Comparative Orthopedics Laboratory, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA.
Equine Vet J. 2012 Sep;44(5):606-13. doi: 10.1111/j.2042-3306.2011.00510.x. Epub 2011 Dec 1.
To evaluate the long-term clinical outcome after allogeneic chondrocyte and insulin-like growth factor-I (IGF-I) grafting of subchondral cystic lesions (SCLs) of the femoral condyle in horses.
To test the hypothesis that chondrocyte and IGF-I grafts will improve the long-term clinical outcome in arthroscopically debrided SCLs.
Medical records of 49 horses with SCLs of the femoral condyle treated by debridement and implantation of chondrocytes and IGF-I were reviewed. Preoperative radiographs were obtained, and caudocranial radiographic projections were used to establish a ratio between cyst and femoral condyle size. Arthroscopic cyst debridement followed by filling of the bone void with autologous cancellous bone (45 horses) or tricalcium phosphate granules (4 horses) was performed. A paired syringe containing a fibrinogen and chondrocyte mixture in one syringe and calcium-activated bovine thrombin with IGF-I in the other was used to cover the surface. A successful outcome was defined as a horse that performed to its intended use without lameness.
A successful outcome was achieved in 36 of 49 horses (74%). Preoperative radiography was performed in all horses, with 33 horses having unilateral SCLs of the medial femoral condyle, 15 horses having bilateral SCLs of the medial femoral condyle, and one horse having bilateral SCLs of the lateral femoral condyle. Median age of the horses was 3.3 years. Fifteen horses had preoperative radiographic and arthroscopic evidence of osteoarthritis (OA). A successful outcome was not influenced by age of horse, presence of pre-existing osteoarthritis or preoperative size of the subchondral cyst. Grafting resulted in success for 80% of horses >3 years old, and in 80% of horses with OA.
Implantation of allogeneic chondrocytes supplemented with IGF-I is an effective treatment for horses with SCLs of the femoral condyle, and particularly for older horses and horses with pre-existing osteoarthritis.
Chondrocyte implantation may offer a greater chance of long-term success in older horses and horses with osteoarthritis than has been previously reported with cyst debridement alone.
评估同种异体软骨细胞和胰岛素样生长因子-I（IGF-I）移植治疗股骨髁下骨软骨下囊性病损（SCL）的长期临床效果。
验证软骨细胞和 IGF-I 移植可改善关节镜下清创术治疗 SCL 的长期临床效果。
回顾性分析 49 例股骨髁 SCL 患者的病历资料，均采用清创术联合软骨细胞和 IGF-I 移植治疗。术前拍摄 X 线片，采用头尾位 X 线片建立囊腔与股骨髁比值。关节镜下进行囊腔清创，然后用自体松质骨（45 例）或磷酸三钙颗粒（4 例）填充骨缺损。使用装有纤维蛋白原和软骨细胞混合物的注射器和装有 IGF-I 的激活牛凝血酶的注射器，将混合物覆盖在表面。成功的结果定义为无跛行的马匹按预期用途执行任务。
49 例中有 36 例（74%）成功。所有马匹均行术前 X 线摄影检查，其中 33 例单侧股骨内侧髁 SCL，15 例双侧股骨内侧髁 SCL，1 例双侧股骨外侧髁 SCL。马匹的平均年龄为 3.3 岁。15 例术前 X 线和关节镜检查有骨关节炎（OA）证据。马的年龄、是否存在预先存在的 OA 或软骨下囊肿的术前大小均不影响手术结果。对于 >3 岁的马和患有 OA 的马，移植成功率分别为 80%和 80%。
同种异体软骨细胞联合 IGF-I 移植是治疗股骨髁 SCL 的有效方法，特别是对于年龄较大的马和患有 OA 的马。
与单独囊腔清创相比，软骨细胞移植可能为年龄较大的马和患有 OA 的马提供更好的长期成功机会。
