Some highlights in the emergence of modern concepts of osteoarthritis.

The present-day concept that osteoarthritis may be amenable to biological modification rather than a hopeless expression of old age or injury has historical roots in the period of 1935 through the early 1970s. One root was the structural and chemical delineation of the connective tissues: discovery of the proteoglycans and multiple molecular species of collagen. Another was the recognition of the ability of mature articular chondrocytes to replicate themselves rather than being terminally differentiated. A third was the elucidation of the engineering physiology of the joint: the role of matrix hydrophilia to the material properties of articular cartilage and biolubrication. Each root has direct relevance to ongoing therapeutic approaches to degenerative joint disease. The early epidemiological studies of Kellgren and Lawrence evolved into new techniques for testing their validity in clinical practice. Along the way there was a rich 2-way interaction between scientists and clinicians in arriving at these ideas. Copyright 2001 by W.B. Saunders Company