The subchondral bone in articular cartilage repair: current problems in the surgical management

Abstract

As the understanding of interactions between articular cartilage and subchondral bone continues to evolve, increased attention is being directed at treatment options for the entire osteochondral unit, rather than focusing on the articular surface only. It is becoming apparent that without support from an intact subchondral bed, any treatment of the surface chondral lesion is likely to fail. This article reviews issues affecting the entire osteochondral unit, such as subchondral changes after marrow-stimulation techniques and meniscectomy or large osteochondral defects created by prosthetic resurfacing techniques. Also discussed are surgical techniques designed to address these issues, including the use of osteochondral allografts, autologous bone grafting, next generation cell-based implants, as well as strategies after failed subchondral repair and problems specific to the ankle joint. Lastly, since this area remains in constant evolution, the requirements for prospective studies needed to evaluate these emerging technologies will be reviewed.

Bioprinting of osteochondral tissues: A perspective on current gaps and future trends

“…There are five clinically available treatment options for osteochondral restoration. These include: 1) osteochondral autograft, 2) osteochondral allograft, 3) impaction bone grafting, 4) Autologous chondrocyte implantation (ACI) "Sandwich Technique", and 5) biphasic scaf folds [16][17][18][19][20][21][22][23][24][25][26] . These techniques, along with their strengths and limitations, are summarized in Table 1.…”

“…Currently, the most commonly utilized restorative option with the most data is osteochondral allograft, which combines viable donor subchondral bone and overlying hyaline articular cartilage [17,18] . This may be performed utilizing a shell or dowel technique incorporating differing amounts of subchondral bone, and can be titrated to the specific clinical situation and needs [18,24] .…”

“…This may be performed utilizing a shell or dowel technique incorporating differing amounts of subchondral bone, and can be titrated to the specific clinical situation and needs [18,24] . This graft provides living osteoblasts and osteocytes, as well as chondroblasts and chondrocytes, along with well-organized extracellular matrix to the defect without the donor site morbidity of autograft osteochondral plugs (mosaicplasty).…”

“…Its use in the patellofemoral compartment is limited because of surface contour matching and complexity. Osteochondral allograft, because of its viability, is particularly susceptible to both donor rejection and incorporation issues, as well as disease transmission [16,18,24] . In addition, because it is the most commonly utilized restorative option, availability is becoming more challenging, often with wait times of over a year, during which time continued pain, functional limitations, and lost work and wages may be experienced.…”

The subchondral bone: a new frontier in articular cartilage repair

“…The last article of this series delves into specific questions of contemporary approaches to common surgical problems affecting the subchondral bone [1]. Issues that continue to complicate the current treatments are reviewed, such as the thickening of the subchondral plate and formation of intralesional osteophytes observed after marrow stimulation techniques, or the large osteochondral defects resulting from removal of focal knee resurfacing implants.…”