Effect of age at presentation on outcome following arthroscopic debridement of subchondral cystic lesions of the medial femoral condyle: 85 horses (1993‐2003)

Abstract

Summary Reasons for performing study: Subchondral cystic lesions of the medial femoral condyle (SCMFC) are well documented in horses 3 years; arthroscopic debridement or enucleation of the cyst is currently the surgical treatment of choice. However, studies of occurence and outcome following surgery in older horses are lacking. Objective: To identify factors important in outcome for horses with SCMFC treated by arthroscopic debridement. Hypothesis: Age of horse at presentation has a significant influence on return to work following arthroscopic treatment for SCMFC. Clinical and diagnostic findings are also significant with respect to prognosis. Methods: A retrospective review of medical records from 6 equine referral centres identified 85 horses that underwent arthroscopic debridement of SCMFC. Clinical examination, radiographic and arthroscopic findings were analysed together with follow‐up data. Univariable analysis and multivariable logistic regression models were used to determine factors affecting return to soundness. Event‐time analysis was performed to evaluate return to work. Results: Older horses (>3 years) were less likely to return to soundness (P = 0.02) or to work (P = 0.04) than younger horses (> 3 years). Of 39 horses age 0‐3 years, 25 (64%, 95% CI 49‐79%) returned to soundness. Of 46 horses age >3 years, 16 (35%, 95% CI 21‐49%) returned to soundness. In addition, cartilage damage at sites other than the SCMFC negatively affected prognosis (P = 0.05). The hospital where treatment was performed had no influence on return to soundness. Conclusions: Older horses carry a worse prognosis for both return to soundness and return to work. Potential relevance: It is important for clients to be made aware of the difference in outcome between age groups.

Ultrasonographic Findings in the Stifle Joint of Active Jumping and Dressage Horses

“…As expected, no lesions were seen in the menisci confirming the findings of previous studies regarding the high clinical relevance of any abnormality detected in the meniscus [17,20].…”

Die Behandlung suchchondraler Knochenzysten des medialen Femurkondylus - Fortschritte auf der Basis von Forschung und klinischer Erfahrung

“…Significantly more unilateral SCLs compared to bilateral (28/31: 90% SCLs) were classified as successful and bilateral (28/42: 67%). There was no significant association between age group (age ≤ 3 years versus >3 years) and outcome or cystic configuration and outcome, which contrasts with the findings of Smith et al (2005). There were significant differences in outcome based on the surgeon operating the case (but this seemed based on recommended lay-up time with shorter layup being more successful) and there was a negative association between pre-existing radiographic findings of osteophytes and negative outcome.…”

Effect of recombinant human bone morphogenetic protein 2 (rhBMP-2) on equine bone formation: A preliminary in vitro and in vivo evaluation

“…Smith et al (2005) have suggested that older horses, and those with pre-existing osteoarthritis, have a significantly poorer prognosis following surgical debridement of femoral SCLs, with only 35 % of horses older than 3 years returning to soundness after debridement. Similarly, phalangeal SCLs have a poorer prognosis in older horses than in younger horses (Howard et al 1995).…”

“…Conservative treatment consists of a rest period out at grass, followed by gradual return to full training (Jeffcott and Kold 1982), or controlled exercise and systemic administration of NSAIDs, often in combination with intra-articular medication (Trotter and Dyson 2003). However, since the outcome of conservative treatment of SCLs is generally poor, surgical intervention is currently the recommended treatment option (McIlwraith 2013), especially in older horses, or in horses that are refractory to conservative treatment (Ortved et al 2012, Smith et al 2005. Since SCLs of the PIP joint are not arthroscopically accessible, surgical debridement is usually performed through a transcortical approach (Fürst et al 1997, Mettenleiter 2014.…”

“…Treatment of equine SCLs using insulin-like growth factor (IGF)-1 in combination with allogeneic chondrocytes led to improved healing in the short-term (8 weeks) and long-term (8 months) follow-up with a successful outcome in 80 % of horses over 3-years-ofage, even in the presence of joint degeneration (Ortved et al 2012). It has been suggested that horses older than three years tend to be more refractory to the previously described treatments; Smith et al (2005) found that only 35 % of horses older than 3 years became sound after surgical debridement of an SCL in the medial femoral condyle.…”