Arthroscopic techniques for cartilage repair

Abstract

Abstract 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 Subchondral drilling (forage) has largely been superseded by microfracture techniques to open the subchondral bone in damaged cartilage areas.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.