Bio-orthopaedics pp 479-486

Subchondral Bone: Healthy Soil for the Healthy Cartilage

Chapter

Abstract

Role of subchondral bone in the natural healing of the cartilage has been largely ignored during the last few decades; whereas the cartilage repair science evolved continuously. Clinicians and scientists were aware of the various properties of the subchondral bone; like nutrition to the cartilage, load sharing with the cartilage and as a constant supplier of chondroblasts, pluripotent cells and the growth factors to the cartilage. Various conditions like osteochondritis dissecans, osteonecrosis, bone marrow oedema in chondral injuries etc constantly indicated that the subchondral bone and the cartilage are one single unit-the osteochondral unit. However, there was an unintended neglect about the role of these important properties of the subchondral bone in the natural repair of the cartilage. The subchondral bone and the overlying cartilage, work as one integral unit and help each other in maintaining the biomechanical equilibrium. The relation between both the components is like a soil-plant relationship where none can survive without the other part. A proper attention to the subchondral bone is thus important to maintain a healthy cartilaginous tissue under physiological stresses and to regenerate a healthy cartilage in case of the cartilage damage.

References

  1. 1.
    Madry H, Dijk CN, Mueller-Gerbl M. The basic science of the subchondral bone. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):419–33.CrossRefPubMedGoogle Scholar
  2. 2.
    Brittberg M. Autologous chondrocyte implantation–technique and long-term follow-up. Injury. 2008;39(Suppl 1):S40–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Gomoll AH, Madry H, Knutsen G, et al. The subchondral bone in articular cartilage repair: current problems in the surgical management. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):434–47.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Imhof H, Breitenseher M, Kainberger F, Rand T, Trattnig S. Importance of subchondral bone to articular cartilage in health and disease. Top Magn Reson Imaging. 1999;10(3):180–92.CrossRefPubMedGoogle Scholar
  5. 5.
    Fisher AGT. Chronic (non-tuberculous) arthritis. London: HK Lewis; 1929.Google Scholar
  6. 6.
    Berry JL, Thaeler-Oberdoerster DA, Greenwald AS. Subchondral pathways to the superior surface of the human talus. Foot Ankle. 1986;7:2–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Nakano T, Thompson JR, Christopherson RJ, Aherne FX. Blood flow distribution in hind limb bones and joint cartilage from young growing pigs. Can J Vet Res. 1986;50(1):96–100.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Lyons TJ, McClure SF, Stoddart RW, McClure J. The normal human chondro-osseous junctional region: evidence for contact of uncalcified cartilage with subchondral bone and marrow spaces. BMC Musculoskelet Disord. 2006;7:52.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Pan J, Zhou X, Li W, Novotny JE, Doty SB, Wang L. In situ measurement of transport between subchondral bone and articular cartilage. J Orthop Res. 2009;27(10):1347–52.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Lane LB, Villacin A, Bullough PG. The vascularity and remodelling of subchondrial bone and calcified cartilage in adult human femoral and humeral heads. An age- and stress-related phenomenon. J Bone Joint Surg Br. 1977;59(3):272–8.PubMedGoogle Scholar
  11. 11.
    Hoechel S, Wirz D, Müller-Gerbl M. Density and strength distribution in the human subchondral bone plate of the patella. Int Orthop. 2012;36(9):1827–34.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Milz S, Putz R. Quantitative morphology of the subchondral plate of the tibial plateau. J Anat. 1994;185(Pt 1):103–10.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Salsich GB, Ward SR, Terk MR, Powers CM. In vivo assessment of patellofemoral joint contact area in individuals who are pain free. Clin Orthop Relat Res. 2003;417:277–84.Google Scholar
  14. 14.
    Kraljević M, Zumstein V, Wirz D, Hügli R, Müller-Gerbl M. Mineralisation and mechanical strength of the glenoid cavity subchondral bone plate. Int Orthop. 2011;35(12):1813–9.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Muller-Gerbl M, Dalstra M, Ding M, Linsenmeier U, Putz R, Hvid I. Distribution of strength and mineralization in the subchondral bone plate of human tibial heads. J Biomech. 1998;31(Suppl 1):123. Proceedings of the 11th conference of the European society of biomechanics.CrossRefGoogle Scholar
  16. 16.
    Egloff C, Paul J, Pagenstert G, et al. Changes of density distribution of the subchondral bone plate after supramalleolar osteotomy for valgus ankle osteoarthritis. J Orthop Res. 2014;32(10):1356–61.CrossRefPubMedGoogle Scholar
  17. 17.
    Milz S, Eckstein F, Putz R. The thickness of the subchondral plate and its correlation with the thickness of the uncalcified articular cartilage in the human patella. Anat Embryol (Berl). 1995;192:437–44.CrossRefGoogle Scholar
  18. 18.
    Qiu Y-S, Shahgaldi BF, Revell WJ, Heatley FW. Observations of subchondral plate advancement during osteochondral repair: a histomorphometric and mechanical study in the rabbit femoral condyle. Osteoarthr Cartil. 2003;11(11):810-820.Google Scholar
  19. 19.
    Orth P, Goebel L, Wolfram U, et al. Effect of subchondral drilling on the microarchitecture of subchondral bone: analysis in a large animal model at 6 months. Am J Sports Med. 2012;40(4):828–36.CrossRefPubMedGoogle Scholar
  20. 20.
    Goyal D, Keyhani S, Lee EH, Hui JHP. Evidence-based status of microfracture technique: a systematic review of level I and II studies. Arthroscopy. 2013;29(9):1579–88.CrossRefPubMedGoogle Scholar

Copyright information

© ISAKOS 2017

Authors and Affiliations

  1. 1.Saumya Orthocare: Centre for Advanced Surgeries of the Knee JointAhmedabadIndia
  2. 2.Department of PathologySmt NHL Municipal Medical CollegeAhmedabadIndia
  3. 3.Department of Orthopaedic Surgery, Graduate School of Biomedical SciencesHiroshima UniversityHiroshimaJapan

Personalised recommendations