Bone Marrow Lesions (Knee)

Bone Marrow Lesions in the Knee: Treatment in Palm Beach

Bone marrow lesions (BMLs), also called bone marrow edema, are areas of inflammation and fluid accumulation within the bone tissue just beneath the cartilage surface of the knee. Research increasingly identifies BMLs as a primary driver of knee pain in osteoarthritis, often more closely associated with pain than cartilage loss alone.

At Palm Beach Regenerative, Dr. Ghattas addresses bone marrow lesions as part of a comprehensive knee treatment approach, using Intraosseous (IO) injection techniques that deliver orthobiologic material directly to the affected bone area. Give us a call today to learn more.

What Are Bone Marrow Lesions?

Bone marrow lesions appear on MRI as areas of abnormal signal within the subchondral bone, which is the bone layer directly beneath the joint surface. They represent a state of inflammation and structural stress within the bone that can be a significant pain generator in arthritic and injured knees.

Addressing the subchondral bone environment, not just the joint space, is an important distinction in the Palm Beach Regenerative approach to knee care.

Signs and Symptoms

• Deep, aching knee pain, often described as pain within the bone rather than the surface
• Pain at rest as well as with activity
• Swelling around the knee
• Pain that may not fully respond to standard joint injections
• Often occurs alongside or mistaken for general knee arthritis symptoms

Common Causes and Risk Factors

• Osteoarthritis with associated mechanical overload on the subchondral bone
• Acute knee injuries with bone bruising
• Repetitive stress loading on the joint
• Obesity increasing compressive forces on the knee
• Prior knee injuries or surgeries

How It Is Diagnosed

Bone marrow lesions are identified on MRI. They do not appear on standard X-rays. Dr. Ghattas reviews MRI findings to assess the size, location, and significance of any bone marrow edema as part of your knee evaluation.

The presence of BMLs can inform which treatment approach is most appropriate: standard joint injection alone, or a combined joint and intraosseous treatment strategy.

Conventional Treatment Options

Bone marrow lesions are often undertreated in conventional care because they may not be recognized as a primary pain source:

• Activity modification and unloading to reduce compressive stress
• Weight management to decrease mechanical load
• Physical therapy focused on joint mechanics and muscle balance
• Standard anti-inflammatory medications (typically offering limited benefit for bone-level inflammation)
• Bisphosphonate medications have been studied for BMLs with variable results

The Palm Beach Regenerative Approach

At Palm Beach Regenerative, bone marrow lesions are addressed through Intraosseous (IO) injection, a technique that delivers concentrated platelet or bone marrow preparations directly into the subchondral bone, targeting the inflammatory environment where BMLs occur.

IO injection is typically combined with a standard intra-articular (joint space) injection for a comprehensive approach to knee joint health.

All procedures are performed under real-time fluoroscopic guidance to confirm accurate needle placement within the bone.

The BioMod Advantage: At Palm Beach Regenerative, treatment does not end with a single injection. Through our BioMod Lab, Dr. Ghattas may combine your orthobiologic procedure with MLS Robotic Laser Therapy to reduce inflammation and support tissue recovery, alongside customized Xymogen supplement protocols designed to optimize your body's healing environment. This integrated, concierge approach is what sets Palm Beach Regenerative apart from a standard injection clinic.

Like all medical procedures, orthobiologic treatments have potential risks and benefits. Results vary by individual. Not all patients are candidates. Dr. Ghattas will discuss your specific situation, realistic expectations, and all treatment options, including when surgery or other interventions may be more appropriate.