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Osteoarthritis results from a complex system of interacting mechanical, biological, biochemical, molecular and enzymatic factors.[1,2] There is strong evidence that bone marrow lesions and bone cysts have an important role in the pathogenesis of knee osteoarthritis.[3] Bone marrow lesions including dense bone islands may cause decrease of the elasticity in subchondral bone.[4] Eventually, they may result in osteoarthritis, playing a key role in the initiation and progression of cartilage erosion.

Is subchondral bone the crucial point for the pathogenesis and the treatment of osteoarthritis?