Cylindrical press-fit osteochondral allografts for resurfacing the equine metatarsophalangeal joint

OBJECTIVE: To investigate the feasibility of resurfacing the equine fetlock joint using cylindrical, orthotopic, press-fit, osteochondral allografts. STUDY DESIGN: Experimental study. ANIMALS: Ten mature, mixed-breed horses. METHODS: Cylindrical, osteochondral grafts (6.5-mm diameter) were harvested aseptically from cadaveric equine metatarsophalangeal joints. Allografts were transplanted into 6 horses; 4 horses were sham operated. The surgical approach involved creation of a bone block at the origin of the medial collateral ligament and luxation of the metatarsophalangeal joint. Grafts were placed into the medial and lateral metatarsal condyles. Radiographs were taken at 8 and 25 weeks, and lameness was evaluated at 25 weeks. Horses were killed at 25 weeks. Analyses included gross evaluation, microradiography, paravital staining, light microscopy, and cartilage biochemistry. RESULTS: No complications occurred that could be attributed to the surgical procedure. Graft congruency with the surrounding articular cartilage was fair to excellent. Two horses were sound at 25 weeks. Most grafts had more than 90% articular cartilage coverage, and histologic and microradiographic analysis revealed good graft incorporation and articular cartilage survival. Sulphated glycosaminoglycan concentration was decreased in grafted tissue. CONCLUSIONS: We attribute the viability of osteochondral allografts in the equine fetlock to adequate congruency, stable graft fixation, and the use of orthotopic tissue. Host response to the allograft bone tissue did not affect cartilage viability. CLINICAL RELEVANCE: Before clinical use, improvements to instrumentation are required that would decrease damage to grafts and minimize technique-associated incongruencies of the articular surface at the time of grafting. Larger grafts would also likely be required to resurface a greater surface area.     

Osteochondral Dowel Transplantation for Repair of Focal Defects in the Knee: An Outcome Study Using an Ovine Model

Objective—A model system was developed to objectively assess the quality of articular cartilage after surgical reconstruction of focal defects in the medial femoral condyle using osteochondral dowel grafts.
Study Design—The surgical technique was developed and customized to reproducibly minimize surgical trauma and graft instability in order to improve the survival of the transplanted cartilage and the long-term integrity of the joint surfaces.
Animals or Sample Population—24 adult female Suffolk-Romanoff crossbred sheep.
Methods—Biomechanical creep testing, paravital staining for chondrocyte viability, histological analysis, and gross morphological analysis were performed at 3, 6, and 12 months postoperatively to compare fresh autografted osteochondral dowels with allografts that had been subject to a freezing protocol known to kill chondrocytes. The latter was used to investigate the time course of cartilage degeneration after injury. These two groups were also compared with normal unoperated control tissue.
Results—Biomechanical behavior, chondrocyte survival, and cartilage histology differed significantly between fresh grafts and those that had been frozen.
Conclusions —Indentation testing and paravital staining were able to identify degenerative changes earlier than other methods of assessment. The technique developed here reproducibly and reliably transplanted osteochondral dowel grafts while minimizing the confounding effects of surgical trauma and graft instability.
Clinical Relevance —The technique provides both a promising surgical technique for the repair of focal defects of the medial femoral condyle and a sensitive model for the future study of cryopreservation strategies for articular cartilage.     

Variations of plasmatic concentrations of Insulin-like Growth Factor-I in post-pubescent horses affected with developmental osteochondral lesions

Developmental osteochondral lesions are often encountered in the equine population and are a major cause of lameness. Different growth factors that act systemically as well as locally regulate the growth of cartilage. Among them is Insulin-like Growth Factor I that has been demonstrated to promote chondrocyte growth and differentiation and that has been shown to influence cartilage repair. The aims of this study were to investigate differences in circulating plasma levels of Insulin-like Growth Factor-I in post-pubescent horses affected with developmental osteochondral lesions compared to unaffected ones. Significantly higher values of circulating Insulin-like Growth Factor-I levels were found in the affected group (n = 82) compared to controls (n = 86). This result may still reflect an earlier imbalance in IGF-I levels from horses with developmental osteochondral lesions considering the aetiopathological link which has been made between IGF-I and the occurrence of osteochondrosis. However, other studies have shown increased expression of IGF-I after cartilage damage. The higher levels found in this study could be due to a healing response of the cartilage to the damage caused by the osteochondral lesions.     

