Subchondral Bone Grafting

The importance of subchondral bone in the pathogenesis of osteoarthritis is well known, but its crucial role in the treatment of traumatic cartilage lesions is still underestimated. The subchondral bone region is both an important shock absorber and crucial for the cartilage nutrition and metabolism. When repairing chondral and osteochondral lesions, more knowledge is needed of how to return the cartilage-bone unit into a well-functioning biomechanical area in order to reestablish the disturbed joint homeostasis. Clinically, subchondral grafting is often used when repairing osteochondral defects, and the surgeon has to consider how to best fill up the subchondral area for the best development of the overlying cartilage. However, also pure chondral lesions with sclerotic bone plates might be turned into a subchondral lesion to improve the gradient repair from bone to cartilage area. Autologous bone in different formats is most often the first choice when repairing defects, but allogeneic and synthetic bone alternatives are in much use. This chapter will discuss the importance of the subchondral bone and how to use subchondral bone grafting in combination with cartilage repairs