Disease-specific clinical problems associated with the subchondral bone.
The subchondral bone is involved in a variety of diseases affecting both the articular cartilage and bone. Osteochondral defects in distinct locations and of variable sizes are the final results of different etiologies. These include traumatic osteochondral defects, osteochondritis dissecans, osteonecrosis, and osteoarthritis. Traumatic osteochondral defects are caused by osteochondral fractures, separating an osteochondral fragment that includes articular cartilage and both subchondral and trabecular bone from the joint surface. In osteochondritis dissecans, the disease originates in the subchondral bone and secondarily affects the articular cartilage. Location, stage, size, and depth of osteochondral lesions play a role in the treatment of traumatic osteochondral defects and osteochondritis dissecans. Surgical options include fragment refixation, transplantation of osteochondral autografts, or bone restoration by impacted cancellous bone grafts combined with autologous chondrocyte transplantation. An insufficiency fracture of the subchondral bone may be the initiating factor of what was formerly believed to be a spontaneous osteonecrosis of the knee (SPONK). Recent histopathological studies suggest that each stage of SPONK reflects different types of bone repair reactions following a fracture of the subchondral bone plate. Osteoarthritis is a disease that does affect not only the articular cartilage, but also the subchondral bone. Reconstructive surgical techniques aim at preserving joint function, inducing fibrocartilaginous repair, and at correcting malalignment. This review summarizes the current status of the clinical treatment of traumatic osteochondral defects, osteochondritis dissecans, osteonecrosis, and osteoarthritis as they affect the subchondral bone region and its adjacent structures.
Department of Orthopaedic Surgery, Centre de l'Appareil Locomoteur de Médicine du Sport et de Prévention, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg.
Dietrich
D
Pape
Giuseppe
G
Filardo
Elisaveta
E
Kon
C Niek
CN
van Dijk
Henning
H
Madry
D000465:Algorithms; D001842:Bone and Bones / Q000473:pathology / Q000601:surgery; D002358:Cartilage, Articular / Q000293:injuries / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D019637:Orthopedic Procedures / Q000379:methods; D010003:Osteoarthritis / Q000473:pathology / Q000601:surgery*; D010008:Osteochondritis Dissecans / Q000473:pathology / Q000601:surgery*; D010020:Osteonecrosis / Q000473:pathology / Q000601:surgery*