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Epidemiology and imaging of the subchondral bone in articular cartilage repair

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Articular cartilage and the subchondral bone act as a functional unit. Following trauma, osteochondritis dissecans, osteonecrosis or osteoarthritis, this intimate connection may become disrupted. Osteochondral defects—the type of defects that extend into the subchondral bone—account for about 5% of all articular cartilage lesions. They are very often caused by trauma, in about one-third of the cases by osteoarthritis and rarely by osteochondritis dissecans. Osteochondral defects are predominantly located on the medial femoral condyle and also on the patella. Frequently, they are associated with lesions of the menisci or the anterior cruciate ligament. Because of the close relationship between the articular cartilage and the subchondral bone, imaging of cartilage defects or cartilage repair should also focus on the subchondral bone. Magnetic resonance imaging is currently considered to be the key modality for the evaluation of cartilage and underlying subchondral bone. However, the choice of imaging technique also depends on the nature of the disease that caused the subchondral bone lesion. For example, radiography is still the golden standard for imaging features of osteoarthritis. Bone scintigraphy is one of the most valuable techniques for early diagnosis of spontaneous osteonecrosis about the knee. A CT scan is a useful technique to rule out a possible depression of the subchondral bone plate, whereas a CT arthrography is highly accurate to evaluate the stability of the osteochondral fragment in osteochondritis dissecans. Particularly for the problem of subchondral bone lesions, image evaluation methods need to be refined for adequate and reproducible analysis. This article highlights recent studies on the epidemiology and imaging of the subchondral bone, with an emphasis on magnetic resonance imaging.

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Acknowledgments

We thank Elke Dooley for help with the manuscript preparation. Supported in part by the Deutsche Forschungsgemeinschaft (DFG) and the Fonds National de la Recherche (FNR).

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Authors and Affiliations

  1. Institute for Experimental Orthopaedics, Saarland University and Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Strasse, Building 37, 66421, Homburg, Germany

    Henning Madry

  2. Unité d’orthopédie et traumatologie du sport, Service de chirurgie orthopédique et traumatologie de l’appareil moteur, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland

    Jacques Menetrey & Florence Unno-Veith

  3. Gent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Iwan Van Breuseghem

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  1. Jacques Menetrey
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Correspondence to Henning Madry.

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Menetrey, J., Unno-Veith, F., Madry, H. et al. Epidemiology and imaging of the subchondral bone in articular cartilage repair. Knee Surg Sports Traumatol Arthrosc 18, 463–471 (2010). https://doi.org/10.1007/s00167-010-1053-0

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