Cartilage Therapy and Repair in Equine Athletes

The status of articular cartilage often defines the level, progression, and subsequent prognosis of joint disease in both human and equine athletes. Although methods to diagnose equine cartilage defects have significantly improved over the past decade, articular cartilage damage and ensuing osteoarthritis remain a challenge to treat. The following 2 categories of surgical options for cartilage repair in the horse are typically considered: palliative and reparative or restorative. Palliative surgical care consists of arthroscopic debridement and lavage, whereas reparative options involve the use of marrow stimulation techniques. Restorative or reparative surgical options are an area of active research, including the use of osteochondral grafting, autologous chondrocyte implantation (ACI), and augmentation with mesenchymal stem cells (MSCs). Subchondral bone microfracture coupled with intra-articular stem cell injection is currently considered to be the optimal treatment combination for equine patients with articular cartilage defects. Following arthroscopic surgery, the rehabilitative goals are to provide support to the affected limb, restore joint flexibility, stability, and manage perioperative pain. In addition, biologic therapy for the treatment of equine joint disease continues to be clinically employed and of investigational interest. With the large amount of ongoing in vitro research in bioprinted osteochondral constructs and potential extracellular matrix components, and the advantages of the in vivo equine model of articular cartilage repair as well as naturally occurring disease, it seems inevitable that the horse would be used to develop these novel techniques.