Mapping of Split-Line Pattern and Cartilage Thickness of Selected Donor and Recipient Sites for Autologous Osteochondral Transplantation in the Canine Stifle Joint

Objective— To characterize donor and recipient sites for autologous osteochondral transplantation in the canine stifle joint with respect to split-line pattern and cartilage thickness.
Study Design— In vitro study.
Sample Population— Stifle joints (n=30) of dogs >20 kg.
Methods— Collagen network orientation of the hyaline cartilage coverage of the distal femur was assessed using split-line technique (n=10). Cartilage thickness was measured radiographically on osteochondral plugs harvested at the abaxial and axial surfaces of the femoropatellar joint (n=15), the most proximal abaxial aspect of the medial condyle (CO; n=5) and at both femoral condyles (n=15).
Results— Cartilage within the femoropatellar joint and both femoral condyles had mostly transversely orientated pattern of split-lines. Abaxial to the femoropatellar joint split-lines were absent. All donor sites had significantly thinner cartilage than the medial condyle (CM). Only the distal trochlea had cartilage thickness comparable to the lateral condyle (CL). The thinnest cartilage was found abaxial to the femoropatellar joint followed by CO, which was ∼2–3 times thinner than the cartilage at both condyles.
Conclusions— None of the investigated donor sites provided transplants of comparable cartilage thickness to CM. Transplants from within the femoropatellar joint should be harvested in priority as they reach cartilage morphology comparable to CL.
Clinical Relevance— Adjusting for cartilage thickness and split-line pattern may improve long-term outcome after autologous osteochondral transplantation. But surface curvature and donor-site morbidity have to be considered as well when choosing the most suitable donor site.     

Morphologic and biochemical study of sternal cartilage autografts for resurfacing induced osteochondral defects in horses.

Using biodegradable pins, sternal cartilage autografts were fixed into osteochondral defects of the distal radial carpal bone in ten 2 to 3-year-old horses. The defects measured 1 cm2 at the surface and were 4 mm deep. Control osteochondral defects of contralateral carpi were not grafted. After confinement for 7 weeks, horses were walked 1 hour daily on a walker for an additional 9 weeks. Horses were euthanatized at 16 weeks. Half of the repair tissue was processed for histologic and histochemical (H&E and safranin-O fast green) examinations. The other half was used for the following biochemical analyses: type-I and type-II collagen contents, total glycosaminoglycan content, and galactosamine-to-glucosamine ratio. On histologic examination, the repair tissue in the grafted defects consisted of hyaline-like cartilage. Repair tissue in the nongrafted defects consisted of fibrocartilaginous tissue, with fibrous tissue in surface layers. On biochemical analysis, repair tissue of grafted defects was composed predominantly of type-II collagen; repair tissue of non-grafted defects was composed of type-I collagen. Total glycosaminoglycan content of repair tissue of grafted defects was similar to that of normal articular cartilage. Total glycosaminoglycan content of nongrafted defects was 62% of that of normal articular cartilage (P less than 0.05). Repair tissue of all defects was characterized by galactosamine-to-glucosamine ratio significantly (P less than 0.05) higher than that of normal articular cartilage. These results at 16 weeks after grafting indicate that sternal cartilage may potentially constitute a suitable substitute for articular cartilage in large osteochondral defects of horses.     

