Cartilago Articular y

Osteoartrosis
Asesor: Dr. Med. Eduardo
lvarez

Toms Alejandro Ramos
Snchez R3
 Cartlago Articular
Tejido elstico avascular, aneural y
alinftico que recubre las articulaciones
diartrodiales del esqueleto
 Cartlago Articular
Funcin
Facilita el deslizamiento y lubricacin
articular
Disminuye la friccin y ayuda a la
movilidad sin dolor
Absorbe los traumatismos mecnicos
Distribuye las cargas sobre el hueso
subyacente
 Cartlago Articular Chapte

Condrocitos

Matriz extracelular
Colgeno
Proteoglicanos
Protenas no colagenicas
Figure 6 A, Electron micrograph sho wing the articular cartilage m
8-month-old rabbit. Arro w heads indicate pericellular matrix, * indicate
electron micrograph sho wing the same matrix compartments and the re
matrix. Bar = 1 nm. Notice the short-cell processes that extend through
Hunziker EB, Rosenberg LC, et al: Articular cartilage: Composition and str
the M usculoskeletal So f t Tissues. Park Ridge, IL, A merican Academy of Or

Articular cartilage contains two major classes of pro- trib

teoglycans: large aggregating molecules or aggrecans (Fig- Inst
ure 4) and smaller proteoglycans including decorin (dEco- infl
RIn), biglycan, and fibromodulin. Because it may have a with
glycosaminoglycan component, type IX collagen is also and
considered a proteoglycan. Aggrecans have large numbers can
 concentrations of collagen and proteoglycans. It is clear, required activities and functions. The chondrocytes are
however, that the chondrocytes are in large measure re- responsible for producing and replacing appropriate

Condrocitos
sponsible for the maintenance and structural competence amounts of macromolecules and assembling them into a
highly ordered macromolecular framework. To accom-
plish these activities, the cells must sense changes in the
matrix composition caused by degradation of macromol-
ecules and the mechanical demands placed on the articu-
lar surface, and then respond by synthesizing appropriate

Clulas especializadas, derivan de las clulas types and amounts of macromolecules.

Aging profoundly alters chondrocyte function. With
aging, the capacity of the cells to synthesize some types of

madre pluripotenciales del mesnquima proteoglycans, their proliferative capacity, and their re-
sponse to anabolic stimuli (including growth factors) de-
creases. These changes may limit the ability of the cells to

Representan el 1% del volumen total. maintain and restore the tissue and thereby contribute to
the development and progression of articular cartilage de-
generation.

Difirieren en forma, tamao yExtracellular

Figure 1 actividad M atrix
Articular cartilage from the medial f emoral condyle
o f an 8-month-old rabbit. The tissue is organized into f our lay-
The articular cartilage matrix consists of two compo-

metablica en las diferentes capas.

ers or zones: the superficial zone (S), the transitional zone (T),
the middle (radial or deep) zone (M), and the calcified cartilage nents: the tissue fluid and the framework of structural
zone (C). Bar = 50 nm. (Reproduced from Buck w alter JA, Hun- macromolecules that give the tissue its form and stability.
ziker EB, Rosenberg LC, et al: Articular cartilage: Composition The interaction of the tissue fluid and the macromolecu-

Retculo endoplasmico y aparato de Golgi

and structure, in W oo SL, Buck w alter JA (eds): Injury and Repair lar framework give the tissue its mechanical properties of
o f the M usculoskeletal So f t Tissues. Park Ridge, IL, A merican
Academy of Orthopaedic Surgeons, 1988, pp 405-425.)
stiffness and resilience. Water contributes up to 80% of

La edad altera su funcionamiento

 Condrocitos
Funcin
Producen y mantiene la matriz extracelular.
Responden a cambios en la composicin de
la matriz extracelular
Degradacin de macromolculas
Demandas mecnicas sobre la superficie articular
Respuesta
Sintetizan macromolculas
(colgeno, proteoglicanos)
 Matriz extracelular
Agua
70% del peso del cartlago articular

Macromolculas estructurales
Da al tejido su forma y estabilidad
30% del peso del cartlago articular
Colgeno 60%
Proteoglicanos 25% a 35%
Protenas no colagenicas 15% a 20%

Rigidez y Resistencia

 Matriz Extracelular
Funcin
Rigidez y resistencia del tejido
Protege las clulas del dao causado por el
uso.
Flexibilidad y Lubricacin del tejido

Proteoglicanos de cadena larga

(Agrecanos)
Limita el ingreso y egreso de molculas al
liquido sinovial.

