Assessment of the injection behavior of commercially available bone BSMs for Subchondroplasty® procedures

Colon, Dinely; Yoon, Byung Jo Victor; Russell, Thomas A.; Cammisa, Frank P.; Abjornson, Celeste

doi:10.1016/j.knee.2015.06.017

Cited by 26 publications

(31 citation statements)

References 15 publications

(20 reference statements)

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“…Subchondroplasty (SCP) was recently investigated for the treatment of subchondral bone defects of the knee. 2,3,[28][29][30] The SCP technique uses the synthetic bone substitute calcium phosphate to target and fill BMLs of the knee. Previous reports in the literature have demonstrated the feasibility of the technique to reduce pain and improve function, with a small risk of complications.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes for the Biologic Treatment of Bone Marrow Edema of the Knee Using Bone Marrow Aspirate Concentrate and Injectable Demineralized Bone Matrix

Kasik

Martinkovich

Mosier

et al. 2019

Arthroscopy, Sports Medicine, and Rehabilitation

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Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes for the Biologic Treatment of Bone Marrow Edema of the Knee Using Bone Marrow Aspirate Concentrate and Injectable Demineralized Bone Matrix

Kasik

Martinkovich

Mosier

et al. 2019

Arthroscopy, Sports Medicine, and Rehabilitation

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“…As highlighted above, different types of calcium phosphate have been described for injection of painful BML. It has been demonstrated that different types of commercially available calcium phosphate used as bone substitute material have considerable variation in their in vitro injectability and biomechanical properties [19]. Using synthetic (polyurethane foam sheets) and cadaveric cancellous bone blocks, Colon et al [19] noted that only AccuFill® (Zimmer, Inc.) and StrucSure™ CP (Smith and Nephew) were able to flow into a closed structure such as cancellous bone.…”

Section: Bone Substitute Materials -Nanocrystalline Calcium Phosphatementioning

confidence: 99%

“…It has been demonstrated that different types of commercially available calcium phosphate used as bone substitute material have considerable variation in their in vitro injectability and biomechanical properties [19]. Using synthetic (polyurethane foam sheets) and cadaveric cancellous bone blocks, Colon et al [19] noted that only AccuFill® (Zimmer, Inc.) and StrucSure™ CP (Smith and Nephew) were able to flow into a closed structure such as cancellous bone. Furthermore, they observed that amongst the eight bone substitute materials tested, AccuFill® had the lowest injection force and achieved desired fill of the void.…”

Section: Bone Substitute Materials -Nanocrystalline Calcium Phosphatementioning

confidence: 99%

“…Furthermore, some authors have reported unsatisfactory clinical results questioning the efficacy of this procedure in advanced osteoarthritis of the knee [17], femoral BML and lesions with mild bone marrow oedema [18]. It has been reported that there is considerable variation in the biomechanical properties of the commercially available calcium phosphate used as injectable bone substitute material during this procedure [19].…”

Section: Introductionmentioning

confidence: 99%

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Calcium phosphate injection of symptomatic bone marrow lesions of the knee: what is the current clinical evidence?