The role of subchondral bone in joint disease: a review

Subchondral bone plays a role in the pathogenesis of osteochondral damage and osteoarthritis in horses and humans. Osteochondral fragmentation and fracture, subchondral bone necrosis and osteoarthritis are common diseases in athletic horses, and subchondral bone is now thought to play an integral role in the pathogenesis of these diseases. There have been numerous research efforts focused on articular cartilage damage and its pathogenesis, yet comparatively little effort focused on subchondral bone pathology or the coordinated disease states of the osteochondral tissues. The purpose of this report is to review the current understanding of osteochondral disease in all species and its application to equine research and practice. It can be concluded from this review that our current understanding of osteochondral disease is based on clinical and pathological sources; and that the lack of information about joint tissue adaptation and disease has hampered objective studies of osteochondral tissues.     

Surgical osteochondral defect repair in the horse—a matter of form or function?

Focal cartilaginous and osteochondral lesions can have traumatic or chondropathic degenerative origin. The fibrocartilaginous repair tissue that forms naturally, eventually undergoes fibrillation and degeneration leading to further disruption of joint homeostasis. Both types of lesion will therefore eventually lead to activity-related pain, swelling and decreased mobility and will frequently progress to osteoarthritis. Most attempts at realising cartilage regeneration have so far resulted in cartilage repair (and not regeneration). The aim of this article was to review experimental research on surgical cartilage restoration techniques performed so far in equine models. Currently available surgical options for treatment of osteochondral lesions in the horse are summarised. The experimental validity of equine experimental models is addressed and finally possible avenues for further research are discussed.     

A Lateral Surgical Approach to the Equine Femoropatellar Joint

A surgical approach to the lateral trochlear ridge of the distal femur of the horse was developed to facilitate evaluation and curettage of osteochondral defects of the lateral trochlear ridge. Surgical exploration of the lateral trochlear ridge was achieved in 11 patients with osteochondral defects of the lateral trochlear ridge using a craniolateral arthrotomy between the middle and lateral patellar ligaments. The technique described allowed adequate exposure for evaluation, removal of loose osteochondral fragments, and curettage of cartilage abnormalities on the lateral trochlear ridge.     

Comparison of proteoglycan and collagen in articular cartilage of horses with naturally developing osteochondrosis and healing osteochondral fragments of experimentally induced fractures

OBJECTIVE: To compare articular cartilage from horses with naturally developing osteochondrosis (OC) with normal articular cartilage and healing cartilage obtained from horses with experimentally induced osteochondral fractures. SAMPLE POPULATION: 109 specimens of articular cartilage from 78 horses. PROCEDURE: Morphologic characteristics, proteoglycan (PG), and type II collagen were analyzed in articular cartilage of OC specimens (group 1), matched healing cartilage obtained 40 days after experimentally induced osteochondral fractures (group 2), and matched normal cartilage from the same sites (group 3). RESULTS: 79 specimens of OC cartilage were obtained from horses. Ex vivo PG synthesis was significantly greater in the femoral cartilage, compared with synthesis in the tibial cartilage, and significantly greater for groups 1 and 2, compared with group 3. For groups 1 and 2, femoral fragments had significantly greater PG content, compared with PG content in tibial fragments. Keratan sulfate content was significantly less in group 3, compared with groups 1 and 2. Cartilage from the OC specimens had loss of structural architecture. The OC tissue bed stained positive for chondroitin sulfate and type II collagen, but the fracture bed did not. CONCLUSIONS AND CLINICAL RELEVANCE: Our analyses could not distinguish articular cartilage from horses with OC and a healing fracture. Both resembled an anabolic, reparative process. Immunohistochemical analysis suggested a chondromyxoid tissue in the OC bed that was morphologically similar to fibrous tissue but phenotypically resembled hyaline cartilage. Thus, tissue in the OC bed may be degenerative cartilage, whereas tissue in the fracture bed may be reparative fibrous callus.     

