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Subchondral Cyst: Causes, Symptoms & Treatment

A subchondral cyst is a fluid-filled cavity that forms in the bone just beneath the joint cartilage. It is commonly associated with osteoarthritis.

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Things worth knowing about "Subchondral Cyst"

A subchondral cyst is a fluid-filled cavity that forms in the bone just beneath the joint cartilage. It is commonly associated with osteoarthritis.

What Is a Subchondral Cyst?

A subchondral cyst is a fluid-filled or tissue-filled cavity that develops in the subchondral bone – the layer of bone located directly beneath the joint cartilage. The term derives from the Latin sub (below) and the Greek chondros (cartilage). These cysts are typically a sign of advanced joint damage and are most commonly observed in patients with osteoarthritis.

Causes

Subchondral cysts can develop through several mechanisms, most of which are related to damage of the joint cartilage:

Osteoarthritis: The most common cause. As cartilage degrades, synovial fluid is forced under pressure into the underlying bone, creating cavities.
Rheumatoid arthritis: Inflammatory processes can erode the subchondral bone, leading to cyst formation.
Avascular necrosis: Bone tissue that dies due to impaired blood supply can result in cystic changes.
Joint trauma: Injuries to a joint can trigger the development of subchondral cysts.
Excessive mechanical loading: Overloading of a joint – for example due to obesity or intensive physical activity – can contribute to cyst formation.

Symptoms

Subchondral cysts do not always cause noticeable symptoms. When they do, patients may experience:

Joint pain that worsens with physical activity
Stiffness of the affected joint, particularly after periods of rest
Swelling around the joint
Reduced range of motion in the affected joint
In advanced cases: joint instability

The knee, hip and shoulder joints are most frequently affected, although subchondral cysts can occur in any joint.

Diagnosis

Subchondral cysts are typically identified through imaging studies:

X-ray: Can reveal characteristic bony changes, although it is less sensitive for detecting early-stage cysts.
Magnetic resonance imaging (MRI): The most precise method for visualising subchondral cysts as well as associated cartilage and soft tissue changes.
Computed tomography (CT): Provides detailed images of the bone structure surrounding the cyst.
Ultrasound: May be used as a complementary tool, especially for assessing soft tissue involvement.

A clinical examination and blood tests are also performed to help identify the underlying condition.

Treatment

Treatment depends on the underlying cause, the size of the cyst, and the severity of the symptoms.

Conservative Treatment

Pain-relieving and anti-inflammatory medications (e.g. NSAIDs such as ibuprofen)
Physiotherapy to strengthen the muscles surrounding the joint and improve mobility
Injection therapy: Corticosteroid or hyaluronic acid injections into the joint to reduce pain and inflammation
Weight management to reduce mechanical stress on the affected joints
Orthopedic aids such as insoles, orthoses, or walking aids to offload the joint

Surgical Treatment

Arthroscopy: A minimally invasive procedure to address cartilage damage
Subchondral drilling or debridement: To stimulate bone healing within the cystic area
Joint replacement (endoprosthesis): Considered in cases of severe osteoarthritis with extensive joint destruction

Prognosis and Outlook

The prognosis of a subchondral cyst depends largely on the underlying condition. With early diagnosis and consistent treatment of the root cause, the progression of joint damage can often be slowed. Without treatment, cysts may enlarge and lead to increasing functional impairment of the affected joint.

References

Lohmann, C. H., Kratz, M., Behrens, P. (2009). Subchondral cysts – pathogenesis, significance, and treatment options. Der Orthopäde, 38(10), 920–929.
Resnick, D., Niwayama, G. (1995). Diagnosis of Bone and Joint Disorders (3rd ed.). W.B. Saunders Company.
Hunter, D. J., Guermazi, A., Roemer, F. (2013). Structural correlates of pain in joints with osteoarthritis. Rheumatic Disease Clinics of North America, 39(1), 111–122.

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