 Agrecanos
Gran numero de cargas negativas
Incrementa la osmolaridad del tejido
Atrae iones de carga positiva
Sodio
Repele iones de carga negativa
Cloro
 Colgeno
La mas comn tipo II (90% a 95%)
VI, IX, X, XI
Se distribuye uniformemente a travs
de las diferentes zonas excepto zona
superficial
Colgeno tipo IX une la red fibrilar con
los proteoglicanos
Colgeno tipos VI une los condrocitos
con la matriz extracelular
 Colgeno
II, IX XI forman la red fibrilar que se
Chapter 9
observa enArticular Cartilage and Osteoarthritis
el microscopio electrnico
 Colgeno
Funcin

Forma y fuerza tensil al cartlago

Forma una red fibrilar

Mantener la localizacin fsica de los

condrocitos
 Proteoglicanos
Protena + 1 mas cadenas de
glucosaminoglicanos Section 2 Physiology of Musculoskeletal Tissues

La concentracin varia de
vides the tensile acuerdo
stiffness a la
and strength of articular cartilage
and contributes to the cohesiveness of the tissue by me-
com
mo
articulacin, edad, dao articular y
chanically entrapping the large proteoglycans. The princi-
pal articular cartilage collagen, type II, accounts for 90%
cro
the
enfermedad. to 95% of the cartilage collagen and forms the primary mo
typ
int
Glucosaminoglicanos: disacridos ing
bin
repetidos lag
pe

Acido hialuronico sur

to
the
Condroitin sulfato an
git
Keratan sulfato it h

Dermatan sulfato Pr
Pro
. cos
cha
 Proteoglicanos
2 tipos principales
Molculas de cadena Larga 90%
Agrecanos

Molculas Cortas 10%
Decorinas
Biglycano
Fibromodulina
Colgeno tipo IX
 Protenas no colgenicas y
glucocoprotenas

Protenas, monosacridos u
oligosacridos

Ayudan a organizar y mantener la

estructura macromolecular

Ancorina CII (ancla condrocitos a las

fibras de colgeno)
 tial for cartilage resiliency and joint lubrication or in the
concentrations of collagen and proteoglycans. It is clear,
however, that the chondrocytes are in large measure re-

Cartlago Articular sponsible for the maintenance and structural competence

Zonas
Superficial o tangencial

Transicional Figure 1 Articular cartilage from the medial f emoral condyle

o f an 8-month-old rabbit. The tissue is organized into f our lay-
ers or zones: the superficial zone (S), the transitional zone (T),
the middle (radial or deep) zone (M), and the calcified cartilage
zone (C). Bar = 50 nm. (Reproduced from Buck w alter JA, Hun-

Zona media o radial ziker EB, Rosenberg LC, et al: Articular cartilage: Composition
and structure, in W oo SL, Buck w alter JA (eds): Injury and Repair
o f the M usculoskeletal So f t Tissues. Park Ridge, IL, A merican

Academy of Orthopaedic Surgeons, 1988, pp 405-425.)

Zona de cartlago calcificado

 Zona Superficial o tangencial
La zona mas delgada
Fuerte y rgida
Se divide en 2 capas
1.- fibras pequeas, pocos polisacridos,
sin clulas
Lamina Splendens
2.- Condrocitos planos de forma helicoidal
y paralelos a la superficie articular
Alta concentracin de colgeno y baja de
proteoglicanos
Alta concentracin de agua y fibronectina
sponsible for the maintenance and structural competence amounts of macromolecules and assembling them into a
highly ordered macromolecular framework. To accom-

Zona Transicional
plish these activities, the cells must sense changes in the
matrix composition caused by degradation of macromol-
ecules and the mechanical demands placed on the articu-
lar surface, and then respond by synthesizing appropriate
Mayor espesor que la zona superficial types and amounts of macromolecules.
Aging profoundly alters chondrocyte function. With
aging, the capacity of the cells to synthesize some types of
Condrocitos esferoidales proteoglycans, their proliferative capacity, and their re-
sponse to anabolic stimuli (including growth factors) de-

Fibras colgeno creases. These changes may limit the ability of the cells to
maintain and restore the tissue and thereby contribute to
the development and progression of articular cartilage de-
Mayor dimetro generation.

