Autologous osteochondral grafting (mosaic arthroplasty) for treatment of subchondral cystic lesions in the equine stifle and fetlock joints.
Authors: Bodo Gabor, Hangody Laszlo, Modis Laszlo, Hurtig Mark
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Autologous Osteochondral Grafting for Equine Subchondral Cystic Lesions Subchondral bone cysts represent a significant challenge in equine orthopaedics, particularly when conservative management fails to resolve lameness and preserve joint function. Gabor and colleagues evaluated mosaic arthroplasty—a technique involving autologous osteochondral graft transplantation—in 11 horses with surgically refractory cystic lesions affecting the femoral condyles, metacarpal, and metatarsal joints. Grafts harvested from the abaxial medial femoral trochlea were implanted either via arthrotomy or arthroscopy depending on lesion location, with all horses demonstrating postoperative improvement and 10 of 11 achieving successful outcomes, including radiographic evidence of graft incorporation and functional articular surface reconstitution on follow-up arthroscopy in five cases. Seven horses returned to their previous activity level or higher, though one recurrence occurred after four years of soundness, and one case experienced delayed incorporation due to surgical technique. The practical significance of this work lies in offering a biologically restorative alternative for cases where conservative therapy and other interventions have been exhausted, potentially arresting the degenerative cascade that typically follows untreated subchondral cyst progression—though careful case selection, meticulous surgical technique, and realistic owner expectations regarding timeline to return to work remain essential for optimal outcomes.
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Practical Takeaways
- •Mosaic arthroplasty should be considered for SBCs in the stifle and fetlock when conservative therapy has failed and lameness persists, particularly in performance horses
- •Graft donor site (abaxial medial femoral trochlea of opposite limb) provides adequate material with minimal morbidity and can be harvested arthroscopically
- •Success rates are high (91%) with most horses returning to work, making this a viable surgical option before accepting permanent disability or retirement
Key Findings
- •All 11 horses showed postoperative improvement following osteochondral autograft transplantation for subchondral bone cysts
- •10 of 11 horses (91%) achieved successful outcomes with radiographic evidence of graft incorporation
- •7 of 11 horses (64%) returned to previous or higher activity levels
- •Follow-up arthroscopy in 5 horses demonstrated successful reconstitution of functional articular surfaces