Evidence-based assessment of best practice for the management of chondral defects in dogs

Chondral lesions are an important cause of morbidity in dogs. Whether developmental or traumatic in origin, discontinuities in the articular surface compromise the functions of cartilage as a low friction, wear-resistant and load-absorbent bearing surface. Additionally, full thickness lesions expose the underlying subchondral bone, to pressurized synovial fluid that can undermine the cartilage-bone interface and incite lysis of the subchondral bone plate. Although partial and full-thickness chondral lesions will undergo a reparative response, the resulting fibrocartilage is poorly adapted as an articulating surface, inevitably leading to the development of degenerative joint disease. The clinical goals for managing chondral defects are therefore to optimize the performance of cartilage surface, to resolve attendant pain and lameness, and to delay or prevent the development of degenerative joint disease. This presentation will review the main techniques that have been described for managing chondral lesions in dogs, making the distinction between techniques that (a) enhance the repair or regeneration of native cartilage, (b) provide exogenous cells to drive cartilage regeneration, and (c) replace bulk cartilage with either natural or synthetic grafts. The results from veterinary clinical studies will be discussed and comparisons made against equivalent data from humans. An algorithm for managing these lesions will be presented, and recommendations made with regard the development of prospective clinical trials to better define the optimal treatment for dogs with focal versus multifocal and partial versus full-thickness chondral lesions.