Can Bone Marrow Lesions Heal? | Madras Joint Rejuvenation Centre

10 November 2026 · Dr. A.K. Venkatachalam

“My MRI shows a bone marrow lesion. Can it heal?”

A bone marrow lesion (BML) is an area of abnormal signal in the bone just beneath the joint surface on certain MRI sequences. Reports often use the term “bone marrow oedema.” In osteoarthritis, however, the MRI appearance does not mean there is simply a pocket of fluid. The underlying tissue may show several changes, including oedema, fibrosis, small areas of bone damage, bleeding or altered bone structure.

BMLs are associated with knee pain and with changes in nearby cartilage. The bone beneath the cartilage has a nerve supply, but pain can come from several parts of the knee. A BML does not, by itself, explain every patient’s pain or establish its cause.

An X-ray cannot show a BML. MRI is needed to assess it. Two knees with similar X-rays can have different findings in the bone beneath the joint surface.

The short answer

Yes. Some BMLs shrink or resolve on follow-up MRI, including without a treatment directed at the lesion. Changes in lesion size have also been reported after treatments directed at the bone.

That does not mean every lesion will shrink, or that a smaller lesion means the cartilage has been restored. The treatment studies are few and use different methods. They support careful assessment and further study—not a promise of healing or a proven result from any one protocol.

What the published evidence shows

These studies answer different questions. The findings should be read in light of each study’s design and limitations.

Do lesions change over time?

Study: Roemer et al., 2009; human cohort MRI study, MOST [1].

Finding: Among 395 knees followed for 30 months, 66% of existing lesions changed in size; 50% regressed or resolved. New or progressing lesions were associated with greater odds of cartilage loss in the same subregion.

Limit: Observational study: it records associations over time, not their cause.

What may be happening in the bone?

Study: Aaron et al., 2018; human mechanism-imaging study [2].

Finding: Dynamic contrast MRI in 15 people with advanced knee osteoarthritis and 7 controls found abnormal blood-flow patterns in the subchondral bone, including reduced venous outflow.

Limit: Small study. It supports a possible mechanism; it does not establish the cause of an individual patient’s BML or pain.

Does the material injected into the bone matter?

Study: Sánchez Santiuste et al., 2025; double-blind, multicentre randomised trial [3].

Finding: 86 patients with severe knee osteoarthritis received either PRGF or saline into the bone. Both groups also received three intra-articular PRGF injections. Both groups improved; the PRGF group had greater improvement in nearly all measured KOOS and WOMAC domains at the reported follow-ups over one year. No serious adverse events were recorded.

Limit: Measured symptoms and function, not change in lesion size on MRI. It tested PRGF, not bone marrow concentrate or PRASAD. One co-author developed PRGF; the authors’ disclosures should be read with the paper.

Does treatment location matter?

Study: Hernigou et al., 2021; randomised comparison in patients with arthritis in both knees [4].

Finding: In 60 patients, bone marrow concentrate was delivered into the subchondral bone of one knee and into the joint of the other. At 15 years, 20% of the subchondral-treated knees and 70% of the intra-articular-treated knees had undergone knee replacement.

Limit: One research group and a selected patient population. It compared two treatment locations; it was not a comparison with no treatment.

Do lesions shrink after treatment directed at the bone?

Studies: Hernigou et al., 2021; Kon et al., 2023; Ezzi et al., 2026; human MRI follow-up studies [5–7].

Finding: Hernigou et al. reported a mean BML-volume reduction of 1.5 cm³ over 24 months after subchondral bone marrow concentrate. Kon et al. reported reduced MRI marrow-oedema scores at 24 months after combined subchondral and intra-articular BMAC. Ezzi et al. reported lower BML severity at three-month MRI follow-up after subchondral BMAC.

Limit: None of the MRI follow-up studies included a nonoperative comparison group. In the Kon study, MRI scores for osteophytes and synovitis worsened while the marrow-oedema score fell. The Ezzi study was retrospective and its MRI follow-up was early.

What about a bone substitute?

Study: Klincke et al., 2026; systematic review of subchondroplasty [8].

Finding: Across 12 studies and 829 patients, pain and function scores improved from one month to at least two years after subchondroplasty.

Limit: This is a different procedure from biologic treatment. The review noted short follow-up and a lack of control groups.

Taken together, the studies show that BMLs can change over time and that bone-directed treatments have produced encouraging results in some human studies. The studies used different treatments and patient groups. They do not establish which approach works best, or show that PRASAD has the same effects.

None of these studies tested the PRASAD protocol itself. They are other groups’ published data on related questions about the bone and the location of treatment.

Who this may apply to—and who needs a different assessment

This evidence concerns people with knee osteoarthritis and MRI findings in the subchondral bone. The studies included selected patients with a range of X-ray grades, including some with severe radiographic osteoarthritis. An advanced X-ray grade alone does not determine whether a particular treatment is suitable.

At MJRC, treatment directed at the bone may form one part of PRASAD (Platelet Rich Adipose Stromal Advanced Derivative), a framework that combines selected orthobiologic approaches according to the findings in the knee. It is not offered as a stand-alone injection, and a BML on MRI does not automatically mean that bone treatment is needed.

Treatment may be deferred, modified or unsuitable in situations such as:

Structural failure or major instability: collapse, gross instability or major deformity requires a broader assessment.
Uncontrolled metabolic disease: for example, persistently raised HbA1c. Treatment may be reconsidered after the condition is addressed.
Active inflammatory arthritis that is not controlled: the inflammatory disease needs assessment and management.
Marked malalignment: the effect of mechanical loading needs to be assessed before a treatment plan is made.
Active synovitis or repeated swelling: the cause should be assessed and managed.
Active infection: treatment should not proceed. A history of, or current, malignancy needs individual assessment.
Inability or unwillingness to complete preparation and rehabilitation: these are part of the treatment plan.

These are reasons for further assessment or a change in timing or plan; they are not a substitute for an individual clinical evaluation.

What this means for your decision

An X-ray shows aspects of the joint, but it cannot show a BML. That finding requires MRI. BMLs may contribute to symptoms and can change over time, but the MRI finding alone cannot identify the source of all knee pain or predict an individual outcome.

A BML is not necessarily permanent. In some studies it has shrunk or resolved. That does not mean new cartilage has formed. The studies described here do not establish that treatment can reliably restore an arthritic knee’s cartilage to normal.

Treating the bone is only one part of care. Assessment also considers the rest of the joint, the forces acting on it, muscle strength, metabolic health and the patient’s ability to take part in rehabilitation.

Consult an orthopaedic surgeon for a clinical assessment of your knee, including your symptoms and examination—not just the X-ray or MRI report.

References

Education note: This page is for general education. It does not diagnose a condition or replace an individual consultation with a qualified clinician.

Dr. A.K. Venkatachalam
Orthopaedic Surgeon
MS (Orth), DNB (Orth), FRCS (Glasg), MCh (Orth), Liverpool
Madras Joint Rejuvenation Centre · Kasthuri Hospital, West Tambaram, Chennai