The Subchondral Bone Is Affected by Bone Marrow Stimulation: A Systematic Review of Preclinical Animal Studies

Seow, D. and Yasui, Y. and Hutchinson, I. D. and Hurley, E. T. and Shimozono, Y. and Kennedy, J. G.

Cartilage (2019) 10: 70–81

DOI: 10.1177/1947603517711220

Abstract

OBJECTIVE: Despite the mechanical and biological roles of subchondral bone (SCB) in articular cartilage health, there remains no consensus on the postoperative morphological status of SCB following bone marrow stimulation (BMS). The purpose of this systematic review was to clarify the morphology of SCB following BMS in preclinical, translational animal models. DESIGN: The MEDLINE and EMBASE databases were systematically reviewed using specific search terms on April 19, 2016 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The morphology of the SCB was assessed using of microcomputed tomography (bone density) and histology (microscopic architecture). RESULTS: Seventeen animal studies with 520 chondral lesions were included. The morphology of SCB did not recover following BMS. Compared with untreated chondral defects, BMS resulted in superior morphology of superficial SCB and cartilage but inferior morphology (specifically bone density, P \textless 0.05) of the deep SCB. Overall, the use of biological adjuvants during BMS resulted in the superior postoperative morphology of SCB. CONCLUSIONS: Alterations in the SCB following BMS were confirmed. Biologics adjuvants may improve the postoperative morphology of both SCB and articular cartilage. Refinements of BMS techniques should incorporate consideration of SCB damage and restoration. Investigations to optimize BMS techniques incorporating both minimally invasive approaches and biologically augmented platforms are further warranted.

Citation

Seow, D., Yasui, Y., Hutchinson, I. D., Hurley, E. T., Shimozono, Y., & Kennedy, J. G. (2019). The Subchondral Bone Is Affected by Bone Marrow Stimulation: A Systematic Review of Preclinical Animal Studies. Cartilage, 10(1), 70–81. https://doi.org/10.1177/1947603517711220 Animals, Treatment Outcome, Postoperative Period, *animal models, *systematic review, Bone Marrow Transplantation/*methods, *Bone Density, *bone marrow stimulation, *subchondral bone, Arteriocyte Inc, Biological Products/therapeutic use, Bone and Bones/*physiopathology, Cartilage, Articular/*physiopathology, conflicts of interest with respect to the research, authorship, and/or publication, is a board member for the European Society of Sports Traumatology,, Knee Surgery, and Arthroscopy (ESSKA), International Society for Cartilage Repair of, of this article: John G. Kennedy is a consultant for Arteriocyte, Inc, Osteochondritis/physiopathology/*therapy, received, research support from the Ohnell Family Foundation, Mr. and Mrs. Michael J. Levitt,, Scholarships Committee, International Cartilage Repair Society (ICRS) finance board., the Ankle (ISCRA), American Orthopaedic Foot & Ankle Society (AOFAS) Awards and

Keywords

• Animals
• Treatment Outcome
• Postoperative Period
• *animal models
• *systematic review
• Bone Marrow Transplantation/*methods
• *Bone Density
• *bone marrow stimulation
• *subchondral bone
• Arteriocyte Inc
• Biological Products/therapeutic use
• Bone and Bones/*physiopathology
• Cartilage
• Articular/*physiopathology
• conflicts of interest with respect to the research
• authorship
• and/or publication
• is a board member for the European Society of Sports Traumatology,
• Knee Surgery
• and Arthroscopy (ESSKA)
• International Society for Cartilage Repair of
• of this article: John G. Kennedy is a consultant for Arteriocyte
• Inc
• Osteochondritis/physiopathology/*therapy
• received
• research support from the Ohnell Family Foundation
• Mr. and Mrs. Michael J. Levitt,
• Scholarships Committee
• International Cartilage Repair Society (ICRS) finance board.
• the Ankle (ISCRA)
• American Orthopaedic Foot & Ankle Society (AOFAS) Awards and