SUBCHONDROPLASTY (REQUIRES PREAUTHORIZATION)

III.242





III.242 SUBCHONDROPLASTY (REQUIRES PREAUTHORIZATION)


Description

The Subchondroplasty® (SCP) Procedure is a minimally-invasive fluoroscopically-assisted procedure that targets and fills subchondral bone defects associated with chronic bone marrow lesions frequently associated with osteoarthritis, primarily of the knee and ankle. A substance called AccuFill (a calcium phosphate mineral compound) is injected arthroscopically into the subchondral defect – it hardens quickly once injected and mimics the strength of normal cancellous bone, and is replaced with new bone during the healing process. It is designed to treat subchondral defects associated with chronic bone marrow edema.

Subchondral bone is anatomically located directly below the articular cartilage. Subchondroplasty is a procedure performed in the outpatient setting and involves filling in bone marrow lesion defects with a bone substitute material (e.g., Accufill, Arthrex).  Eight of the most common commercially available BSMs were tested (AccuFill® (Zimmer, Inc.), Beta-BSM™ (Zimmer, Inc.), Cerament™ (Biomet, Inc.), HydroSet™ (Styker®), Norian™ SRS (DePuy Synthes®), Pro-Dense® (Wright Medical Inc.), StrucSure™ CP (Smith & Nephew plc), Simplex™ (Stryker®)) using the polyurethane block material, while three were additionally tested in femoral condyle cadaveric bone blocks from healthy donors (AccuFill®, Beta-BSM™ and StrucSure™).

 



Dates

  • Original Effective
    06-01-2022
  • Last Review
    08-07-2024
  • Next Review
    08-07-2025

Policy

  • Related Policies - III.188 Autologous Chondrocyte Implantation for Focal Articular Cartilage lesions

Subchondroplasty is considered investigational because there is insufficient evidence to establish the clinical effectiveness and the impact on net health outcomes has yet to be determined.



Background

Osteoarthritis (OA) is thought to begin as subchondral bone pathology. This rationale has led to an increasing interest in development of various treatment options for OA including subchondral injections. The subchondral injection procedure refers to fluoroscopically guided injections of different products including PRP (platelet rich plasma), MSCs (mesenchymal stem cells) or as a calcium phosphate bone substitute.  When calcium phosphate is used the procedure is known as Subchondroplasty.

 

Available literature consists of case reports and case series involving small sample sizes, lack of post injection imaging to assess the healing potential of the treatment and a lack of high-quality evidence in peer reviewed scientific literature.  Further evaluation with well-designed studies is needed to establish clinical efficacy and inclusion as part of the standard treatment of OA.

 



Practice Guidelines and Position Statements

Clinical literature search revealed a paucity of high-quality evidence in peer reviewed scientific literature. Available literature consists of case reports and case series involving small sample sizes. There were no clinical guidelines found in our search that incorporated the Subchondroplasty procedure as part of standard treatment for osteoarthritis.

 



Quick Code Search

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Procedure

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Diagnosis

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Codes

      
          Full Description
            Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed
      
          Full Description
            Injection(s), bone-substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion, bone bruise, stress injury, microtrabecular fracture), including imaging guidance and arthroscopic assistance for joint visualization
      
          Full Description
            UNLISTED PROCEDURE, SHOULDER
      
          Full Description
            Unlisted procedure, pelvis or hip joint
      
          Full Description
            UNLISTED PROCEDURE, FEMUR OR KNEE
      
          Full Description
            UNLISTED PROCEDURE, LEG OR ANKLE
      
          Full Description
            UNLISTED PROCEDURE, FOOT OR TOES
      
          Full Description
            Unlisted procedure, arthroscopy




References

2021

Fusco, G., Gambaro, F. M., Di Matteo, B., & Kon, E. (2021). Injections in the osteoarthritic knee: a review of current treatment options. EFORT open reviews, 6(6), 501–509. https://doi.org/10.1302/2058-5241.6.210026.   
2016

Madry, Henning MD; Orth, Patrick MD; Cucchiarini, Magali PhD Role of the Subchondral Bone in Articular Cartilage Degeneration and Repair, Journal of the American Academy of Orthopaedic Surgeons: April 2016 - Volume 24 - Issue 4 - p e45-e46. doi: 10.5435/JAAOS-D-16-00096.

2021

Nairn LN, Subramaniam M, Ekhtiari S, Axelrod DE, Grant JA, Khan M. Safety and early results of Subchondroplasty® for the treatment of bone marrow lesions in osteoarthritis: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2021 Nov;29(11):3599-3607.
2020

Di Matteo B, Polignano A, Onorato F, et al. . Knee intraosseous injections: a systematic review of clinical evidence of different treatment alternatives. Cartilage 2020; doi: 10.1177/1947603520959403.

2021

Betzler, B. K., Chee, Y. J., & Bin Abd Razak, H. R. (2021). Intraosseous Injections Are Safe And Effective in Knee Osteoarthritis: A Systematic Review. Arthroscopy, sports medicine, and rehabilitation, 3(5), e1557–e1567. https://doi.org/10.1016/j.asmr.2021.06.006
2024

Anzillotti, G.; Öttl, F.C.; Franceschi, C.; Conte, P.; Bertolino, E.M.; Lipina, M.; Lychagin, A.; Kon, E.; Di Matteo, B. No Significant Differences between Bisphosphonates and Placebo for the Treatment of Bone Marrow Lesions of the Knee: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J. Clin. Med. 2024, 13, 3799. https:// doi.org/10.3390/jcm13133799 

Revisions

05-19-2025

Review of policy, added one new refernece, no changes made to policy statement.