No organizadas y oblicuas
Figure 1
a la superficie
Extracellular M atrix
Articular cartilage from the medial f emoral condyle
o f an 8-month-old rabbit. The tissue is organized into f our lay-
The articular cartilage matrix consists of two compo-
ers or zones: the superficial zone (S), the transitional zone (T),
nents: the tissue fluid and the framework of structural
Mayor contenido de proteoglicanos
the middle (radial or deep) zone (M), and the calcified cartilage
zone (C). Bar = 50 nm. (Reproduced from Buck w alter JA, Hun-
ziker EB, Rosenberg LC, et al: Articular cartilage: Composition
macromolecules that give the tissue its form and stability.
The interaction of the tissue fluid and the macromolecu-
lar framework give the tissue its mechanical propertiesChap
Menos concentracin de agua
and structure, in W oo SL, Buck w alter JA (eds): Injury and Repair of
o f the M usculoskeletal So f t Tissues. Park Ridge, IL, A merican
Academy of Orthopaedic Surgeons, 1988, pp 405-425.)
stiffness and resilience. Water contributes up to 80% of
amounts of macromolecules and assembling them into a
highly ordered macromolecular framework. To accom-
plish these activities, the cells must sense changes in the

Zona media o radial

matrix composition caused by degradation of macromol-
ecules and the mechanical demands placed on the articu-
lar surface, and then respond by synthesizing appropriate
types and amounts of macromolecules.
Aging profoundly alters chondrocyte function. With
Condrocitos de forma esferoidal
aging, the capacity of the cells to synthesize some types of
proteoglycans, their proliferative capacity, and their re-

alineados en columnas perpendiculares a

sponse to anabolic stimuli (including growth factors) de-
creases. These changes may limit the ability of the cells to

la superficie
maintain and restore the tissue and thereby contribute to
the development and progression of articular cartilage de-
generation.

Fibras
Extracellular M atrixde colgeno de mayor dimetro
The articular cartilage matrix consists of two compo-

Mayor concentracin de proteoglicanos

nents: the tissue fluid and the framework of structural
macromolecules that give the tissue its form and stability.
The interaction of the tissue fluid and the macromolecu-

Menor concentracin de agua

lar framework give the tissue its mechanical properties of
stiffness and resilience. Water contributes up to 80% of Chapter 9 Articular Cartilage and Osteoarthritis

Resiste la fuerza de cizallamiento

 sponse to anabolic stimuli (including growth fac
creases. These changes may limit the ability of th

Zona de cartilago calcificado

maintain and restore the tissue and thereby cont
the development and progression of articular car
generation.

Figure 1 Articular cartilage from the medial f emoral condyle Extracellular M atrix

Separa la zona radial del hueso

o f an 8-mon th-old rabbit. The tissue is organized in to f our lay-
ers or zones: the superficial zone (S), the transitional zone (T),
the middle (radial or deep) zone (M), and the calcified cartilage
zone (C). Bar = 50 nm. (Reproduced from Buck w alter JA, Hun-
The articular cartilage matrix consists of two
nents: the tissue fluid and the framework of s
macromolecules that give the tissue its form and

subcondral
ziker EB, Rosenberg LC, et al: Articular cartilage: Composition
and structure, in W oo SL, Buck w alter JA (eds): Injury and Repair
o f the M usculoskeletal So f t Tissues. Park Ridge, IL, A merican
The interaction of the tissue fluid and the macro
lar framework give the tissue its mechanical prop
stiffness and resilience. Water contributes up to
Academy of Orthopaedic Surgeons, 1988, pp 405-425.)

Las clulas contienen un retculo

endoplasmico y aparato de Golgi
pequeo.
Nivel metablico muy bajo, no
funcionales

Figure 2 Electron micrographs sho w ing the superficial zone (A), transitional zone (B), middle (radial or deep) zone (C),
fied cartilage zone (D) o f mature articular cartilage chondrocytes from the medial f emoral condyle o f a rabbit. N = n u
 Interaccin Matriz -
Condrocito
En respuesta a diferentes estmulos
Autocrino o paracrino
Interleucina 1
Metaloproteasas
Degradan macromolculas
Interfieren en la sntesis te proteoglicanos

Factor de crecimiento dependiente de

insulina 1
Factor de crecimiento transformador beta
Estimulan la sntesis de matriz extracelular y
proliferacin celular
 Biomecnica
Cargas mecnicas estticas y dinmicas
Compresin (red fibrilar) Colgeno
.5 a 1 MPa
Cizallamiento (red fibrilar) Colgeno
.25 MPa
Tensin (Proteoglicanos)
10 a 50 MPa

