Subchondroplasty for Treatment of Bone Marrow Edema in the Foot and Ankle

Study Overview
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Brief Summary
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The subchondroplasty procedure has been used to treat bone marrow edema mostly located in the periarticular region of the knee. In the past few years, it has expanded its use in the foot and ankle. There has, however, been very minimal research documented on its utilization in that area. This study aims to prospectively evaluate the course of treatment and outcomes of painful bone marrow lesions in these associated podiatric circumstances using subchondroplasty. It is hypothesized that use of calcium phosphate bone substitute in the foot and ankle to treat bone marrow edema will have more favorable short and long-term outcomes than joint destructive and joint sparing procedures more commonly performed for treatment in the past.

Detailed Description
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The subchondroplasty procedure has been used to treat bone marrow edema mostly located in the periarticular region of the knee. In the past few years, it has expanded its use in the foot and ankle. There has, however, been very minimal research documented on its utilization in that area. Bone marrow edema arises from altered stresses on bones due to osteoarthritis, biomechanical abnormalities, coalitions, infection, and trauma. This study aims to prospectively evaluate the course of treatment and outcomes of painful bone marrow lesions in these associated podiatric circumstances using subchondroplasty. This should, therefore, expose this modality as a viable treatment option for bone marrow edema. Patients will be evaluated in the office/clinic setting with a positive diagnosis of bone marrow edema confirmed via MRI. They must have failed 3 months of conservative treatment measures including, but not limited to, orthotic modifications, taping, immobilization or offloading, and anti-inflammatories. The study population includes individuals over the age of 18 with no significant comorbidities or previous foot and ankle surgical interventions. These patients will go on to have calcium phosphate mineral compound injected into the bone marrow lesions. We will track the progression of their symptoms and evaluate via Visual Analog Scale (VAS) pain score and the American Orthopedic Foot and Ankle Score (AOFAS) at 3-month, 6-month, and 1-year follow-ups. The subchondroplasty procedure is a viable treatment option for bone marrow edema in the setting of altered pedal biomechanics, gait abnormalities, osteoarthritis, and trauma. It is a minimally invasive procedure that maximizes positive outcomes, allows the patient to be immediately weight bearing following surgery, and has short operating room times. This surgical procedure is a new and innovative technique introduced to the podiatric field that will allow the surgeon to intervene at an earlier stage in efforts to alleviate symptoms. It is hypothesized that use of calcium phosphate bone substitute in the foot and ankle to treat bone marrow edema will have more favorable short and long-term outcomes than joint destructive and joint sparing procedures more commonly performed for treatment in the past.

Official Title
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Subchondroplasty for Treatment of Bone Marrow Edema in the Foot and Ankle

Conditions
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Bone Marrow Edema

Intervention / Treatment
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* Procedure: Subchondroplasty


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Bone marrow edema diagnosed on MRI Pain in the foot and ankle due to the presence of bone marrow edema Failed 3 months of conservative treatment Exclusion Criteria: Patient <18 years of age Presence of osteomyelitis of poor surgical candidates due to comorbidities such as diabetics with an HbA1c of >8% Patient with previous foot and ankle surgeries that may interfere with future outcomes

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Subchondroplasty in treating bone marrow edema<br>These patients will have calcium phosphate mineral compound injected into the bone marrow lesions. | Procedure: Subchondroplasty<br>* Calcium phosphate mineral compound injected into the bone marrow lesions<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analog Scale for pain | Best 0-10 worst - Continuous scale to measure current pain level | 0-12 months | 
| Subchondroplasty Patient Satisfaction Survey | Worst 0-5 best. 5-item scale to measure patient satisfaction after subchondroplasty procedure | 0-12 months | 
| The American Orthopedic Foot and Ankle Score (AOFAS) | Worst 0-100 best | 0-12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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bone marrow edema, subchondroplasty, foot and ankle