Subchondroplasty Procedure in Patients With Bone Marrow Lesions

Prospective Post-Market Data Collection on Patients With Bone Marrow Lesions (BMLs) in the Knee Treated With the Subchondroplasty® (SCP®) Procedure

This is a prospective, multi-center, post-market data collection study intended to collect data on the short- and long-term safety and performance of the SCP Procedure.

Study Overview

• Status: Completed
• Conditions: Bone Marrow Edema; Bone Marrow Lesions
• Intervention / Treatment: Device: Subchondroplasty Procedure

Detailed Description

Patients with symptomatic BML(s) of the knee(s) who qualify for a SCP Procedure will be invited to participate. This study will enroll up to 95 patients across 4 investigative centers in Europe over a period of 12 months. The maximum study duration is expected to be 6 years.

Follow-up assessments will be conducted at 1 month, 3, 6, 12-months and 24-months post injection; and subjects will be asked questions regarding their pain and functioning to further understand long-term outcomes.

For all subjects at selected centers, a long standing X-ray and MRI at screening and either at 12 months or 24 months will be obtained.

• Study Type: Observational
• Enrollment (Actual): 93

Contacts and Locations

Study Locations

• Germany
  • Regensburg, Germany
    • Universitaetsklinikum Regensburg
• Italy
  • Rozzano (MI), Italy
    • Istituto Clinico Humanitas
• Netherlands
  • Maastricht, Netherlands
    • Maastricht UMC
• Spain
  • Barcelona, Spain
    • Hospital Universitari Vall d´Hebrón
• United Kingdom
  • Cheltenham, United Kingdom
    • Gloucestershire Hospitals NHS
  • Leeds, United Kingdom
    • Harrogate & District NHS Foundation Trust

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Patients with symptomatic BML(s) of the knee(s) who qualify for a SCP Procedure.

Description

Inclusion Criteria:

• At least 18 years of age at time of screening
• Patient with BML(s) in one or both knees, as diagnosed by the treating physician, willing and eligible to undergo the SCP Procedure
• One or more BML(s) of the tibial plateau and/or femoral condyle extending to the articular surface of the joint confirmed on T2 weighted fat-suppressed or fat-suppressed Proton Density MR Imaging by presence of white signal
• Patient's index knee alignment, which is defined radiographically, must be one of the following: Neutral, 6 degree mechanical varus, or 6 degree mechanical valgus

• Patient is refractory to conservative non-surgical management of BML:

  • Having failed 2 or more of the following: hyaluronic acid (HA) injection, corticosteroid injection, non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, bracing, or minimal surgical intervention (e.g. arthroscopy, debridement/chondroplasty, and/or loose body removal)
  • and diagnosis of BML is more than 3 months of the study treatment
• Willing and able to comply with the study procedures
• Signed an informed consent form approved by independent ethics committee (IEC)

Exclusion Criteria:

• Existing acute or chronic infections at the surgical site
• Bone in the index knee is non-viable or not capable of supporting and anchoring the implant.
• Known systemic disorders or any systemic inflammatory condition (e.g. rheumatoid arthritis)
• Acute traumatic injuries with open wounds close to the bone defect which are likely to become infected
• Known metabolic bone disease, including disorders in calcium metabolism
• Known immunologic abnormalities, including inflammatory bone disease
• Has a history of any invasive malignancy (except non-melanoma skin cancer), unless treated with curative intent and with no clinical signs or symptoms of the malignancy for 5 years
• Diagnosis of patella-femoral joint OA and/or primarily patella-femoral symptoms
• BML caused by acute trauma less than 3 months prior to enrollment

• Clinical and/or radiographic disease diagnosis of the index knee that includes any of the following:

  • Kellgren-Lawrence grade 4 Osteoarthritis (OA)
  • BML located at anterior cruciate ligament (ACL)/ posterior cruciate ligament (PCL) insertion
• Any major or cartilage repair or alignment surgery (i.e. osteotomy, autograft, scaffold, marrow stimulation, debridement, all cell-based therapies, etc.) of the index knee within 12 months prior to enrollment
• Pregnant at time of injection
• Lactating at time of injection
• Use of any investigational drug or device within 30 days prior to enrollment
• Use of any investigational biologics within 30 days prior to enrollment

