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Beyond Cartilage Repair: The Role of the Osteochondral Unit in Joint Health and Disease

Once believed to be limited to articular cartilage, osteoarthritis is now considered to be an organ disease of the “whole joint.” Damage to the articular surface can lead to, be caused by, or occur in parallel with, damage to other tissues in the joint. The relationship between cartilage and the und...

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Published in:Tissue engineering. Part B, Reviews Reviews, 2019-04, Vol.25 (2), p.114-125
Main Authors: Lepage, Sarah I.M., Robson, Naomi, Gilmore, Hillary, Davis, Ola, Hooper, Allyssa, St. John, Stephanie, Kamesan, Vashine, Gelis, Paul, Carvajal, Diana, Hurtig, Mark, Koch, Thomas G.
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creator Lepage, Sarah I.M.
Robson, Naomi
Gilmore, Hillary
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Carvajal, Diana
Hurtig, Mark
Koch, Thomas G.
description Once believed to be limited to articular cartilage, osteoarthritis is now considered to be an organ disease of the “whole joint.” Damage to the articular surface can lead to, be caused by, or occur in parallel with, damage to other tissues in the joint. The relationship between cartilage and the underlying subchondral bone has particular importance when assessing joint health and determining treatment strategies. The articular cartilage is anchored to the subchondral bone through an interface of calcified cartilage, which as a whole makes up the osteochondral unit. This unit functions primarily by transferring load-bearing weight over the joint to allow for normal joint articulation and movement. Unfortunately, irreversible damage and degeneration of the osteochondral unit can severely limit joint function. Our understanding of joint pain, the primary complaint of patients, is poorly understood and past efforts toward structural cartilage restoration have often not been associated with a reduction in pain. Continued research focusing on the contribution of subchondral bone and restoration of the entire osteochondral unit are therefore needed, with the hope that this will lead to curative, and not merely palliative, treatment options. The purpose of this narrative review is to investigate the role of the osteochondral unit in joint health and disease. Topics of discussion include the crosstalk between cartilage and bone, the efficacy of diagnostic procedures, the origins of joint pain, current and emerging treatment paradigms, and suitable preclinical animal models for safety and efficacy assessment of novel osteochondral therapies. The goal of the review is to facilitate an appreciation of the important role played by the subchondral bone in joint pain and why the osteochondral unit as a whole should be considered in many cases of joint restoration strategies.
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identifier ISSN: 1937-3368
ispartof Tissue engineering. Part B, Reviews, 2019-04, Vol.25 (2), p.114-125
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subjects Animal models
Bone marrow
Calcification
Cartilage (articular)
Cartilage diseases
Clinical trials
Degeneration
Localization
NMR
Nuclear magnetic resonance
Osteoarthritis
Pain
Review
Review Articles
Subchondral bone
Tissue engineering
title Beyond Cartilage Repair: The Role of the Osteochondral Unit in Joint Health and Disease
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