Use of a parathyroid hormone peptide (PTH 1-34)-enriched fibrin hydrogel for the treatment of subchondral cystic lesions in 15 horses

Abstract

Various treatment methods have been used for the management of subchondral cystic lesions (SCLs) in horses. Filling the defect with parathyroid hormone fragment peptide 1-34 (PTH1-34) in a fibrin matrix represents a relatively new approach that requires further investigation. For this reason fifteen horses with clinical and radiographic evidence of a total of sixteen SCLs (one horse bilaterally affected) were treated surgically with debridement of the cystic contents and injection of PTH1-34 in a fibrin hydrogel into the cyst cavity. Objectives of the study were to determine the clinical and radiographic outcome of SCLs treated locally with PTH1-34 and to identify factors that may predict outcome. Clinical and radiographic follow-up examinations were carried out at two, four, six and 12 months postoperatively and a telephone inquiry was carried out five to seven years later. The mean age of the horses was 4.9 years. Six SCLs were in the medial condyle of the femur, three in the distal metacarpus, three in the proximal sesamoid bone, two in the first phalanx, one in the patella and one in the calcaneus. Treatment was considered successful in 11 of the 15 cases (73%) because the horses were sound and returned to full work. In the remaining patients, there was improvement in one and no change in three others after treatment. Based on the outcome of this study, PTH1-34 in a fibrin matrix administered directly into the cyst after surgical debridement appears to be a promising treatment option for treating SCLs at various anatomic sites in horses