Orthotopic Osteochondral Transplantation of the Canine Proximal Femur

An 18-week study was conducted to evaluate orthotopic osteochondral transplantation of the proximal femur in the dog. Eighteen dogs were divided into 3 groups of 6 each. The first group received autografts, the second received fresh allografts, and the third received grafts that had been frozen in a bone bank for 24–28 days. The grafts were fixed in position using dynamic compression plates. The grafted limbs were maintained in a sling and thus were nonfunctional and non-weight bearing throughout the 18-week study. Postoperatively the dogs were given oral tetracycline to assess osteo- cyte viability. The dogs were radiographed at 2–week intervals and 1 dog in each group was euthanatized every 3 weeks. The femurs were examined using standard histopathologic and fluorescent labeling techniques. All femoral heads were luxated by the 2nd postoperative week. The bones of all the femoral heads underwent avascular necrosis and degenerative changes were present in the transplanted cartilage by the 6th postoperative week. During the first 18 weeks following transplantation there was little radiographic and histologic difference among the 3 types of grafts regarding the nature and rate of bone healing. Based on the data obtained from techniques utilized in this study, the femoral head, neck, and articular cartilage did not survive, while the femoral diaphysis did survive the transplantation process. Different techniques may alter to some degree the results obtained.     

Arthroscopic mosaic arthroplasty in the equine third carpal bone

OBJECTIVE--To investigate survival and function of autogenous heterotopic osteochondral grafts in a site where injuries are common. STUDY DESIGN--Three osteochondral grafts were harvested arthroscopically from the femoropatellar joint and transplanted to the third carpal bone (C(3)). Nine months later, histologic, histomorphometric, and biochemical comparisons were made between the transplanted grafts in C(3) and tissue adjacent to the recipient site, the opposing radial carpal bone (C(r)), the donor site in the femoropatellar joint, and the sham-operated contralateral C(3). ANIMALS--One mixed-breed pony and 5 Standardbred horses aged 3 to 8 years old. METHODS--Using instruments modified for equine use, four 4.5-mm-diameter osteochondral grafts were harvested arthroscopically from the distal aspect of the lateral trochlea of the right femur and inserted into the radial facet of the right third carpal bone. The fourth graft was kept as a donor-site control sample. Three months later, regular exercise was started and at 6 months, repeat arthroscopy was conducted to evaluate healing. The horses were euthanatized 9 months after transplantation, and comparisons were made between the grafts, opposing radial carpal bone, and contralateral third carpal bone. The assessment criteria included paravital staining, a modified Mankin scoring system, and biochemical analyses for collagen type, total collagen content, and sulfated glycosaminoglycan concentration. RESULTS--All horses were sound 21 days' postoperatively. At 6 months, all 18 grafts were intact but somewhat soft and opaque compared with surrounding carpal cartilage. Nine months' postoperatively, the bony portions of the grafts were well integrated with the recipient sites, but 6 grafts had histologic evidence of cartilage degeneration. From biochemical analysis of grafts, there was little or no new repair tissue invading the experimental sites, but sulfated glycosaminoglycan (proteoglycan) loss from the transplanted cartilage was marked. CONCLUSIONS--Heterotopic transfer of osteochondral grafts from the distal aspect of the lateral femoral trochlea to the third carpal bone is feasible with minor modifications of human mosaic arthroplasty instruments. The bony portion of the osteochondral grafts was quickly remodeled to provide subchondral support to the transplanted articular cartilage. The loss of proteoglycan from the transplanted cartilage indicates that the grafts might have been injured during harvesting or insertion, or, more likely, did not remodel to meet the demands of a new biomechanical environment. CLINICAL RELEVANCE--These findings suggest that arthroscopic resurfacing of focal osteoarticular defects will not be successful in the long term unless donor and recipient sites can be matched with respect to cartilage thickness, biochemical constituents, and physical properties. Mosaic arthroplasty may be indicated in selected cases in which no other options exist to create a confluent cartilage-covered surface.     

