Disease-specific clinical problems associated with the subchondral bone

被引:72
作者
Pape, Dietrich [3 ]
Filardo, Giuseppe [4 ]
Kon, Elisaveta [4 ]
van Dijk, C. Niek [5 ]
Madry, Henning [1 ,2 ]
机构
[1] Univ Saarland, Inst Expt Orthopaed, D-66421 Homburg, Germany
[2] Univ Saarland, Dept Orthopaed Surg, Med Ctr, D-66421 Homburg, Germany
[3] Ctr Hospi Luxembourg, Clin Eich, Ctr Appareil Locomoteur Med Sport & Prevent, Dept Orthopaed Surg, L-1460 Luxembourg, Luxembourg
[4] Ist Ortoped Rizzoli, Lab Biomeccan, I-40136 Bologna, Italy
[5] Univ Amsterdam, Acad Med Ctr, Dept Orthopaed Surg, NL-1100 DD Amsterdam, Netherlands
关键词
Subchondral bone; Osteochondral defects; Osteochondritis dissecans; Osteonecrosis; Osteoarthritis; HIGH TIBIAL OSTEOTOMY; MEDIAL FEMORAL CONDYLE; FRESH OSTEOCHONDRAL ALLOGRAFTS; TERM-FOLLOW-UP; ARTHROSCOPIC SURGERY; SPONTANEOUS OSTEONECROSIS; ARTICULAR-CARTILAGE; SURGICAL TECHNIQUE; CRUCIATE LIGAMENT; CHONDRAL DEFECTS;
D O I
10.1007/s00167-010-1052-1
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
100224 [整形外科学];
摘要
The subchondral bone is involved in a variety of diseases affecting both the articular cartilage and bone. Osteochondral defects in distinct locations and of variable sizes are the final results of different etiologies. These include traumatic osteochondral defects, osteochondritis dissecans, osteonecrosis, and osteoarthritis. Traumatic osteochondral defects are caused by osteochondral fractures, separating an osteochondral fragment that includes articular cartilage and both subchondral and trabecular bone from the joint surface. In osteochondritis dissecans, the disease originates in the subchondral bone and secondarily affects the articular cartilage. Location, stage, size, and depth of osteochondral lesions play a role in the treatment of traumatic osteochondral defects and osteochondritis dissecans. Surgical options include fragment refixation, transplantation of osteochondral autografts, or bone restoration by impacted cancellous bone grafts combined with autologous chondrocyte transplantation. An insufficiency fracture of the subchondral bone may be the initiating factor of what was formerly believed to be a spontaneous osteonecrosis of the knee (SPONK). Recent histopathological studies suggest that each stage of SPONK reflects different types of bone repair reactions following a fracture of the subchondral bone plate. Osteoarthritis is a disease that does affect not only the articular cartilage, but also the subchondral bone. Reconstructive surgical techniques aim at preserving joint function, inducing fibrocartilaginous repair, and at correcting malalignment. This review summarizes the current status of the clinical treatment of traumatic osteochondral defects, osteochondritis dissecans, osteonecrosis, and osteoarthritis as they affect the subchondral bone region and its adjacent structures.
引用
收藏
页码:448 / 462
页数:15
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