Subcondral Reconditioning in the Ankle

Joint preservation has traditionally focused on cartilage restoration, but with mixed results. One example is a meta-analysis by Rikken et al. reporting “satisfactory” results with microfracture, despite a third of patients showing progressive cartilage and subchondral deterioration. Many in the cartilage space believe the missing link for joint preservation is a treatment strategy for the subchondral bone.

Symptoms correlate with subchondral changes

Edema is a signal of subchondral bone injury, and it correlates with outcomes. In a study of 30 patients treated for osteochondral defects of the talus, edema as measured by MRI was prognostic for clinical outcome. Patients with moderate or severe edema after treatment were more likely to have a poor clinical result. 

Innovations in subchondral insufficiency treatment

KneeBar is a surgical technique for subchondral insufficiency fractures of the femur and tibia, using OSSIO's bio-integrative 4.0mm cannulated, trimmable fixation nail. In one study, patients saw consistent improvements in pain and function at 6, 12, and 24 months, with meaningful gains in both KOOS and IKDC scores after treatment for insufficiency fractures – a form of subchondral injury.

AnkleBar

Early evidence suggests similar success in persistent distal tibia edema associated with injury or evolving cartilage deterioration. Watch for more focus on the subchondral bone in ankle joint preservation.