Diagnostic findings and prognosis following arthroscopic treatment of subtle osteochondral lesions in the shoulder joint of horses: 15 cases (1996-1999)

OBJECTIVE: To determine clinical, scintigraphic, radiographic, and arthroscopic findings and results of treatment in horses with lameness attributable to subtle osteochondral lesions of the shoulder joint. DESIGN: Retrospective study. ANIMALS: 15 horses. PROCEDURE: Medical records were reviewed, and results of physical examination, scintigraphy, radiography, arthroscopy, and treatment were recorded. RESULTS: Severity of lameness ranged from grade 1 to 4. Response to shoulder flexion or extension was variable. Twelve horses had a narrow upright foot. Intra-articular anesthesia of the shoulder joint localized the cause of the lameness to the shoulder joint in 9 of 10 horses. Scintigraphic abnormalities were detected in 4 of 6 horses. Radiographic lesions were subtle and included glenoid sclerosis, focal glenoid lysis, small glenoid cysts, and alterations in the humeral head contour. Arthroscopic evaluation confirmed clefts in the glenoid cartilage, glenoid cysts, a humeral head cyst, fibrillation of the humeral head cartilage, cartilage fragmentation, or a nondisplaced fracture of the humeral head. After treatment, 12 horses returned to their previous level of performance, 1 was sound for light riding, 1 remained lame, and 1 was euthanatized because of chronic lameness. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that a combination of physical examination, scintigraphy, and radiography is necessary to diagnose subtle osteochondral lesions of the shoulder joint in horses. Arthroscopy can be used to confirm the diagnosis and treat cartilage and subchondral bone lesions. Young and middle-aged horses with subtle osteochondral lesions of the shoulder joints have a good prognosis for return to performance following arthroscopic treatment.     

Osteochondrosis and arthrosis in pigs. I. Incidence in animals up to 120 kg live weight

Joint and bone lesions in growing pigs are described on the basis of post-mortem examination of 341 gilts, boars or castrates from 10 to 120 kg live weight, and 869 separate bones from pigs between 80 and 115 kg live weight at slaughter. No evidence of rickets or generalized osteodystrophia fibrosa was found. Lesions occurred in both sexes. The typical osteochondral lesions were most often symmetrical, occurred at certain sites in joints and epiphyseal plates and were most obvious in the elbow and stifle joint, and in the distal epiphyseal plate of the ulna. Lesions of varying degree could be demonstrated in most pigs at 90–100 kg live weight. The use of the diagnosis osteochondrosis is suggested for local primary non-inflammatory disturbances which lead to a failure of endochondral ossification in joint cartilage as well as in epiphyseal plates. The diagnosis arthrosis is used when the superficial layer of the joint cartilage is affected. Investigations of the early changes in the medial condyle of the femur suggest that the osteochondral lesions start in the deep layers of the joint cartilage. Arthrosis occurred frequently in the lumbar intervertebral joints of Norwegian pigs. Otherwise the lesions appeared to be identical with those described from other countries.     

Arthroscopic techniques for cartilage repair

Joint injuries are a major concern for horses used in athletic and recreational sports. Spontaneous cartilage repair diminishes as horses reach maturity, and surgical measures have been developed to bolster these meager intrinsic responses. Local debridement, joint lavage, and marrow stimulation techniques provide improved symptomatic therapy that may last several years. Subchondral drilling (forage) has largely been superseded by microfracture techniques to open the subchondral bone in damaged cartilage areas. Marrow-derived cells and growth factors then contribute to better fibrocartilage formation. Transplantation techniques can result in more durable hyaline cartilage but add a level of complexity to cartilage repair that can be costly, time-consuming, and occasionally painful. Autogenous osteochondral dowel transplantation or mosaicplasty provides an integrated weight-bearing island that may sustain better loads than cell-grafting methods. However, donor-site morbidity and technical difficulties both in harvest and implant of osteochondral grafts dampens the promise of major hyaline cartilage rejuvenation. Equine joint repair demands arthroscopic methods, and chondrocyte and pluripotent stem-cell implantation provide promise of improved cartilage repair. Combination of insulin-like growth factor-I and chondrocytes provides a clinically useful grafting method for extensive osteochondritis dissecans (OCD), subchondral cysts, and traumatic injuries. Future directions look toward gene-enhanced cell transplants that may provide a major early matrix response and durable in situ cartilage reformation.     

