Intraosseous Orthobiologic Injections for Knee Arthritis
A Precision-Guided Approach to Treating Knee Arthritis
For many years, knee osteoarthritis was thought to be primarily a disease of worn cartilage. Today, research has shown that osteoarthritis affects the entire joint, including the cartilage, synovium, ligaments, meniscus, and the subchondral bone beneath the cartilage.
Growing evidence suggests that changes within the subchondral bone play an important role in pain generation and disease progression. This has led to the development of intraosseous orthobiologic injections, an advanced technique designed to deliver treatment directly into the bone beneath the damaged cartilage.
At Detroit Biologics, intraosseous procedures are performed using precision fluoroscopic guidance to accurately target the areas of pathology while maximizing procedural safety and accuracy.
Why Treat the Bone?
Traditional knee injections—including corticosteroids, hyaluronic acid, and even many PRP injections—are typically placed only inside the knee joint.
However, research has demonstrated that arthritis is not confined to the joint space alone.
The bone beneath the cartilage undergoes structural and biologic changes that contribute to pain, inflammation, and progression of osteoarthritis. Treating both the joint and the underlying subchondral bone may provide a more comprehensive approach for appropriately selected patients.
What Does the Research Show?
Growing evidence supports the role of intraosseous orthobiologic injections for appropriately selected patients with knee osteoarthritis.
Research by Dr. Philippe Hernigou and colleagues has demonstrated encouraging long-term outcomes using Bone Marrow Concentrate for knee osteoarthritis, including improved pain and function and delayed progression to knee replacement in many appropriately selected patients.
Additional work by Dr. Cristóbal Sánchez and colleagues has demonstrated that combining intra-articular and intraosseous PRP injections may produce greater improvements in pain and function than treating the joint alone. These studies continue to support the concept that knee osteoarthritis involves the entire joint—not just the cartilage—and that treating the subchondral bone may play an important role in optimizing outcomes for select patients.
While research continues to evolve, these studies have helped establish intraosseous orthobiologic procedures as one of the most exciting developments in the non-surgical treatment of knee osteoarthritis.
Why Precision Matters
Successful intraosseous procedures require advanced training and meticulous technique.
Accurately placing treatment into the subchondral bone requires specialized needles, fluoroscopic imaging, and a detailed understanding of knee anatomy. Physician experience is critical to safely and precisely target the intended area of pathology.
At Detroit Biologics, every intraosseous procedure is personally performed by Dr. Melanie Worley using advanced image-guided techniques developed through fellowship training in interventional orthobiologics.
