Objective

To systematically review the available clinical evidence regarding the safety and efficacy of knee intraosseous injections for the treatment of bone marrow lesions in patients affected by knee osteoarthritis.

Design

A literature search was carried out on PubMed, Embase, and Google Scholar databases in January 2020. The following inclusion criteria were adopted: (1) studies of any level of evidence, dealing with subchondral injection of bone substitute materials and/or biologic agents; (2) studies with minimum 5 patients treated; and (3) studies with at least 6 months’ follow-up evaluation. All relevant data concerning clinical outcomes, adverse events, and rate of conversion to arthroplasty were extracted.

Results

A total of 12 studies were identified: 7 dealt with calcium phosphate administration, 3 with platelet-rich plasma, and 2 with bone marrow concentrate injection. Only 2 studies were randomized controlled trials, whereas 6 studies were prospective and the remaining 4 were retrospective. Studies included a total of 459 patients treated with intraosseous injections. Overall, only a few patients experienced adverse events and clinical improvement was documented in the majority of trial. The lack of any comparative evaluation versus subchondral drilling alone is the main limitation of the available evidence.

Conclusions

Knee intraosseous injections are a minimally invasive and safe procedure to address subchondral bone damage in osteoarthritic patients. They are able to provide beneficial effects at short-term evaluation. More high-quality evidence is needed to confirm their potential and to identify the best product to adopt in clinical practice.

中文翻译：

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膝关节骨内注射：对不同治疗方案临床证据的系统评价。

客观的

系统评价有关膝关节骨内注射治疗膝关节骨性关节炎患者骨髓病变的安全性和有效性的现有临床证据。

设计

2020 年 1 月在 PubMed、Embase 和 Google Scholar 数据库上进行了文献检索。采用了以下纳入标准：（1）任何证据水平的研究，涉及骨替代材料和/或生物制剂的软骨下注射；(2) 至少有 5 名患者接受治疗的研究；(3) 至少有 6 个月随访评估的研究。提取了有关临床结果、不良事件和关节置换术中转率的所有相关数据。

结果

共确定了 12 项研究：7 项涉及磷酸钙给药，3 项涉及富含血小板的血浆，2 项涉及骨髓浓缩物注射。只有 2 项研究是随机对照试验，而 6 项研究是前瞻性的，其余 4 项是回顾性的。研究包括总共 459 名接受骨内注射治疗的患者。总体而言，只有少数患者经历了不良事件，并且在大多数试验中记录了临床改善。与单独的软骨下钻孔相比，缺乏任何比较评估是现有证据的主要限制。

结论

膝关节骨内注射是一种微创且安全的手术，可解决骨关节炎患者的软骨下骨损伤。它们能够在短期评估中提供有益效果。需要更多高质量的证据来确认它们的潜力并确定在临床实践中采用的最佳产品。