Arthroscopic reattachment of osteochondritis dissecans cartilage flaps of the femoropatellar joint: long-term results.

The research article examines the effectiveness of arthroscopic cartilage reattachment as a treatment for osteochondritis dissecans (OCD) lesions in horses. The study concludes that reattaching the cartilage to the joint surface had an overall 95% success rate based on the long-term soundness and performance of the treated horses.

Objective and Methodology

• The study’s main objective was to evaluate the long-term outcomes for horses who had OCD cartilage flaps reattached in their joints. The idea was to reincorporate these separated cartilage flaps back into the joint surface rather than removing them.
• The process was carried out using polydioxanone pins to arthroscopically reattach these OCD lesions. The reattachment was applicable when the cartilage retained its perimeter continuity, the surface wasn’t irregular or deeply fissured, and the cartilage wasn’t protruding or extensively mineralised.
• To fill out areas that were devoid of cartilage or alongside reattached cartilage, a bone marrow aspirate concentrate was grafted.

Results

• The study was conducted on 27 horses with varied breeds and a mean age of 9.7 months. Lesions length ranged from 1.5-6.3cm. Various methods were used: 32 joints were treated with reattachment alone, 8 with a mixture of debridement and reattachment, and 4 with debridement only.
• One horse had to be euthanised due to a tendon laceration. The mean follow-up duration for the remaining 26 horses was 15.6 months (ranging from 2 months to 12 years).
• The study reported a significant improvement in the radiographic resolution of OCD lesions that were treated with reattachment after 6 months.
• Of the twenty horses that had long-term performance data, 19 were sound and had reached their athleticism potential. Only one horse remained lame, while six others were sound but still unbroken or were in the healing stages. Hence, the study found a 95% success rate based on the continued soundness in the athletic performance of the horses.

Conclusions

• OCD cartilage flaps can be reintegrated into the joint through the reattachment process, hence saving these cartilages.
• The study suggests that restoring extensive OCD cartilage flaps through reattachment could lead to a normal radiographic subchondral bone contour and thus improve long-term athletic performance.