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Subchondral cystic Lesions: Curetting, Filling or Drilling
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Introduction
Subchondral cystic lesions (SCLs), also referred to as subchondral bone cysts or osseous cyst-like lesions (OCLLs), can affect many different joints in horses and are the result of a variety of pathological mechanisms. In 1975, Rooney described subchondral cystic lesions of the equine stifle as a manifestation of the osteochondrosis (OC) complex, in which retained, thickened and necrotic cartilage in the epiphyseal physis folds into the subchondral bone in the weightbearing areas of the joint. Recent studies have shown that in pigs and horses with osteochondrosis, abnormal ossification is the result of ischemic chondronecrosis caused by failure of the blood supply to the epiphyseal growth cartilage. Another mechanism associated with the development of SCLs is trauma to the articular cartilage, subchondral bone or both, which creates a communication between the subchondral bone and the joint allowing synovial fluid to move under pressure into the subchondral region; the result is necrosis of the adjacent bone and cyst formation. In a recent study evaluating the morphology of SCLs in the limbs of horses, it was shown that in almost one third of the cystic lesions, a concomitant fissure was visible using computed tomography es in the subchondral bone, which could lead to the development of subchondral bone cysts. Another finding was that all stress components were elevated around large cysts in the stifle of horses, which could result in a cycle of stress-induced bone remodelling perpetuating the growth of subchondral cystic lesions.2Alternatively, trauma can cause subchondral bone damage and bone ischaemia and necrosis, followed by revascularisation and resorption of necrotic bone, leaving a subchondral lesion.3 Lameness is attributed to increased intracystic or intraosseous pressure or both.4 In some cases, radiography can be used to diagnose subchondral cystic lesions.5 A typical radiographic finding is a dome shaped or round to oval subchondral area of lucency surrounded by a sclerotic rim of varying size. Some SCLs are difficult to detect on radiographs and several views may be needed to visualise the extent of the lesions. In a recent study, of 42 SCLs diagnosed by CT in the limbs of horses, only 33(79%) were identified radiographically.1
What is the best treatment for subchondral cystic lesions?
Even though SCLs constitute a very important orthopaedic problem in horses, there are no controlled comparative studies concerning the different treatment options.6Another important consideration is that treatment options differ with different joints so the specific treatment of individual SCLs depends on multiple variables including the type and age of the horse, the joint involved, the location of the cyst in the joint and the size of the SCL. [...]
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