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Advances in Anatomy
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Vol. 141
Editors
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K. Zilles, Dusseldorf
Springer-Verlag Berlin Heidelberg GmbH
Magdalena Miiller-Gerbl
The Subchondral
Bone Plate
With 29 Figures and 16 Tables
Springer
MAGDALENA MULLER-GERBL
Anatomische Anstalt I
PettenkoferstraBe 11
80336 Munchen
Germany
ISBN 978-3-540-63673-1 ISBN 978-3-642-72019-2 (eBook)
DOI 10.1007/978-3-642-72019-2
Library of Congress-Cataloging-in-Publication Data
Miiller-Gerbl, Magdalena: The subchondral bone plate 1 Magdalena Miiller
Gerbl. p. cm. - (Advances in anatomy, embrology, and cell biology; Vol. 141)
Includes bibliographical references and index.
1. Bones, 2. Bone densitometry, 3. Joints, 4. Biominerlization, I. Title, II.
Series. QL801.E67 Vol. 141
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Dedicated to my husband Michael
my son Maximilian
and my mentor Professor Dr. R. Putz
Contents
1 Introduction (Review of Literature) .................. 1
1.1 Preliminary Remarks ............................... 1
1.2 General Mechanisms for the Regulation
of the Morphology of Bone Tissue .................... 3
1.3 Morphology of the Subchondral Bone ................. 5
1.3.1 Definition of the Term "Subchondral Bone" .... 5
1.3.2 Structure of Normal Subchondral Bone ........ 6
1.3.2.1 Architecture ................................ 6
1.3.2.2 Vascularity of the Subchondral Bone Plate ..... 7
1.3.2.3 Thickness of the Subchondral Bone Plate ...... 9
1.3.2.4 Density Distribution in the Subchondral Plate .. 9
1.3.3 Structure of Pathologically Altered
Subchondral Bone .......................... 10
1.3.3.1 In Osteoarthritis (OA) ....................... 10
1.3.3.2 In Chondromalacia Patellae .................. 13
1.3.4 Mechanical Properties
of the Subchondral Bone Plate in Normal
and Pathological Conditions ................. 14
1.3.4.1 Strength of Subchondral Bone ................ 14
1.3.4.2 Stiffness of the Subchondral Bone Plate ........ 16
1.3.4.3 Energy Absorption Capacity
of the Subchondral Bone Plate ................ 17
1.3.4.4 Hardness of the Subchondral Bone Plate ....... 18
1.3.5 Correlation Between Structural Parameters
and Mechanical Properties ................... 18
1.4 Function of the Subchondral Bone Plate ............... 20
1.5 Possible Pathomechanisms Leading
to Osteoarthritic Changes ........................... 21
1.5.1 Is Osteoarthritis a "Final Common Pathway"? .. 22
1.6 Factors Regulating the Remodeling
of the Subchondral Bone . . . . . . . . . . . . . . . . . . . . . . . . . . .. 24
1.7 The Aims of this Investigation ....................... 27
VII
2 Materials •••....•••.••.•....•................••.....• 29
2.1 Material for the Validation of CT -OAM ............... 29
2.2 Materials Used for CT-OAM ......................... 31
2.2.1 Spine Samples .............................. 31
2.2.2 Shoulder Joint Samples ...................... 31
2.2.3 Elbow Joint Samples ........................ 31
2.2.4 Radiocarpal Joint Samples ................... 31
2.2.5 Hip Joint Samples .......................... 32
2.2.6 Femorotibial Joint Samples .................. 32
2.2.7 Animal Studies of the Femorotibial Joint ...... 32
2.2.8 Femoropatellar Joint Samples ................ 32
2.2.9 Ankle Joint Samples ......................... 32
3 Methods ••...•..•..•...•......•......••.•...••.•..•• 33
3.1 X-ray Densitometry ................................ 33
3.2 CT OAM Used to Demonstrate the Patterns
of Subchondral Mineralization in the Living Subject .... 33
3.2.1 CTOAM
With a Radiotherapy Planning Computer ...... 33
3.2.2 CT OAM With an X-Ray Computer Tomograph. 34
3.2.3 CT OAM Processed by Means
of the Software ANALyZE ................... 36
3.3 The Production of Secondary Sections ................ 38
3.4 Dual-energy QCT with basis material decomposition ... 38
3.5 Methods of Achieving Standardized Evaluation
and Quantification of the Mineralization Patterns ...... 38
3.5.1 Localization and Displacement of the Maxima . 38
3.5.2 Degree of Mineralization .................... 40
3.5.3 Extent of Changes in Depth .................. 40
4 Validation ofCT OAM ............................... 41
M. MULLER-GERBL, N. HODAPP
4.1 Comparison with Conventional Procedures ........... 41
4.1.1 The Physical Background to the Assessment
of the Mineral Content of Bone Tissue
by Means of the X-Ray Densitometry
