The importance of the subchondral bone in the treatment of cartilage defects

The hyaline cartilage and subchondral bone form a highly complex osteochondral unit, closely communicating and depending on each other. The integrity of the subchondral bone is crucial for the hyaline cartilage both in its native state and following cartilage repair procedures. These tissues are not only in constant dynamic biochemical exchange but also simultaneously constitute a complex microarchitecture capable of effectively absorbing and distributing the daily mechanical loads. Alterations in either the hyaline cartilage or the subchondral bone lead to significant changes on the opposing side. Consequently, in the assessment and treatment of chondral and osteochondral defects, it is essential to evaluate the subchondral bone and, if necessary, treat it surgically to achieve optimal results after cartilage repair.