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Management of Medial Femoral Condyle OCLs - Enucleation vs. Injection?
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Management of medial femoral condyle osteochondral lesions (OCL; aka subchondral bone cysts) should encompass medical, surgical and rehabilitation therapies. Proper management requires an accurate diagnosis including intra-articular anaesthesia and radiographs as a minimum. A minimum of 3 radiographs should be obtained (Ca-Cr, lateral, CaLat-CrMed projections) to ascertain the 3D configuration of the OCL. OCLs can be primary in origin, or secondary to osteoarthritis (OA). Lesions can be bilateral, so both femorotibial joints should be radiographed. Horses with advanced OA, as indicated by osteophyte formation on the proximal-medial tibia and distal-medial femur, ± joint space narrowing and mineralisation of the menisci, were previously not considered candidates for surgery. However, newer biological grafting techniques are beginning to challenge this paradigm.
The majority of surgical treatments for OCL and cartilage lesions have centred on arthroscopic enucleation or removal of the necrotic tissue and debridement to healthy underlying subchondral bone. Other treatment options include corticosteroid injection into the cyst lining and cartilage grafting procedures. [...]
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