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Subchondral Bone Augmentation for Treatment of Bone Marrow Lesions

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Knee Arthroscopy and Knee Preservation Surgery

Abstract

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.

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Authors and Affiliations

  1. Cedars Sinai-Kerlan Jobe Institute, Santa Monica, CA, USA

    Ajith Malige & Bert R. Mandelbaum

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  1. Ajith Malige
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  2. Bert R. Mandelbaum
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Editor information

Editors and Affiliations

  1. Sports Medicine Clinic, Stanford University, Redwood City, CA, USA

    Seth L. Sherman

  2. Orthopaedics, Midwest Orthopaedics at Rush, Chicago, IL, USA

    Jorge Chahla

  3. Complex Knee and Sports Medicine Surgeon, Twin Cities Orthopedics, Edina, MN, USA

    Robert F. LaPrade

  4. Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA

    Scott A. Rodeo

Section Editor information

  1. No affiliation provided

    Andreas Gomoll

  2. No affiliation provided

    Saris Daniel

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Malige, A., Mandelbaum, B.R. (2024). Subchondral Bone Augmentation for Treatment of Bone Marrow Lesions. In: Sherman, S.L., Chahla, J., LaPrade, R.F., Rodeo, S.A. (eds) Knee Arthroscopy and Knee Preservation Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-29430-3_57

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  • DOI: https://doi.org/10.1007/978-3-031-29430-3_57

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