Subchondral drilling for articular cartilage repair: a systematic review of translational research

Abstract

Articular cartilage defects may initiate osteoarthritis. Subchondral drilling, a widely applied clinical technique to treat small cartilage defects, does not yield cartilage regeneration. Various translational studies aiming to improve the outcome of drilling have been performed; however, a robust systematic analysis of its translational evidence was still lacking. Here, we performed a systematic review of the outcome of subchondral drilling for knee cartilage repair in translational animal models. A total of 12 relevant publications studying 198 animals was identified, detailed study characteristics were extracted, and methodological quality and risk of bias were analyzed. Subchondral drilling led to improved repair outcome compared with defects that were untreated or treated with abrasion arthroplasty for cartilage repair in multiple translational models. Within the 12 studies, considerable subchondral bone changes were observed, including subchondral bone cysts and intralesional osteophytes. Furthermore, extensive alterations of the subchondral bone microarchitecture appeared in a temporal pattern in small and large animal models, together with specific topographic aspects of repair. Moreover, variable technical aspects directly affected the outcomes of osteochondral repair. The data from this systematic review indicate that subchondral drilling yields improved short-term structural articular cartilage repair compared with spontaneous repair in multiple small and large animal models. These results have important implications for future investigations aimed at an enhanced translation into clinical settings for the treatment of cartilage defects, highlighting the importance of considering specific aspects of modifiable variables such as improvements in the design and reporting of preclinical studies, together with the need to better understand the underlying mechanisms of cartilage repair following subchondral drilling.

Association of Nicotine with Osteochondrogenesis and Osteoarthritis Development: The State of the Art of Preclinical Research

“…Finally, nicotine negatively influenced MSC-based osteochondral repair, perhaps through a decreased expression of Col2a1 following suppressing of SOX9 in a rat model [9]. This report is in good agreement with the known inhibitory effects of nicotine on MSC chondrogenesis in vitro [9,22,23] since MSC is a key cell type involved in spontaneous and therapeutic osteochondral repair [36,37].…”

Exosomes produced from 3D cultures of umbilical cord mesenchymal stem cells in a hollow-fiber bioreactor show improved osteochondral regeneration activity

“…The adult hyaline articular cartilage is an avascular tissue that exhibits limited self-renewal capacity (Chijimatsu and Saito 2019). Traditional treatment modalities such as autografting, autologous chondrocyte implantation, and micro-fracture can temporarily alleviate symptoms, but often fail to fully restore the damaged cartilage because the regenerated tissue is unable develop an organized tissue architecture with surrounding hyaline cartilage (Gao et al 2018).…”

Articular Cartilage Regeneration in Osteoarthritis

“…Osteotomy involves adding or removing a small section of bone either above or below the joint; it is aimed at unloading the damaged area, reducing pain, and slowing the degenerative process [21,22]. “Marrow stimulation techniques”, like subchondral drilling, consist in subchondral bone penetration, thus inducing bleeding and migration of bone marrow stem cells to the site of injury, along with blood clot formation [23]. However, generally, the resulting repair tissue is mainly composed of fibrocartilage [24].…”