surgery” in which the diseased or damaged knee joint is removed and replaced with an artificial one, subchondroplasty, which literally means ‘surgical repair below the cartilage’, is a minimally invasive procedure that may actually delay or prevent the progression of knee osteoarthritis itself, by treating underlying causes of osteoarthritis knee pain and mobility limitations.

A recent study performed by the Center for Disease Control in Atlanta estimates that the lifetime risk of developing painful knee osteoarthritis is 45%.  Many patients who anticipate many more years of their active lifestyle, are looking for alternatives to invasive full knee re-placement surgery, and the lengthy recovery process in addition to some lifetime activity limitations (no running/jumping for example) that accompanies it.  Subchondroplasty offers just such an option.

“…there are those who suffer from chronic knee pain who are “too young” to be candidates for a knee replacement…”

Dr. Pietropaoli performs knee replacements, but also states, “While knee replacement is usually a highly successful procedure that can greatly increase a patient’s mobility and bring significant reduction in pain, there are those who suffer from chronic knee pain who are “too young” to be candidates for a knee replacement, or whose degenerative changes and arthritis do not yet warrant the full invasive procedure. This gives us an alternative to reduce pain and increase mobility by repairing the underlying damage, rather than replacing body parts with artificial components of metal and plastic.”

What is a Bone Marrow Lesion?

Subchondral bone defects are often referred to as Bone marrow lesions (sometimes called Bone Marrow Edema, or BME), which are are small defects typically found in subchondral bone, the region below the cortical bone near a joint. They can only be seen on certain MRI sequences, appearing as a hazy white area against the background of darker bone.

These microfractures cause the bone to become weaker and less able to support the cartilage. Dr. Pietropaoli likens it to the weakening/washing away of the soil and substructure under an asphalt highway. If the soil begins to erode or wash away, the overlying asphalt weakens and starts to break down resulting in a “pot hole”, although the damage to the substructure is not visible. In his analogy, repairing the microfractures in the bone marrow is like strengthening and repairing the road substructure, preventing pot holes from happening, thus solidifying and stabilizing the highway, i.e. slowing down the progression of arthritis.  “Early detection of these microfractures can show that a patient has a higher potential for subsequent cartilage damage,” Dr. Pietropaoli noted, “and if we treat them with the subchondroplasty procedure, we can often prevent further osteoarthritic damage.”

Knee Pain & Osteoarthritis:

Very often, the cause of knee pain is osteoarthritis: the most common of the more than 100 types of arthritis, and aptly named degenerative arthritis, since it’s a ‘wear-and-tear condition’ that occurs as the joints degenerate with use and age. Traditionally, osteoarthritis of the knee is diagnosed by assessing pain levels, the presence of swelling or tenderness, range of motion, muscle strength, and an evaluation of how you walk. X-rays of the affected joints will have a characteristic appearance in which the ends of the bones appear closer to each other, due to the joint space narrowing as cartilage wears away.

In addition, cysts or fluid-filled cavities may be visible in the bone as the body responds to cartilage destruction. Increased bone density or uneven joints may be observed since, when bones are no longer cushioned by cartilage, they can rub against one another with more pressure, creating friction and pain. The body responds to this pressured increased force by laying down more bone, and increasing bone density, which creates uneven joint surfaces and osteophytes (‘bone spurs’) around the joint margins.

What is AccuFill® BSM?

AccuFill® BSM is an engineered calcium phosphate mineral compound. It flows readily to fill the subchondral bone defect and hardens quickly into a bioinductive implant once injected. AccuFill® BSM mimics the properties of cancellous bone and is replaced with new bone during the healing process.

Advantages of Treating BML’s with Subchondroplasty®

The SCP® Procedure is a minimally-invasive surgery that targets and fills chronic subchondral bone defects often referred to as Bone Marrow Lesions (BML). The procedure is usually performed along with arthroscopy (“scoping”) of the nearby joint, allowing the surgeon to visualize and treat findings inside the joint. Benefits include:

  • Minimally Invasive (OUTPATIENT-SAME DAY SURGERY) procedure– Does not limit future care options, Preserves natural joint, Bone substitute is remodeled into new bone while healing
  • Recovery Time:  Most patients are back to work in 2-8 weeks
  • Proven Results:  Pain relief & increased function as early as 2 weeks;  shown to last up to 8-9 years so far
  • Only Treatment Option that Specifically Treats Defects Associated with BML’s (not a “perfect” treatment, but gives us  a “bridge” treatment for “in between” patients who were not going to be helped by arthroscopy alone, but too early for joint replacement.)

What can Patients Expect After Surgery?

John Turose, of Sennett, New York, was the first patient in the Rochester-Syracuse area to undergo the subchondroplasty procedure, which was done on an outpatient basis at the Camillus Surgery Center in June of 2014 performed by Dr. Pietropaoli. When interviewed at just three months post-surgery, Turose said he feels better than he has in years. He’s committed to his physical therapy workouts – which include squats and repetitive step-up exercises –and grateful that he can sleep at night without constant pain. “It’s not just my left knee that feels better– it’s my whole body. I may have an occasional little ache once in a while, but nothing like before.”  John continues to do very well almost four years after the surgery.

 

Dr. Pietropaoli notes that many early recipients of the procedure are still doing well five to eight years later. He also commented “One of the biggest assets of this procedure is that it allows us to proactively treat osteoarthritis, to prevent or delay its progression, and to repair affected joints rather than replacing them with artificial materials.”

Am I a Potential Candidate for SCP®?

Patients may suffer from chronic BML if they meet all/some of the following criteria:

  • Symptomatic pain for 3+ months
  • Chronic, aching pain; increased pain with weight-bearing; gradual onset & worsening of pain; &/or localized, intense pain
  • Failed trial of conservative, non-operative care
  • Physical therapy, NSAIDs, bracing, cortisone / HA injections
  • Cartilage loss, deterioration, or focal lesions
  • Possible history of Osteoarthritis or suspected Avascular Necrosis
  • Symptoms inconsistent with X-Ray findings
  • Disproportionate pain despite intact joint space

The Subchondroplasty Process In Summary

Featured Interview in New York Physician Magazine

Read the featured interview with Marc P. Pietropaoli, MD and learn how the subchondroplasty procedure can benefit people with knee pain.

Watch the video of Dr. Marc Pietropaoli discussing the Subchondroplasty knee repair procedure.

Watch the video of Dr. Marc Pietropaoli discussing the Subchondroplasty knee repair procedure during a Q&A segment on Bridge Street (Channel 9 WSYR).

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