Subchondral bone lesion staging aids in treatment decisions
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NASHVILLE, Tenn. — Subchondral bone lesions can usually be managed nonoperatively. However, once collapse occurs, biologic options or knee replacement should be considered, a presenter said.
At the Biologic Association Annual Summit, held during the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America Combined Meeting, Jorge Chahla, MD, PhD, presented a treatment algorithm for subchondral bone lesions and said staging the treatment of these lesions is critical.
Surgeons should look at all factors, such as knee alignment, mechanics and any ligamentous deficiencies, when determining which treatment approach is appropriate, he said.
“The joint is like an organ” and surgeons should treat it as an organ, Chahla said.
Unloading the knee joint that has a subchondral bone lesion with a brace that unloads the medial or lateral compartment or allowing protected weight-bearing can be effective for knees with lesions that are in a pre-collapse state, according to Chahla.
“Most of the pre-collapse ones, or when we have a small lesion, will be treated nonsurgically. Any subset of those have resolution of symptoms within 6 to 12 weeks if we unload the joint,” he said.
Additional approaches at this stage include bisphosphonates, calcium and vitamin D, according to Chahla.
Patients with excessive osteoarthritis and/or malalignment, as well as subchondral bone lesions, may benefit most from total knee replacement or unicompartmental knee replacement. The status of the knee cartilage and any damage to it also affects the decision-making regarding treatment, he said.
For cases of collapse, where there is no cartilage damage, patients may benefit from and have pain relief with core decompression and biologic treatment, according to Chahla. However, treatment options for collapse in the setting of small and large amounts of cartilage include microfracture and osteochondral allograft transplantation, or osteochondral allograft or UKR, respectively.
“Always start with nonsurgical treatment,” he said.
Collapse
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