Subchondral Bone Injections for the Treatment of Knee Osteoarthritis

Document Type : In Brief

Author

Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain

10.22038/abjs.2025.88678.4020

Abstract

The existing literature on whether subchondral bone injections in knee osteoarthritis is advisable for relieving patient pain is minimal and the level of evidence is low. A recent case series (2023) analyzed 30 individuals with knee OA (Kellgren-Lawrence 2-3). It showed that combined intraarticular and subchondral BMAC (bone marrow aspirate concentrate injections) provided clinical and imaging benefits up to 24 months for the treatment of symptomatic knee OA, with a low failure rate, and a significant reduction of bone marrow edema. Besides, VAS (visual analog scale) pain worsened at the final follow-up, although remained lower compared to the baseline value. Although some studies mention that subchondral bone injections can relieve pain in mild/moderate knee OA, it does not seem reasonable to advise it until better-designed research can confirm the preliminary studies discussed in this article.
        Level of evidence: III

Keywords

Main Subjects

References

  1.  

    1. Rodriguez-Merchan EC. Intraarticular injections of platelet-rich plasma (PRP) in the management of knee osteoarthritis. Arch Bone Jt Surg. 2013;1(1):5-8.
    2. Hedayatabad JJ, Kachooei AR, Chaharjouy NT, et al. The effect of ozone (O3) versus hyaluronic acid on pain and function in patients with knee osteoarthritis: a systematic review and meta-analysis. Arch Bone Jt Surg. 2020;8(3):343-354. doi: 10.22038/abjs.2020.46925.2292.
    3. Jalali Jivan S, Monzavi SM, Zargaran B, et al. Comparative analysis of the effectiveness of intra-articular injection of platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: results of an open-label trial. Arch Bone Jt Surg. 2021;9(5):487-495. doi: 10.22038/abjs.2021.52003.2569.
    4. Rodriguez-Merchan EC, De la Corte-Rodriguez H. The role of intraarticular injections of hyaluronic acid and platelet rich plasma for the treatment of articular pain in knee osteoarthritis. Arch Bone Jt Surg. 2025;13(1):54-61. doi: 10.22038/ABJS.2024.78852.3621.
    5. Sundaram K, Vargas-Hernández JS, Sanchez TR, et al. Are subchondral intraosseous injections effective and safe for the treatment of knee osteoarthritis? A systematic review. J Knee Surg. 2019;32(11):1046-1057. doi: 10.1055/s-0039-1677792.
    6. Hernigou P, Delambre J, Quiennec S, Poignard A. Human bone marrow mesenchymal stem cell injection in subchondral lesions of knee osteoarthritis: a prospective randomized study versus contralateral arthroplasty at a mean fifteen year follow-up. Int Orthop. 2021;45(2):365-373. doi: 10.1007/s00264-020-04571-4.
    7. Hernigou P, Bouthors C, Bastard C, Flouzat Lachaniette CH, Rouard H, Dubory A. Subchondral bone or intra-articular injection of bone marrow concentrate mesenchymal stem cells in bilateral knee osteoarthritis: what better postpone knee arthroplasty at fifteen years? A randomized study. Int Orthop. 2021;45(2):391-399. doi: 10.1007/s00264-020-04687-7.
    8. Hernigou J, Vertongen P, Rasschaert J, Hernigou P. Role of scaffolds, subchondral, intra-articular injections of fresh autologous bone marrow concentrate regenerative cells in treating human knee cartilage lesions: different approaches and different results. Int J Mol Sci. 2021;22(8):3844. doi: 10.3390/ijms22083844.
    9. Kon E, Boffa A, Andriolo L, et al. Subchondral and intra-articular injections of bone marrow concentrate are a safe and effective treatment for knee osteoarthritis: a prospective, multi-center pilot study. Knee Surg Sports Traumatol Arthrosc. 2021;29(12):4232-4240. doi: 10.1007/s00167-021-06530-x.
    10. Gardner JE, Williams CW, Bowers RL. Subchondral versus intra-articular orthobiologic injections for the treatment of knee osteoarthritis: a review. Regen Med. 2022;17(6):389-400. doi: 10.2217/rme-2021-0174.
    11. Kon E, Boffa A, Andriolo L, et al. Combined subchondral and intra-articular injections of bone marrow aspirate concentrate provide stable results up to 24 months. Knee Surg Sports Traumatol Arthrosc. 2023;31(6):2511-2517. doi: 10.1007/s00167-022-07195-w.
    12. Wu C, Xu H, Wu Z, et al. Subchondral injection of human umbilical cord mesenchymal stem cells ameliorates knee osteoarthritis by inhibiting osteoblast apoptosis and TGF-beta activity. Stem Cell Res Ther. 2025;16(1):235. doi: 10.1186/s13287-025-04366-7.

     

     

     

     

The Archives of Bone and Joint Surgery
Volume 14, Issue 4
April 2026
Pages 332-336

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History

  • Receive Date: 01 June 2025
  • Revise Date: 31 March 2026
  • Accept Date: 23 June 2025

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