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Injectable Orthobiologics for the Treatment of Subchondral Insufficiency Fractures of the Knee (SIFK) and Related Pathogenic Processes

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Abstract

Spontaneous osteonecrosis of the knee (SONK) presents a challenging treatment scenario as the etiology of these lesions has been poorly defined, and therefore appropriate treatment remains uncertain. More recently, it has been proposed that these lesions are better characterized as the culmination of subchondral insufficiency fractures of the knee (SIFK). As a result, treatment options better aimed at reversing or halting this pathophysiologic process have been considered. The use of injectable orthobiologics, such as platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and calcium phosphate, has become of interest for treating such lesions. However, the efficacy of these treatment modalities remains poorly understood. The purpose of the current chapter is to provide a comprehensive and evidence-based review of the pathophysiology of and risk factors for SIFK. Additionally, this chapter discusses the most recent evidence surrounding the use of orthobiologics to treat SIFK and future directions for research pertaining to this pathology.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Kyle N. Kunze

  2. Harvard Graduate School of Education, Harvard University, Cambridge, MA, USA

    Zaamin B. Hussain

  3. Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Zaamin B. Hussain

  4. UNIDAD DE CIRUGÍA ARTROSCÓPICA, Hospital Vithas San José, Gasteiz, Araba, Spain

    Mikel Sánchez

  5. Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Jorge Chahla

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  1. Kyle N. Kunze
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  2. Zaamin B. Hussain
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  3. Mikel Sánchez
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  4. Jorge Chahla
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Editor information

Editors and Affiliations

  1. Rizzoli Orthopaedic Institute, Bologna, Italy

    Giuseppe Filardo

  2. Orthopaedic & Sports Medicine Group, Santa Monica Orthopaedic & Sports Medicine, Santa Monica, CA, USA

    Bert R. Mandelbaum

  3. Orthopaedic Surgery and Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA

    George F. Muschler

  4. Hospital for Special Surgery, New York, NY, USA

    Scott A. Rodeo

  5. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

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Kunze, K.N., Hussain, Z.B., Sánchez, M., Chahla, J. (2022). Injectable Orthobiologics for the Treatment of Subchondral Insufficiency Fractures of the Knee (SIFK) and Related Pathogenic Processes. In: Filardo, G., Mandelbaum, B.R., Muschler, G.F., Rodeo, S.A., Nakamura, N. (eds) Orthobiologics. Springer, Cham. https://doi.org/10.1007/978-3-030-84744-9_28

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