ofThin Sections and Using CT or DEQCT ..... 41
4.1.2 The Basis of X-Ray Densitometry ............. 43
4.1.3 The Basis ofCT OAM ....................... 43
4.1.4 Conventional X-Ray Densitometry as Applied
to Physical Sections Compared with CT OAM .. 44
4.1.4.1 First Model (Two Component Model) ......... 46
4.1.4.2 Second Model (Four Component Model) ...... 46
VIII
4.2 Dependence of the Absorption Value
on the Calcium Concentration ....................... 54
4.2.1 Fundamentals of Dual Energy Quantitative
Computed Tomography (DEQCT)
with Basis Material Decomposition. ........... 54
4.2.1.1 Selective Measurement and Imaging
of Substances ............................... 56
4.2.1.2 Calibration of Values Against
a Standard Phantom Bone ................... 57
4.2.2 Comparison of the Hounsfield
and Calcium Values ......................... 58
4.3 The Use ofCT OAM in Connection
With Sections Cut at Other Angles .................... 60
5 Mineralization Patterns in Healthy Subjects. . . . . . . . . .. 65
5.1 Vertebral Column (Lumbar Region) .................. 65
5.2 Shoulder Joint ..................................... 66
5.2.1 Control Group .............................. 66
5.2.2 Mineralization Patterns of Athletes ............ 68
5.2.3 Mineralization Patterns
in Cases of Unreduced Traumatic Dislocation
of the Shoulder Joint ........................ 68
5.3 Elbow Joint ........................................ 68
5.4 Radiocarpal Joint ................................... 70
5.5 Hip Joint .......................................... 70
5.6 Femorotibial Joint. ................................. 72
5.7 Femoropatellar Joint. ............................... 74
5.8 Ankle Joint ........................................ 74
6 Pathological Mineralization Patterns. . . . . . . . . . . . . . . .. 77
6.1 Vertebral Column .................................. 77
6.1.1 Low-Grade Scoliosis ......................... 77
6.2 Shoulder Joint ..................................... 77
6.2.1 Comparison Between Individuals with Healthy
and Diseased Shoulders. . . . . . . . . . . . . . . . . . . . .. 77
6.3 Radiocarpal Joint. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 79
6.3.1 Healed Defective Repositioning
of a Distal Fracture of the Radius ............. 79
6.3.2 KienbOck's Disease
(Avascular Necrosis of the Lunate) ............ 79
6.4 Hip Joint .......................................... 79
6.4.1 Dysplasia of the Hip. . . . . . . . . . . . . . . . . . . . . . . .. 79
6.5 Femorotibial Joint .................................. 80
IX
6.5.1 Patterns in Patients with Malalignment
of the Knee Joint ........................... 80
6.5.2 Patterns Found in Patients
with Genu Varum
After a Correction Osteotomy ............... 80
6.5.3 Patterns Following Reconstruction
of the Anterior Cruciate Ligament
with a Patellar Tendon Transplant (Sheep) .... 83
6.5.4 Patterns After Medial Meniscectomy (Sheep) .. 83
6.5.5 Patterns After Primary Replacement
of the Meniscus by an Autogenous Graft
of the Patellar Tendon Covered
with a Layer of Fascia Lata .................. 83
6.6 Femoropatellar Joint .............................. 89
6.6.1 Patients with Retropatellar Pain ............. 89
7 Factors Influencing the Development
of Normal Patterns of Mineralization ............... 91
7.1 The Shape of the Joint Surfaces..................... 92
7.1.1 Spherical and Hinge Joints. . . . . . . . . . . . . . . .. 92
7.1.2 Nonspherical Joints.. . . . . . . . . . . . . . . . . . . . . .. 95
7.2 The Magnitude ofthe Joint Reaction Force. . . . . . . . . .. 97
7.3 Position and Extent of the Contact Surfaces. . . . . . . . . . 99
7.4 Penetration Point of the Joint Reaction Force. . . . . . . .. 100
7.5 Changes in the Mineralization Patterns with Age ...... 101
8 Factors Influencing the Development
of Pathological Patterns of Mineralization ........... 103
8.1 Abnormal Geometrical Relationships ................ 103
8.2 Changes in the Magnitude of the Joint Reaction Force. 104
8.3 Changes in Size and Position of the Contact Surfaces .. 104
8.4 Changes in the Penetration Point
of the Joint Reaction Force ......................... 105
8.5 The Temporal Course of the Changes ................ 107
9 Possible Clinical Application of CT OAM ............ 109
9.1 Basic Clinical Research ............................ 109
9.2 Diagnosis ........................................ 111
9.3 Following the Progress of Treatment ................ 112
10 Summary ........................................ 115
x