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Only
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Subchondroplasty Procedure; The SCP Procedure targets and fills bone defects with AccuFill bone substitute material utilizing an arthroscopic / percutaneous approach	Device: Subchondroplasty Procedure; AccuFill is an injectable, self-setting, macro-porous, osteoconductive, calcium phosphate bone graft substitute material that is intended for use to fill bony voids or gaps of the lower extremities (pelvis through foot) that are not intrinsic to the stability of the bony structure; Other Names: AccuFill Injectable Calcium Phosphate

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale	Change in pain following SCP Procedure as measured by the KOOS pain subscale. The KOOS is a validated instrument which measures knee pain and function using five subscales: pain, symptoms, function in daily living, function in sport and recreation, and quality of life. The instrument consists of 42 standardized questions each having 5 point Likert response scale.	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Knee Injury and Osteoarthritis Outcome Score (KOOS)	Change in KOOS pain and function subscales and overall scores. The KOOS is a validated instrument which measures knee pain and function using five subscales: pain, symptoms, function in daily living, function in sport and recreation, and quality of life. The instrument consists of 42 standardized questions each having 5 point Likert response scale.	2 year
Numerical Rating Scale (NRS) pain scale	Change in pain as measured by NRS pain scale. The NRS is a validated measure of knee pain. The NRS is an 11 point Likert type scale anchored by 0 "no pain" and 10 "worst possible pain". Subjects rate their average pain over the last week	2 year
EuroQol-5 Dimensions (EQ-5D)	Change in quality of life as measured by EQ-5D. The EQ-5D is a validated instrument that assesses an individual's current health status and heath related quality of life. The EQ-5D-5L descriptive component assesses five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression over five levels of severity	2 year
Heath care utilization Questionnaire	Healthcare utilization for each subject will be recorded via a not validated questionnaire to capture information about any treatments, therapies, specialists, etc. utilized for pain or symptom relief following study treatment and follow-up.	2 year
Subject global satisfaction Questionnaire	The subject global satisfaction is concerned with determining patient-related factors such as patients' satisfaction with treatment, and experienced health outcomes. The questionnaire uses a not validated 11 point scale anchored by 0 "totally dissatisfied" and 10 "extremely satisfied".	2 year
Occurrence of Re-operations	Occurrence of subjects that require any re-operation on the index knee from initial SCP Procedure.	2 year
Time to Re-operations	Time from initial SCP Procedure to any re-operation	2 year
Occurrence of Revisions	Occurrence of subjects that require revision on the index knee from initial SCP Procedure.	2 year
Time to Revisions	Time from initial SCP Procedure to revisions	2 year
X-ray	X-ray evaluation of alignment, joint space narrowing, osteophyte and cyst formation and subchondral sclerosis	12 months
MRI BML lesion size	MRI evaluation of Bone Marrow Lesion Size	12 months
MRI BML type	MRI evaluation of Bone Marrow Lesion Type	12 months
MRI Intraosseous vascularity	MRI evaluation of Intraosseous Vascularity	12 months
MRI location of injectate	MRI evaluation of Location of Injectate.	12 months
Adverse Events	Occurrence of Adverse Events	2 year

Collaborators and Investigators

• Sponsor: Zimmer Biomet
• Investigators: Principal Investigator: Peter Angele, Prof.Dr.med, University of Regensburg

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2018
• Primary Completion (Actual): March 16, 2023
• Study Completion (Actual): March 16, 2023

Study Registration Dates

• First Submitted: January 11, 2018
• First Submitted That Met QC Criteria: February 5, 2018
• First Posted (Actual): February 12, 2018

Study Record Updates

• Last Update Posted (Actual): June 22, 2023
• Last Update Submitted That Met QC Criteria: June 20, 2023
• Last Verified: June 1, 2023

More Information

Terms related to this study

• Keywords: Subchondroplasty; AccuFill; Injectable Calcium Phosphate
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Calcium-Regulating Hormones and Agents; Calcium
• Other Study ID Numbers: SCP-EMEA-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No