Subchondroplasty for bone-marrow lesions in the osteoarthritic knee improves pain and function: a systematic review and meta-analysis.

Abstract

To investigate the effect of Subchondroplasty in subchondral bone-marrow lesions related to knee osteoarthritis. A systematic literature review was conducted following the PRISMA guidelines. PubMed/MEDLINE and Embase were searched up to September 25th, 2025, for studies investigating patient-reported outcome measures, reoperations or conversion to knee arthroplasty, and complications in patients receiving Subchondroplasty. Studies with a focus on patients with a knee osteoarthritis related bone-marrow lesion were included. Studies were excluded if they had a study size < ten participants. In case of sufficient data, meta-analysis was performed using a random-effects model. Risk of bias was analysed using MINORS. The search strategy yielded a total of 12 studies with 829 patients deemed fit for this review. Meta-analysis of patient-reported outcome measures revealed a clinically important improvement for both pain and function, starting at one month and continuing at least up to two years post-operatively (e.g. visual analogue scale for pain at two years post-operatively compared to pre-operatively; mean difference: 39.01 (95%CI [19.62, 58.40]), P < 0.0001). Of the included patients, 3.5% received some form of reoperation. At one year follow-up, 2.4% of patients were converted to knee arthroplasty. At two year follow-up, this was 22.4%. Median complication rate was 6.7%, with Calcium phosphate leakage being the most common. Subchondroplasty for bone-marrow lesions in the osteoarthritic knee successfully relieves pain and returns function. It may delay knee arthroplasty in carefully selected patients, although current evidence is limited by short follow-up durations and the lack of control groups.