The Subchondral Bone Plate

ISBN-13: 9783540636731 / Angielski / Miękka / 1998 / 134 str.

Magdalena Muller-Gerbl; M. Muller-Gerbl; Magdalena Muller-Gerbl

Opis

Investigations on anatomical specimens have demonstrated that the subchondral mineralization does indeed show regular distribution patterns from which conclusions about the mechanical situation within an individual joint may be drawn. Since radiographical densitometry and histological methods are only available for determining the adaptive reaction of the bone to the mechanical situation in a joint after death, the information obtained applies only to an end situation and tells us nothing about the development of the changes with time. Furthermore, investigations carried out on human specimens by radiographical densitometry mostly apply to samples of a particular age, since such specimens can be acquired only from departments of pathology, forensic medicine or anatomy.

Spis treści

1 Introduction (Review of Literature).- 1.1 Preliminary Remarks.- 1.2 General Mechanisms for the Regulation of the Morphology of Bone Tissue.- 1.3 Morphology of the Subchondral Bone.- 1.3.1 Definition of the Term “Subchondral Bone”.- 1.3.2 Structure of Normal Subchondral Bone.- 1.3.2.1 Architecture.- 1.3.2.2 Vascularity of the Subchondral Bone Plate.- 1.3.2.3 Thickness of the Subchondral Bone Plate.- 1.3.2.4 Density Distribution in the Subchondral Plate.- 1.3.3 Structure of Pathologically Altered Subchondral Bone.- 1.3.3.1 In Osteoarthritis (OA).- 1.3.3.2 In Chondromalacia Patellae.- 1.3.4 Mechanical Properties of the Subchondral Bone Plate in Normal and Pathological Conditions.- 1.3.4.1 Strength of Subchondral Bone.- 1.3.4.2 Stiffness of the Subchondral Bone Plate.- 1.3.4.3 Energy Absorption Capacity of the Subchondral Bone Plate.- 1.3.4.4 Hardness of the Subchondral Bone Plate.- 1.3.5 Correlation Between Structural Parameters and Mechanical Properties.- 1.4 Function of the Subchondral Bone Plate.- 1.5 Possible Pathomechanisms Leading to Osteoarthritic Changes.- 1.5.1 Is Osteoarthritis a “Final Common Pathway”?.- 1.6 Factors Regulating the Remodeling of the Subchondral Bone.- 1.7 The Aims of this Investigation.- 2 Materials.- 2.1 Material for the Validation of CT-OAM.- 2.2 Materials Used for CT-OAM.- 2.2.1 Spine Samples.- 2.2.2 Shoulder Joint Samples.- 2.2.3 Elbow Joint Samples.- 2.2.4 Radiocarpal Joint Samples.- 2.2.5 Hip Joint Samples.- 2.2.6 Femorotibial Joint Samples.- 2.2.7 Animal Studies of the Femorotibial Joint.- 2.2.8 Femoropatellar Joint Samples.- 2.2.9 Ankle Joint Samples.- 3 Methods.- 3.1 X-ray Densitometry.- 3.2 CT OAM Used to Demonstrate the Patterns of Subchondral Mineralization in the Living Subject.- 3.2.1 CT OAM With a Radiotherapy Planning Computer.- 3.2.2 CT OAM With an X-Ray Computer Tomograph.- 3.2.3 CT OAM Processed by Means of the Software ANALYZE.- 3.3 The Production of Secondary Sections.- 3.4 Dual-energy QCT with basis material decomposition.- 3.5 Methods of Achieving Standardized Evaluation and Quantification of the Mineralization Patterns.- 3.5.1 Localization and Displacement of the Maxima.- 3.5.2 Degree of Mineralization.- 3.5.3 Extent of Changes in Depth.- 4 Validation of CT OAM.- 4.1 Comparison with Conventional Procedures.- 4.1.1 The Physical Background to the Assessment of the Mineral Content of Bone Tissue by Means of the X-Ray Densitometry of Thin Sections and Using CT or DEQCT.- 4.1.2 The Basis of X-Ray Densitometry.- 4.1.3 The Basis of CT OAM.- 4.1.4 Conventional X-Ray Densitometry as Applied to Physical Sections Compared with CT OAM.- 4.1.4.1 First Model (Two Component Model).- 4.1.4.2 Second Model (Four Component Model).- 4.2 Dependence of the Absorption Value on the Calcium Concentration.- 4.2.1 Fundamentals of Dual Energy Quantitative Computed Tomography (DEQCT) with Basis Material Decomposition.- 4.2.1.1 Selective Measurement and Imaging of Substances.- 4.2.1.2 Calibration of Values Against a Standard Phantom Bone.- 4.2.2 Comparison of the Hounsfield and Calcium Values.- 4.3 The Use of CT OAM in Connection With Sections Cut at Other Angles.- 5 Mineralization Patterns in Healthy Subjects.- 5.1 Vertebral Column (Lumbar Region).- 5.2 Shoulder Joint.- 5.2.1 Control Group.- 5.2.2 Mineralization Patterns of Athletes.- 5.2.3 Mineralization Patterns in Cases of Unreduced Traumatic Dislocation of the Shoulder Joint.- 5.3 Elbow Joint.- 5.4 Radiocarpal Joint.- 5.5 Hip Joint.- 5.6 Femorotibial Joint.- 5.7 Femoropatellar Joint.- 5.8 Ankle Joint.- 6 Pathological Mineralization Patterns.- 6.1 Vertebral Column.- 6.1.1 Low-Grade Scoliosis.- 6.2 Shoulder Joint.- 6.2.1 Comparison Between Individuals with Healthy and Diseased Shoulders.- 6.3 Radiocarpal Joint.- 6.3.1 Healed Defective Repositioning of a Distal Fracture of the Radius.- 6.3.2 Kienböck’s Disease (Avascular Necrosis of the Lunate).- 6.4 Hip Joint.- 6.4.1 Dysplasia of the Hip.- 6.5 Femorotibial Joint.- 6.5.1 Patterns in Patients with Malalignment of the Knee Joint.- 6.5.2 Patterns Found in Patients with Genu Varum After a Correction Osteotomy.- 6.5.3 Patterns Following Reconstruction of the Anterior Cruciate Ligament with a Patellar Tendon Transplant (Sheep).- 6.5.4 Patterns After Medial Meniscectomy (Sheep).- 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.- 6.6 Femoropatellar Joint.- 6.6.1 Patients with Retropatellar Pain.- 7 Factors Influencing the Development of Normal Patterns of Mineralization.- 7.1 The Shape of the Joint Surfaces.- 7.1.1 Spherical and Hinge Joints.- 7.1.2 Nonspherical Joints.- 7.2 The Magnitude of the Joint Reaction Force.- 7.3 Position and Extent of the Contact Surfaces.- 7.4 Penetration Point of the Joint Reaction Force.- 7.5 Changes in the Mineralization Patterns with Age.- 8 Factors Influencing the Development of Pathological Patterns of Mineralization.- 8.1 Abnormal Geometrical Relationships.- 8.2 Changes in the Magnitude of the Joint Reaction Force.- 8.3 Changes in Size and Position of the Contact Surfaces.- 8.4 Changes in the Penetration Point of the Joint Reaction Force.- 8.5 The Temporal Course of the Changes.- 9 Possible Clinical Application of CT OAM.- 9.1 Basic Clinical Research.- 9.2 Diagnosis.- 9.3 Following the Progress of Treatment.- 10 Summary.- References.

Blurb

This monograph offers a comprehensive review of present knowledge of the structure.... (Text forwarded to production editor, diskette available, please contact A. Clauss)