Osteochondral Fragmentation in the Synovial Pad of the Fetlock in Warmblood Horses

Objectives— To determine clinical and arthroscopic characteristics associated with fragments in the synovial pad of the fetlock and to characterize their morphology. Study Design— Retrospective study. Animals— Warmblood horses (n=104) with fragment(s) in the synovial pad. Methods— S ignalment and results of radiographic and clinical examination were collected before surgery. After arthroscopic fragment removal and joint evaluation for synovial and/or cartilage abnormalities, fragments were measured, and evaluated by histopathology. Results— Synovial pad fragments (n=142) were removed from 127 fetlocks. Two older horses had lameness. During arthroscopy, abnormalities were observed in 40 joints (31.5%) and multivariate logistic regression analysis showed a significant correlation between the observed arthroscopic abnormalities and the presence of large fragments (P=.016). Fragments were osteochondral bodies completely surrounded by fibrous tissue. At the edges of the hyaline cartilage cap an underlying fibrous structure was obvious in the extracellular matrix giving it a reactive pattern. Conclusions— Although the impact on lameness was minimal, there was a significant correlation between arthroscopic abnormalities and presence of large synovial pad fragments. On histopathology, these osteochondral fragments are embedded in fibrous tissue and show a reactive pattern. They are not a manifestation of any well‐described joint pathology. Clinical Relevance— Large synovial pad fragments in Warmblood horses can be associated with synovial and cartilage abnormalities, but further studies are warranted to determine their origin and clinical importance.     

Epiglottic Augmentation in the Horse

Epiglottic augmentation with injectable bovine collagen or an autogenous or allogenous auricular cartilage graft was performed in 12 horses with endoscopically and radiographically normal epiglottises. The grafting procedures were easy to perform and did not cause apparent discomfort. Cartilage graft extrusion or resorption may have occurred, but was not seen by endoscopy and lateral laryngeal radiography. Only collagen implants remained evident endoscopically, as smooth round submucosal bulges ventral to the epiglottic cartilage. Two horses with collagen implants, and all horses with cartilage autografts and allografts, were euthanatized at week 16. One horse with a collagen implant was euthanatized at week 4 and one at week 6. The epiglottis appeared thickened in three horses with collagen implants, two horses with autogenous grafts, and three horses with allogenous grafts. Pharyngeal lymphoid tissue was hyperplastic in two horses with autografts and three horses with allografts, but not in horses with collagen implants. Collagen grafts persisted as one or two smooth bulges 8 mm in diameter. Collagen incited a brisk foreign body reaction that was surrounded by a fibrous connective tissue capsule. Epiglottises of the horses with collagen implants were significantly thicker 20 mm from the tip than those of normal horses and horses with allografts. Cartilage graft incorporation was not evident grossly and was seen on microscopic examination in only one autograft. Thickening was caused by submucosal fibrosis.     

Interleukin-6 and high mobility group box protein-1 in synovial membranes and osteochondral fragments in equine osteoarthritis

Cytokine production in synovial membranes (SM) and osteochondral fragments (OCF) may influence the development of equine osteoarthritis (OA). In this study, the presence of interleukin (IL)-6 and cytoplasmic and extracellular high mobility group box protein (HMGB)-1 in SM and osteochondral tissue from healthy and diseased equine joints was investigated by immunohistochemistry. Additionally, microscopic synovitis was graded. IL-6 was commonly found in SM cells and in chondrocytes in uncalcified cartilage of OCF, whereas little staining was detected in healthy cartilage. Cytoplasmic and/or extracellular HMGB-1 was widespread only in SM from diseased joints, and also detected in OCF in areas of cartilage damage, fibrous repair tissue, and tidemark reduplication. Joints with OCF and cartilage lesions (without OCF) showed significantly higher median synovitis scores than healthy joints (p = 0.013 and p = 0.042, respectively). The study identifies OCF as a source of inflammatory mediators in equine OA, as shown by the presence of IL-6 and extracellular HMGB-1 in the fragment. Based upon HMGB-1 release in SM and OCF, further studies to investigate possible involvement of HMGB-1 in the pathogenesis of OA are warranted.     

