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Knee Surg Sports Traumatol Arthrosc (2010) 18:419433 DOI 10.1007/s00167-010-1054-z
KNEE
The basic science of the subchondral bone
Henning Madry C. Niek van Dijk
Magdalena Mueller-Gerbl
Received: 18 December 2009 / Accepted: 8 January 2010 / Published online: 30 January 2010 Springer-Verlag 2010
Abstract In the past decades, considerable efforts have been made to propose experimental and clinical treatments for articular cartilage defects. Yet, the problem of cartilage defects extending deep in the underlying subchondral bone has not received adequate attention. A profound understanding of the basic anatomic aspects of this particular site, together with the pathophysiology of diseases affecting the subchondral bone is the key to develop targeted and effective therapeutic strategies to treat osteochondral defects. The subchondral bone consists of the subchondral bone plate and the subarticular spongiosa. It is separated by the cement line from the calcied zone of the articular cartilage. A variable anatomy is characteristic for the subchondral region, reected in differences in thickness, density, and composition of the subchondral bone plate, contour of the tidemark and cement line, and the number and types of channels penetrating into the calcied
cartilage. This review aims at providing insights into the anatomy, morphology, and pathology of the subchondral bone. Individual diseases affecting the subchondral bone, such as traumatic osteochondral defects, osteochondritis dissecans, osteonecrosis, and osteoarthritis are also discussed. A better knowledge of the basic science of the subchondral region, together with additional investigations in animal models and patients may translate into improved therapies for articular cartilage defects that arise from or extend into the subchondral bone.
Keywords Subchondral bone Subchondral bone plate
Osteochondral defects Osteochondritis dissecans
Osteonecrosis Osteoarthritis
Introduction
Subchondral bone lesions are commonly associated with articular cartilage defects. Although promising results have been achieved in the past two decades to treat isolated cartilage defects [13], the problem of cartilage defects extending into the underlying subchondral bone has not received much attention so far. Several reviews of treatment strategies for chondral defects have been published [9, 15, 59, 106], but few have elaborated on the basic scientic and technical issues that continue to complicate the treatment of osteochondral lesions. To adequately evaluate and treat lesions that extend into the subchondral bone, a deep understanding of the subchondral bone anatomy and morphology is necessary....