Angadi

Edwards

Melton

2020

Knee Surg & Relat Res

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Background: Chronic bone marrow lesions (BML) in the weight-bearing portions of the knee are often associated with symptomatic degenerative arthritis resulting in pain and dysfunction. Injection of bone substitute material like calcium phosphate has been described. Whilst some studies have reported encouraging results others have shown limited benefit of this technique. Aim: The aim was to collate the available evidence on the injection of calcium phosphate and systematically evaluate the results to answer the questions encountered in clinical decision making: (1) does it provide effective long-lasting pain relief to avoid further surgical intervention? (2) which factors (patient/surgical) significantly influence the outcome? and (3) does it adversely affect the outcomes of subsequent arthroplasty? Methods: A literature search was performed to identify the studies describing the clinical outcomes of calcium phosphate injection for treatment of BML. We evaluated the reported clinical outcomes with respect to pain, function and complications. Isolated case reports and studies with no objective assessment of clinical outcomes were excluded. Results: We noted 46 articles in the current literature of which 8 described clinical outcomes of calcium phosphate injection. Mean (plus/minus SD) score on the visual analog scale (VAS) has been reported to improve from 7.90 (± 0.38) to 2.76 (± 0.90), whereas the International Knee Documentation Committee (IKDC) score improved from 30.5 (SD not reported (NR)) to 53.0 (SD NR). Pre and post procedure Short form survey (SF-12) scores were 29.8 (SD NR) and 36.7 (SD NR), respectively. In one study, scores on the Tegner Lysholm knee scoring scale improved in 12 out of 22 patients, whereas the remainder had no change in symptoms. Extravasation of calcium phosphate into the joint was the most common complication, whereas no adverse effect has been reported on subsequent arthroplasty. Conclusion: Limited data from the published studies would suggest that calcium phosphate injection of BML may potentially improve pain and function. However, no evidence is currently available to clearly identify patient/surgical factors that may influence the long-term outcomes of this procedure. Hence pragmatic, prospective studies with stratified patient cohorts and robust reporting of outcome measures are essential to improve the understanding of the indications and clinical effectiveness of this novel procedure.

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“…11 The SCP procedure is a proprietary term that describes a minimally invasive technique for injection of a bioabsorbable highly flowable calcium phosphate bone substitute material (BSM), named AccuFill (Zimmer Biomet; Warsaw, Indiana, United States), into the bone marrow lesions diagnosed on magnetic resonance imaging (MRI). 12 The material sets in an endothermic process, minimizing damage to the bone and is reported to be both osteoconductive and osteoinductive. 13 The goal in humans is to reach lesions seen on MRI, guided by fluoroscopy, that have not progressed to significant osteoarthritis.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Novel Bone Substitute Injection Technique for Potential Treatment of Impact Injury to the Equine Palmar Metacarpal Condyle

Rice

Brokken

Hostnik

et al. 2019

Vet Comp Orthop Traumatol

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Objective The aim of this study was to evaluate the injection of a bone substitute material (BSM) into an impact lesion in the palmar condyle of the third metacarpal bone. Study Design This was an in vivo controlled study performed on six horses. Materials and Methods Medial metacarpal condyles were exposed via arthrotomy and a compressive lesion created in anaesthetized horses using 80 psi (27.6 MPa) onto the articular surface (n = 12). Paired limbs were randomly selected as a control or for extra-articular injection of BSM towards the subchondral bone near the compressive lesion. Parameters of the surgical techniques and BSM distribution outcomes were evaluated using magnetic resonance imaging analysis, histology and histomorphometry. Results Injection of the BSM required significant pressure, as well as the use of a pilot hole. The BSM was visible in all magnetic resonance imagings in treatment limbs. Post-impact treatment limbs had greater average grey scale values than controls (p = 0.041), and greater average grey scale values than pre-impact treatment limbs (p = 0.004). Histology demonstrated haemorrhage and microfractures at the site of compression with no evidence of bone disruption from BSM injection. Conclusion Injection of BSM into the dense subchondral bone of the equine palmar condyle could be targeted to a site of injury, distributed subchondrally and without further injury to bone or cartilage. Clinical Significance This procedure has potential for the treatment of clinical impact injury or osteoarthritis in horses, and long-term studies are warranted.

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Assessment of the injection behavior of commercially available bone BSMs for Subchondroplasty® procedures

Cited by 26 publications

References 15 publications

Short-Term Outcomes for the Biologic Treatment of Bone Marrow Edema of the Knee Using Bone Marrow Aspirate Concentrate and Injectable Demineralized Bone Matrix

Short-Term Outcomes for the Biologic Treatment of Bone Marrow Edema of the Knee Using Bone Marrow Aspirate Concentrate and Injectable Demineralized Bone Matrix

Calcium phosphate injection of symptomatic bone marrow lesions of the knee: what is the current clinical evidence?

Evaluation of a Novel Bone Substitute Injection Technique for Potential Treatment of Impact Injury to the Equine Palmar Metacarpal Condyle

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