Zimmer Biomet Brings Subchondroplasty to Foot and Ankle

Zimmer Biomet is commercializing subchondroplasty procedures from the knee to the foot and ankle.

The company announced on September 15, 2015 that surgeons have performed more than 10, 000 such procedures since 2010, mostly in the knee.

The subchondroplasty procedure, according to the company, is a fluoroscopic, minimally invasive outpatient intervention that addresses the defects associated with subchondral bone marrow lesions (BML). Diagnosed using MRI and physical exam, BML are associated with stress fractures or micro-fractures of the bone adjacent to the joint. Left untreated, these defects have been shown to lead to cartilage degeneration, limited function, pain and greater risk for joint deterioration.

Bone Void Filler

Navigation instruments are used in this arthroscopically assisted procedure to inject a specialized bone void filler to treat the bone defect and begin the healing process, without violating the joint.

Eric Nilssen, M.D. of The Nilssen Orthopedic Ankle & Foot Center at The Andrews Institute, said that prior to subchondroplasty, he had no viable treatment for patients with chronic stress fractures in the foot and ankle. “These injuries show up on MRI, are very painful and often fail to heal with conservative treatment.”

Knee Creations, LLC

The company acquired the proprietary technology in 2013 from Knee Creations, LLC, a Viscogliosi Brothers company. Zimmer Biomet now owns 16 patents and 8 trademarks in this area, with numerous others still pending.

According to Zimmer Biomet, the procedure was invented in 2007 by Peter Sharkey, M.D., and Charlie Leinberry, M.D., of the Rothman Institute, Philadelphia, for the treatment of subchondral bone defects associated with chronic BML. Sharkey recognized that, in many of his patients, joint pain associated with knee osteoarthritis was due to BML.

The first surgery took place in 2008 and was performed by Steven Cohen, M.D. Between 2008 and 2012, 69 knee patients were treated at Rothman. All patients were scheduled for total knee replacement but opted for subchondroplasty, instead. Patients were followed for at least 24 months. On average, patients experienced a significant reduction in mean VAS pain scores, and 70% of patients delayed knee replacement for 2+ years.1

Knee Creations then commercialized the technology in 2010. The first surgical usage in the ankle was in 2012 for the treatment of a post-traumatic talar dome lesion. Surgeons, according to the company, have used the subchondroplasty procedure in other joints, as well, including the hip and shoulder.