Subchondral bone drilling: a treatment for cartilage defects.

Clearly, no one surgical procedure is ideal for the treatment of degenerative joint disease. Many factors are involved in planning for the proper approach, such as age and activity of the patient, etiology, and stage of the disease. Arthroplasty, implant arthroplasty, cheilectomy, enclavement, various osteotomies, and joint fusions have been advocated as procedures for choice of degenerative joint disease of the first metatarsophalangeal joint (24-26). Similar procedures have been used to treat arthroses of the lesser metatarsophalangeal joints as well. Some of these procedures are designed to address the etiology of the degenerative process. This is the case with the enclavement and metatarsal osteotomies such as the Watermann procedure (25, 26). Most of these procedures are primarily effective in the early stages of the disease (26). Other procedures attempt to alleviate symptomatology as with the Keller arthroplasty, implant arthroplasties, cheilectomy, and joint fusions (24, 26). With the exception of the cheilectomy, these generally are reserved for late stage arthroses. Subchondral drilling has been used to treat cartilage defects in conjunction with other procedures that address the etiology and symptomatology of the disease process. It has been shown that small drill holes may be effective in producing fibrocartilage to replace full- and partial-thickness cartilage defects (14, 18). Such drilling has been useful in the treatment of osteochondral lesions of the ankle and promises to be equally effective in treatment of osteochondral lesions of the metatarsophalangeal joints. As with any procedure, applications are limited. Subchondral drilling addresses only the cartilage defect and the pain attributed to that defect. It does nothing to address the etiology of a biomechanical problem. (ABSTRACT TRUNCATED AT 250 WORDS)