Influence of site and age on biochemical characteristics of the collagen network of equine articular cartilage

OBJECTIVE: To determine variations in biochemical characteristics of equine articular cartilage in relation to age and the degree of predisposition for osteochondral disease at a specific site. SAMPLE POPULATION: Articular cartilage specimens from 53 horses 4 to 30 years old. PROCEDURE: Healthy specimens were obtained from 2 locations on the proximal articular surface of the first phalanx that had different disease prevalences (site 1 at the mediodorsal margin and site 2 at the center of the medial cavity). Water, total collagen, and hydroxylysine contents and enzymatic (hydroxylysylpyridinoline [HP]) and nonenzymatic (pentosidine) crosslinking were determined at both sites. Differences between sites were analyzed by ANOVA (factors, site, and age), and age correlation was tested by Pearson's product-moment correlation analysis. Significance was set at P< 0.01. RESULTS: Correlation with age was not found for water, collagen, hydroxylysine contents, and enzymatic cross-linking. Nonenzymatic crosslinking was higher in older horses and was linearly related to age (r = 0.94). Water and collagen contents and HP and pentosidine crosslinks were significantly higher at site 1. Hydroxylysine content was significantly lower at site 1. CONCLUSIONS: Except for nonenzymatic glycation, the composition of articular cartilage collagen does not change significantly in adult horses. A significant topographic variation exists in biochemical characteristics of the articular cartilage collagen network in equine metacarpophalangeal joints. These differences may influence local biomechanical properties and, hence, susceptibility to osteochondral disease, as will greater pentosidine crosslinks in older horses that are likely to cause stiffer and more brittle cartilage.     

A review of the treatment methods for cartilage defects

The purpose of this article is to provide a broad review of the literature related to the treatment of cartilage defects and degenerated cartilage in animals with some inferences to the treatment in humans. Methods range from the insertion of osteochondral tissue or cells to the application of radio frequency or insertion of scaffolds and growth factors alone or in combination. Debridement, microfracture, radio frequency, and chondrocyte implantation are all methods normally utilized when treating smaller articular cartilage defects. Scaffolds and mosaicplasty are examples of methods to treat larger defects. This review will cover all major treatment methods currently used to treat articular cartilage defects.     

Mapping of donor and recipient site properties for osteochondral graft reconstruction of subchondral cystic lesions in the equine stifle joint

REASONS FOR PERFORMING STUDY: To improve osteochondral graft reconstruction of subchondral cystic lesions in the medial and lateral femoral condyles by matching the material properties of donor and recipient sites. OBJECTIVES: To measure biomechanical and biochemical parameters that influence the function and healing of osteochondral grafts used to reconstruct subchondral cystic lesions. HYPOTHESIS: Suitable donor sites are available within the stifle joint for reconstructing the femoral condyles, despite considerable regional property variation. METHODS: Fifty-six osteochondral cores were harvested from 6 distal femurs for initial studies that determined subchondral bone modulus of elasticity and ultimate stress. In a second study, 28 osteochondral cores were harvested from 6 distal femurs to measure cartilage aggregate modulus, thickness and sulphated glycosaminoglycan (sGAG) content. Using micro-CT imaging, subchondral bone mineral density and bone volume fraction were also measured. In both studies 2-dimensional contour plots using a bicubic interpolation method and normalised data were generated to allow visual comparison of joint surface characteristics. Statistical comparisons between donor and recipient site raw data were made using an ANOVA for repeated measures with a post hoc Tukey test. RESULTS: Material properties of cartilage and bone vary considerably over the surface of the stifle joint but the central region of the medial condyle, where subchondral cystic lesions freqdently occur, typically demonstrated bone strength and modulus values of the highest observed. Cartilage thickness and aggregate modulus were highest in the medial femoral condyle and axial aspect of the lateral condyle. CONCLUSIONS: Material properties of the grafts from the trochlear groove and axial aspect of the lateral trochlear ridge were the closest match for those found in the medial condyle, whereas properties of the lateral condyle were most similar to those found in the trochlear groove and axial aspect of the medial trochlear ridge.