Perspectives: a biomechanical model of the pathogenesis of arthroses

This model views the common, initiating cause of arthroses as excessive articular cartilage microdamage. If so, understanding it would become a central problem for understanding the pathogenesis of arthroses. The model proposes the microdamage can stem from: (1) Excessive total loads on normal joints; (2) underadaptations in a joint's size or shape that leave its momentarily loaded area too small for normal loads; (3) impaired microdamage repair in subchondral bone or articular cartilage; (4) abnormal composition or structure that makes a tissue develop excessive microdamage under normal loads. (5) (2)-(4) above could stem from changed set points or "lead times" for a joint's adaptations and maintenance, which in turn could stem from (6) genetic influences, some drugs, toxins, diseases, and "X," and (7) from combinations of the above. In the pathogenesis of arthroses this model assigns special importance to the stiffness of joint tissues (as distinguished from their strength), to the typical largest unit loads they carry as a result of a subject's usual physical activities, and to microdamage in those tissues.