Subchondroplasty®: Minimally Invasive Surgery for Bone Defects Associated with Chronic Bone Marrow Lesions

(Oceanside, NY) Long Islanders suffering from chronic achy knees that have not responded to ibuprofen, injections such as Synvisc®, arthroscopic surgery, bracing or physical therapy may be candidates for an innovative solution offered by orthopedic surgeons at South Nassau Communities Hospital.

The solution, Subchondroplasty® (sub-con-dr?-plas-tee, and also referred to as SCP), is a minimally invasive surgery that allows orthopedic surgeons Bradley Gerber, MD, chief of joint replacement surgery; Craig Levitz, MD, chair of orthopedic surgery, and James Germano, MD, to access and treat bone defects associated with chronic bone marrow lesions (BMLs).

South Nassau’s Center for Advanced Orthopedics was the first on Long Island to offer and perform SCP. Dr. Gerber is a pioneer of SCP in the U.S. and is involved in research and training surgeons nationwide on the procedure. Subchondroplasty comes from “sub,” meaning “below” and the Greek word “chondros,” meaning “cartilage.”

Defined by radiologists as “bone marrow edema,” a BML is swelling in the soft bone just underneath the joint’s surface, producing chronic pain and reduced mobility. BML, most easily detected by magnetic resonance imaging (MRI), is identified by inflammation surrounding a microscopic insufficiency fracture within the subchondral bone.

BMLs will not heal without treatment, and ultimately lead to severe osteoarthritis and the need for total knee replacements. More than 600,000 total knee replacements were performed in 2011. “Subchondroplasty is a much simpler and less expensive corrective and preventive surgery that will delay or in some cases even eliminate the need for knee replacement surgery,” said Dr. Gerber.

The procedure involves putting the patient under general anesthesia and then making a total of three incisions in the knee. Imaging and a special device help pinpoint exactly where the damage is located. A needle is then inserted and a small amount of calcium phosphate (also referred to as a biomimetic bone substitute material, BSM) is injected into the damaged area.

Depending on the number of BMLs, the operation takes an average of 30 to 45 minutes. The BSM takes about 30 minutes to dry and harden. If not combined with another procedure, most patients can walk out of the hospital under their own power after the surgery. Typical post-operative recovery time is six weeks (as compared to four to six months for a knee replacement).

Drs. Gerber, Germano and Levitz are among the more than 200 other physicians in the US who specialize in subchondroplasty. To date, more than 1,200 procedures have been performed in the US.

Subchondroplasty is the most recent advancement in orthopedic surgery that South Nassau’s Center for Advanced Orthopedics has introduced to Long Island. The center is in the vanguard of using orthopedic innovations and orthobiologics to repair and prevent the wear and tear caused by severe or chronic cartilage, tendon and ligament injuries that can lead to joint replacement surgery.

The center was the first on Long Island to offer Carticel® Therapy and to perform meniscal cartilage transplantations. Carticel Therapy is a minimally-invasive surgical approach that uses cloned cartilage cells to correct recurring knee cartilage injuries. The meniscal cartilage transplantation is a revolutionary, minimally invasive surgical technique that hinders degeneration of the knee joint and eliminates the constant pain caused by the damaged cartilage.

It was also among the first in the US to offer the a biologic patch that harnesses the healing power of the human body to repair painful, debilitating shoulder rotator cuff tears. Commonly referred to as the biologic rotator cuff implant, the patch relies on the body’s natural biological agents to jumpstart healing, even as surgery is in progress. The patch is proving to be highly effective for patients with severely degraded rotator cuffs and is resulting in less pain and faster recovery after the surgery.

Hip Arthroscopy and PRP are two more examples of minimally invasive surgical techniques and technologies that the Center offers to repair common and serious musculoskeletal injuries. Hip arthroscopy is a minimally-invasive procedure that is also used to repair torn tissue, treat some forms of arthritis and possibly prevent future arthritis.

PRP is an innovation from the expanding field of medicine known as orthobiologics, which is developing new techniques that combine the body’s natural ability to heal itself and the use of stem cells and advanced medical technologies to repair and heal orthopedic injuries. PRP is blood plasma with a high concentration of platelets with significant bioactive proteins, which are vital to the repair and regeneration of musculoskeletal soft tissue. PRP is safe because the platelet-rich plasma is taken from the patient’s blood and adheres to the highest standards of patient safety and sterile technique.

Musculoskeletal injuries repaired at the Center include knee cartilage and ligaments tears; shoulder instability, impingement, recurrent dislocations and rotator cuff or labrum tears; foot and ankle and hand and upper extremity injuries. The Center’s surgeons also specialize in total knee and hip replacement surgery, as well as custom-fitted total joint replacements and partial joint replacement techniques, including Birmingham Hip™ resurfacing and the Uni-Knee™ partial knee replacement. The Center’s orthopedic spine surgeons use a range of surgical approaches to fix painful lower back problems. These approaches include lumbar disc replacement and kyphoplasty.

South Nassau Communities Hospital is one of the region’s largest hospitals, with 435 beds, more than 900 physicians and 3,000 employees. Located in Oceanside, NY, the hospital is an acute-care, not-for-profit teaching hospital that provides state-of-the-art care in cardiac, oncologic, orthopedic, bariatric, pain management, mental health and emergency services. In addition to its extensive outpatient specialty centers, South Nassau provides emergency and elective angioplasty and is the only hospital on Long Island with the Novalis Tx™ and Gamma Knife® Perfexion radiosurgery technologies. South Nassau is a designated Stroke Center by the New York State Department of Health and Comprehensive Community Cancer Center by the American College of Surgeons and is recognized as a Bariatric Surgery Center of Excellence by the American Society for Metabolic and Bariatric Surgery. For more information, visit www.southnassau.org.