Dataset Information

Hitting the Mark: Optimizing the Use of Calcium Phosphate Injections for the Treatment of Bone Marrow Lesions of the Proximal Tibia and Distal Femur.

ABSTRACT: Increased contact pressures of the osteoarthritic joint can lead to underlying osseous injury, with resultant marrow edema changes of the subchondral bone. These osteoarthritis-related bone marrow lesions can subsequently lead to persistent pain and further disability. Limited joint preservation treatment options exist to alleviate symptoms or potentially alter the natural history of the affected joint; however, recent success with injectable calcium phosphate has provided early pain relief and may provide a scaffold for endogenous repair mechanisms. In this Technical Note, a comprehensive surgical approach using injectable calcium phosphate to target bone marrow lesions of the proximal tibia and distal femur is presented. Critical technique considerations include the use of magnetic resonance and fluoroscopic imaging to target the area of the subchondral bone while refraining from overfilling and/or forced pressurization during delivery and the use of postinjection arthroscopy to prevent potential injurious sequelae.

SUBMITTER: Rebolledo BJ

PROVIDER: S-EPMC6203229 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Hitting the Mark: Optimizing the Use of Calcium Phosphate Injections for the Treatment of Bone Marrow Lesions of the Proximal Tibia and Distal Femur.

Rebolledo Brian J BJ Smith Kevin M KM Dragoo Jason L JL

Arthroscopy techniques 20180910 10

Increased contact pressures of the osteoarthritic joint can lead to underlying osseous injury, with resultant marrow edema changes of the subchondral bone. These osteoarthritis-related bone marrow lesions can subsequently lead to persistent pain and further disability. Limited joint preservation treatment options exist to alleviate symptoms or potentially alter the natural history of the affected joint; however, recent success with injectable calcium phosphate has provided early pain relief and ...[more]

PMID: 30377580

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Project description:Computed tomography and finite element modeling were used to assess bone structure at the knee as a function of time after spinal cord injury. Analyzed regions experienced degradation in stiffness, mineral density, and content. Changes were well described as an exponential decay over time, reaching a steady state 3.5 years after injury. INTRODUCTION:Spinal cord injury (SCI) is associated with bone fragility and an increased risk of fracture around the knee. The purpose of this study was to investigate bone stiffness and mineral content at the distal femur and proximal tibia, using finite element (FE) and computed tomography (CT) measures. A cross-sectional design was used to compare differences between non-ambulatory individuals with SCI as a function of time after injury (0-50 years). METHODS:CT scans of the knee were obtained from 101 individuals who experienced an SCI 30 days to 50 years prior to participation. Subject-specific FE models were used to estimate stiffness under axial compression and torsional loading, and CT data was analyzed to assess volumetric bone mineral density (vBMD) and bone mineral content (BMC) for integral, cortical, and trabecular compartments of the epiphyseal, metaphyseal, and diaphyseal regions of the distal femur and proximal tibia. RESULTS:Bone degradation was well described as an exponential decay over time (R2?=?0.33-0.83), reaching steady-state levels within 3.6 years of SCI. Individuals at a steady state had 40 to 85% lower FE-derived bone stiffness and robust decreases in CT mineral measures, compared to individuals who were recently injured (t???47 days). Temporal and spatial patterns of bone loss were similar between the distal femur and proximal tibia. CONCLUSIONS:After SCI, individuals experienced rapid and profound reductions in bone stiffness and bone mineral at the knee. FE models predicted similar reductions to axial and torsional stiffness, suggesting that both failure modes may be clinically relevant. Importantly, CT-derived measures of bone mineral alone underpredicted the impacts of SCI, compared to FE-derived measures of stiffness. TRIAL REGISTRATION:ClinicalTrials.gov (NCT01225055, NCT02325414).

Dataset Information

Hitting the Mark: Optimizing the Use of Calcium Phosphate Injections for the Treatment of Bone Marrow Lesions of the Proximal Tibia and Distal Femur.

Publications

Hitting the Mark: Optimizing the Use of Calcium Phosphate Injections for the Treatment of Bone Marrow Lesions of the Proximal Tibia and Distal Femur.

Similar Datasets

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