Removal of damaged tissue beneath the cartilage.
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Subchondroplasty Knee Orthopaedics
Subchondroplasty is a procedure that involves removing damaged subchondral bone tissue beneath the articular cartilage. This can help relieve pain and improve knee function in some cases of arthritis.
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Introduction
The knee joint consists of bone, cartilage, ligaments, and tendons. When the articular cartilage wears out due to aging, the bones rub together, causing pain. This is called osteoarthritis. Problems like osteoarthritis can lead to bone marrow lesions (BMLs), which are areas of chronic inflammation and swelling just below the bone surface.
Subchondroplasty is a minimally invasive procedure to repair these chronic BMLs by filling them with a bone substitute material. This material is then slowly replaced with healthy bone.
Indications and Contraindications
Subchondroplasty is for patients whose primary source of knee pain is bone marrow lesions that have not healed with conservative treatments like pain medication or physical therapy. This procedure is not recommended for patients with a BMI over 40 or those with severe knee misalignment.
Symptoms
Symptoms of bone marrow lesions include long-lasting knee pain, joint stiffness, discomfort when standing or walking, and faster cartilage destruction. BMLs can be seen on an MRI but not on an X-ray.
Surgical Procedure and Post-operative Care
The procedure is performed under general anesthesia with the guidance of real-time X-ray images (fluoroscopy) to accurately target the lesions. A pin is inserted into the bone, followed by a cannula, and a bone substitute material is injected. The incisions are then closed. After surgery, patients may experience some pain for a day or two. Recovery guidelines include keeping the incision clean and dry, using crutches for 1-2 weeks, and starting physical therapy. Patients should call their doctor if they experience a high fever, redness, swelling, or intolerable pain.
Advantages
Subchondroplasty is minimally invasive, allows patients to go home the same day, and provides a quick recovery. It also does not prevent other future treatment options for the knee.