Subchondral Insufficiency in Osteochondral Lesions & Osteoarthritisof the Foot & Ankle

​Subchondral insufficiency is defined as a type of stress fracture occurring below the cartilage surface on the weight bearing surface of a bone. It occurs when normal physiological forces are repeatedly applied to an area compromised by a non-tumorous disease resulting in fracture. The consequences? Cartilage degeneration and osteoarthritis.

A fine balance

Together, the cartilaginous, subchondral cortical, and subchondral trabecular bone surfaces of weight-bearing joints interact as a single osteochondral unit, maintaining native biological and mechanical function. However, because the compounds work in concert, any alteration to a singular components creates a ripple effect of disruption on the other components.

Restoring the osteochondral unit

Microfracture, a.k.a. bone marrow stimulation, autologous osteochondral transplantation and allogenic juvenile chondrocyte transplantation have been viewed as mainstays of treatment for osteochondral lesions of the foot and ankle. All have been limited by less than satisfactory mid-term to long-term outcomes, donor-site morbidity, and/or cost.

Subchondral Solutions, a Huntington Beach, CA-based company led by CEO Thomas Kinder, is staking its claim for treatment of the entire osteochondral unit with its S-Core technology. S-Core is a fenestrated and threaded implant plug designed from a titanium alloy coated with hydroxyapatite. A dermal graft product is added to the plug prior to insertion, recreating all 3 layers of the osteochondral unit. FDA clearance was issued in mid-2020.

A white paper showing promising early clinical outcomes is set to release soon.