New aspects in the etiology of osteoarthritis

Author(s): Graf, J., Schneider, U., Niethard, F.

Journal/Book: Physikalische Medizin Rehabilitationsmedizin Kurortmedizin. 1994; 4/6: 197-201.

Abstract: Object: Searching for etiology of degenerative changes in hyaline cartilage, nowadays reveals numerous theories. These are: physical forces and biomaterial failure, cell injury (impaired chondrocyte nutrition, immobilisation compression), synovial changes, microfractures or other extracartilaginous factors with cartilage changes being secondary. There is some evidence concerning a relationship between the subchondral area and degeneration in the cartilage. In the international literature many authors suggest that these changes depend an microvascular irritation and its consequences in the intraosseous pressure.Design: a) In an animal experiment all the vessels of the patella in rabbits were ligated. After different periods the hyaline cartilage was examined with the methods of macroscopy, scanning electron microscopy and with the light microscope. b) In a second trial, the intraosseous Pressure were compared in patients with or without degenerative changes as well as during flexion and extension of the knee joint. 55 patients were measured with a specially constructed bone-biopsy needle. Based an the results of this investigationwe started to treat patients with patellar pain syndrome in a prospective study by means of an intraosseous drilling.Results: a) The results showed that our animal model is suitable to produce changes inside the hyaline cartilage similar to the well known changes in osteoarthritis. b) Patients with degenerative changes in the cartilage (evaluated by arthroscopy) have an increased intraosseous pressure, compared to patients with normal cartilage. In 95 % of our patients followed up over 12 month, an increased intraosseous pressure has been successfully reduced by a w-shaped intraosseous, extraarticular drilling. 80 % of the patients reported subjective improvement after the operation.Conclusion: Based an these results, we think that there must be a relationship between the subchondral area and degenerative cartilage diseases. We therefore think that in many cases of unknown origin in osteoarthritis the beginning is situated in the subchondral bone.

Keyword(s): Arthrose

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