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

Andreas H. Gomoll, Henning Madry, Gunnar Knutsen, Niek van Dijk, Romain Seil, Mats Brittberg, Elizaveta Kon

    Research output: Contribution to journalArticleResearchpeer-review

    315 Citations (Scopus)

    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.

    Original languageEnglish
    Pages (from-to)434-447
    Number of pages14
    JournalKnee Surgery, Sports Traumatology, Arthroscopy
    Volume18
    Issue number4
    DOIs
    Publication statusPublished - Apr 2010

    Keywords

    • Autologous chondrocyte implantation
    • Cartilage repair
    • Microfracture
    • Subchondral bone

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