La habilidad del cartlago para resistir las fuerzas

de compresin, tensin y cizallamiento depende de
la composicin e integridad de l matriz extracelular
Cuando el cartilago es comprimido expulsa agua/
solutos de proteoglicanos , stos balanceando las cargas
Chapter 9 Articular Cartilage and Osteo
 Osteoartrosis
Perdida progresiva de la estructura y
funcin normal del cartlago articular,
acompaado por un intento de
reparacin del mismo
 Osteoartritis
Se desarrolla frecuentemente en
ausencia de una causa aparente
(primaria o idioptica)
Secundarias
Dao articular
Infeccin
Desordenes neurolgicos, metablicos,
hereditarios
 Osteoartritis
Primaria o Idioptica
Edad, predisposicin gentica,
desordenes metablicos y hormonales,
inflamacin
Peso
Actividad fisica
Incidencia y prevalencia aumenta >40
aos
 Osteoartritis
Secundaria
La edad de inicio depende de la causa
Deformidades (displasia del desarrollo de
la cadera)
Se puede presentar en adultos jvenes e
incluso en nios

 Osteoartrosis
Rodillas

Caderas

Pie

Columna

Manos
 Osteoartritis
Sntomas y signos
Dolor

Limitacin de la movilidad

Crepitacin

Inflamacin

Deformidad
 Osteoartrosis
Tejidos involucrados
Tejido sinovial
Cartilago articular
Hueso subcondral y metafisiario
Ligamentos
Capsula articular
Msculos
Cambio Primario
Perdida del cartilago articular, remodelacin de
hueso subcondral y formacin de osteofitos.
 Osteoartrosis
Microscpicos + tempranos
Deshilachamiento o desfibrilacin de la zona
superficial hasta transicional del cartlago
articular.

Disminucin del la tincin de proteoglicanos

en zonas superficial y transicional

Cambio la vascularidad subcondral.
 Osteoartrosis
Visibles + tempranos
Desfibrilacin o disrupcin de las capas
superficiales del cartlago articular
Progresin
Hendiduras, la superficie articular se vuelve
rugosa e irregular
Las hendiduras y fibrilacin alcanzan el
hueso subcondral
Se liberan fragmentos libres articulares y
disminuye el grosor del cartlago.
Al mismo tiempo existe una degeneracin
enzimtica de la matriz
Osteoartrosis
 Osteoartrosis
Los mecanismos responsables de la
progresin no estn claros
Proceso en 3 fases
1.-Alteracin o dao en la matriz del
cartilago
2.- Respuesta de los condrocitos al dao
del tejido
3.- Disminucin de la respuesta sinttica
de los condrocitos y progresin de la
perdida de tejidos
 Osteoartritis
1 Fase. Causas

Carga torsional o impacto de alta

intensidad

Inflamacin Articular

Cambios metablicos en el tejido

 Osteoartritis
1 Fase
Disrupcin de la estructura macromolecular
en incremento en el contenido de agua.
Colgeno tipo II permanece constante
Disminuye agregacin de proteoglicanos
Agrecanos
Disminucin de la longitud y de las cadenas de
glucosaminoglicanos.

Disminucin en la rigidez
de la matriz extracelular
 Osteoartrosis
2 Fase

Condrocitos detectan dao en los tejidos o
alteracin en la osmolaridad, densidad o
estructura y liberan mediadores que
estimulan la respuesta celular
 Osteoartritis
2 Fase. Respuesta
Actividad anablica y catablica
Respuesta Anablica
Proliferacin de condrocitica
Sntesis de matriz extracelular
Respuesta Catablica
Produccin de Oxido Ntrico
Produccin de Interleucina 1
 Condrocitos
Liberacin en
respuesta a un estrs

Oxido
ntrico

Interleucina
1

Metaloproteas
as
Degradacin de
las molculas de
la matriz
(fibronectina)

Interleucina
1
 Osteoartritis
3 Fase
Falla en estabilizar o restaurar el tejido.
Dao progresivo el cartlago articular
Disminucin en la respuesta anablica de los
condrocitos
Osteoartrosis
 Osteoartritis
Alteraciones del hueso subcondral
Incremento en la densidad del hueso
subcondral o esclerosis subcondral
(Primer signo de enf. articular degenerativa en hueso
subcondral)
Formacin de cavidades seas en forma de
quiste con tejido mixoide, fibroso o
cartilaginoso
Apariencia de cartilago regenerativo en o
sobre el hueso subcondral. OSTEOFITOS
 Osteoartritis
Acortamiento

Deformidad

Inestabilidad
 Tratamiento

Objetivos
Alivio de sintomas
Mantener/mejorar funcin
Limitar incapacidad fsica
Evitar toxicidad medicamentosa