Pathogenetic and clinical aspects of osteoarthritis and osteoarthritis-associated defects of the cartilage of the knee joint from the standpoint of understanding the role of the subchondral bone

The article presents an analytical review on modern ideas about the osteoarthritis pathogenesis based on the findings regarding the subchondral bone and its importance in the development of this disease. It is shown that the data of numerous studies in recent years reveal more and more evidence demonstrating the primacy of pathological changes in the subchondral bone in the development of osteoarthritis and its progression. The vast majority of scientific papers confirm the fact that hyaline cartilage and subchondral bone tissue are a single morphofunctional biocomposite with an interdependent system of biochemical connections and molecular signaling, as well as correlative reactions to stressful mechanical loads. The authors analyzed in detail the mechanisms of cellular and molecular interaction in the system "hyaline cartilage — subchondral bone" in the development of osteoarthritis, vividly demonstrating the active and priority involvement of subchondral bone tissue in the debut and maintenance of the destructive-dystrophic process. The necessity to leave the chondrocentric model of osteoarthritis pathogenesis and the expediency to revise the points of application of therapeutic measures in patients with knee joint osteoarthritis are discussed. The current methods of surgical treatment of knee joint osteoarthritis are critically reviewed from the perspective of their pathogenetic orientation. The authors discuss the relevance in developing the concept of organ-preserving surgery in destructive-dystrophic joint lesions, which should be based on the findings describing the role and significance of subchondral and metaphyseal bone tissue in the above pathologic processes.