Disease-specific clinical problems associated with the subchondral bone |
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Authors: | Dietrich Pape Giuseppe Filardo Elisaveta Kon C Niek van Dijk Henning Madry |
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Institution: | 3. Department of Orthopaedic Surgery, Centre de l’Appareil Locomoteur de Médicine du Sport et de Prévention, Centre Hospitalier de Luxembourg-Clinique d’Eich, 78, rue d’Eich, 1460, Luxembourg 4. Laboratorio di Biomeccanica, Istituti Ortopedici Rizzoli, Via Di Barbiano, 1/10, 40136, Bologna, Italy 5. Head of Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Room G4-219, PO Box 22660, 1100 DD, Amsterdam, The Netherlands 2. Institute for Experimental Orthopaedics, Saarland University and Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Strasse, Building 37, 66421, Homburg, Germany
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Abstract: | 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. |
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