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Subchondroplasty© (SCP©) Procedure

Introduction

Your doctor has diagnosed you as having a chronic Bone Marrow Lesion (BML), an often-painful defect of the spongy cancellous bone near a joint. You have been recommended to be treated with the Subchondroplasty© (SCP©) procedure, a minimally-invasive surgery that fills the bony defect with AccuFill©, Bone Substitute Material (BSM), a unique calcium phosphate that mimics the properties of natural cancellous bone, and is resorbed and replaced with new bone. Let’s explore these topics to help you make an informed treatment decision...

What is a Bone Marrow Lesion?

Bone Marrow Lesion, or BML, is a term for a finding on an MRI that represents an abnormal area or defect inside the bone. These defects are often present in patients who have chronic (long-term) joint pain. Patients with BML have been shown to have:

  • More pain
  • Less function
  • Faster joint cartilage destruction, and
  • Reduced benefits from arthroscopy alone than patients without BML

BML are typically found in subchondral bone (shown here). They can only be seen on certain MRI sequences, where they appear as a hazy white area against the background of darker bone. Because white “signal” on MRI indicates fluid, radiologists often call the lesions bone marrow edema (BME). Pathologists have shown these defects to represent a healing response surrounding an insufficiency fracture of the subchondral bone. Lesions are more commonly found in the knee, hip, foot and ankle. However, BML can be found in any joint that sees weight-bearing or repetitive motion stress. BML are also often found adjacent to an area of worn joint cartilage.

What Causes a BML?

The causes of a BML defect are not specifically known. In some joints, particularly in the foot and ankle, some defects result from a bone injury that doesn’t heal properly, leading to persistent pain. In other cases, BML may be a stress reaction that forms from overuse of the joint, excessive loading of the joint, or poor joint mechanics.

  • Obesity and poor diet are thought to increase the likelihood of developing BML
  • BML are more commonly found in middle-aged patients than in younger patients
  • Patients with poor joint alignment are more likely to develop BML
  • Adults who quickly increase activity may develop BML

What is the Subchondroplasty© (SCP©) procedure?

The SCP© procedure is a minimally-invasive surgery that targets and fills bone defects associated with BML. The procedure is usually performed along with arthroscopy (“scoping”) of the affected joint, allowing your surgeon to visualize and treat lesions inside the joint that may also be causing pain. During the procedure, your surgeon will use fluoroscopy (intraoperative X-ray) to guide a small, drillable cannula to create a portal to the area of the bone defect. Your surgeon will then deliver AccuFill© BSM into the defect, where it sets hard to match the properties of the bone while the body heals the lesion.

What is AccuFill© BSM?

AccuFill© BSM is an engineered Calcium Phosphate mineral compound. It flows readily to fill the subchondral defect and hardens quickly once injected. AccuFill® BSM mimics the strength of normal cancellous bone and is resorbed and replaced with new bone during the healing process.

What can I Expect After Surgery?

Patients are typically treated in an outpatient setting, returning home the same day of the procedure. Postoperatively, your doctor will recommend a short recovery course, similar to that of arthroscopy.

It’s important to note that recovery from the SCP© procedure is different for every patient. However, the following is common for most patients:

  • For the first 48-72 hours after SCP®, patients will often experience significant pain in the operative area Your doctor will likely prescribe pain medication to treat these symptoms. Follow your doctor’s advice closely.
  • For the initial period, most doctors will recommend walking and standing with crutch support, to reduce load on the bone. The use of crutches is typically reduced as tolerated. Your doctor will also recommend a course of physical therapy and activities to help you regain strength and maintain mobility of your joint.
  • It is important to follow your doctor’s advice as you recover.

What are the Precautions and Risks for this Treatment?

The SCP© procedure is not recommended for patients with body mass index (BMI) >40 or patients with severe joint malalignment. All surgical procedures carry a certain level of risk. Only your health care team can determine if you are healthy enough for surgery. Consult your doctor for a complete assessment of possible risks before deciding to have surgery.

Are there Alternatives to SCP©?

A course of conservative treatment—to include pain medications, joint braces, crutches, physical therapy and/or injections into the joint—may allow the body to heal bone defects associated with BML, and is usually recommended before proceeding with any surgical procedure.

If the bone doesn't heal with conservative care your surgeon may recommend surgery, including SCP©. Current surgical alternatives to SCP© include:

  • Total or partial arthroplasty (e.g., knee replacement surgery)—a surgical removal and replacement of the surface of the opposing bones of the joint, to improve function and reduce pain.
  • Osteotomy—a surgical cutting of the bone and realignment of the joint, to restore proper distribution of joint forces.
  • Cadaveric bone grafting—damaged bone is removed through an incision and human cadaveric bone is placed in the defect, to improve function and reduce pain.

Will the SCP© Procedure Keep Me from Future Surgery?

Many patients delay or avoid progressing to more invasive procedures such as total joint replacement. However, results of any surgical procedure vary from patient to patient. Talk to your doctor to decide what is appropriate for you. Should it become necessary to proceed to total joint surgery, it is no harder to have a total joint replacement after SCP©.