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Santschi EM. Equine subchondral lucencies: Knowledge from the medial femoral condyle. Vet Surg 2024; 53:426-436. [PMID: 38229531 DOI: 10.1111/vsu.14062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/25/2023] [Accepted: 12/02/2023] [Indexed: 01/18/2024]
Abstract
Equine subchondral lucencies (SCL) have been described since the first availability of suitable radiographic equipment. The initial clinical sign can be lameness, but SCLs are often first found on surveys of juvenile horses and are primarily a radiographic concern for public auctions. When lameness is present, it varies from subtle to obvious and can be intermittent. Some SCLs heal spontaneously, and some remain blemishes, but when the SCL and lameness are persistent, further damage to the joint and limitations to an athletic career are likely. SCLs were initially described in the distal limb followed by the stifle, and the medial femoral condyle (MFC) is now considered the most common location. The aim of this review is to highlight the initial pathology and discuss the clinical and experimental information available on equine SCLs. SCL treatment has evolved from rest alone and has progressed to debridement, grafting, intralesional injection, and most recently, transcondylar screw and absorbable implant placement. Comparison of success rates between techniques is difficult due to variations in follow-up and outcome measures, and no single technique is best for all SCLs. Treatment appears to increase success by 15%-20% over rest alone, but the method chosen depends on many factors. This review emphasizes the need for further work to fully understand SCL formation and all aspects of trabecular bone healing to optimize surgical therapy and improve treatment success.
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Canonici F, Marcoccia D, Bonini P, Monteleone V, Innocenzi E, Zepparoni A, Altigeri A, Caciolo D, Tofani S, Ghisellini P, Rando C, Pechkova E, Rau JV, Eggenhöffner R, Scicluna MT, Barbaro K. Arthroscopic Treatment of a Subchondral Bone Cyst via Stem Cells Application: A Case Study in Equine Model and Outcomes. Biomedicines 2023; 11:3307. [PMID: 38137527 PMCID: PMC10741679 DOI: 10.3390/biomedicines11123307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Subchondral bone cysts in horses represent one of the main causes of lameness that can occur in different anatomical locations. The study describes the treatment in regenerative therapy of the intracystic implantation of adipose tissue mesenchymal stromal cells (AMSCs) included in platelet-rich plasma (PRP). The ability of AMSCs to differentiate in osteogenic cells was tested in vitro and in vivo. Given the aim to investigate the application of AMSCs in bone defects and orthopedic pathologies in horses, a four-year-old male thoroughbred racing horse that had never raced before was treated for lameness of the left hind leg caused by a cyst of the medial femoral condyle. The horse underwent a new surgery performed with an arthroscopic approach in which the cystic cavity was filled with AMSCs contained in the PRP. Radiographs were taken 3, 5, and 10 months after the surgery to assess the development of newly regenerated bone tissue in the gap left by the cyst. Twelve months after the operation and after six months of regular daily training, the horse did not show any symptoms of lameness and started a racing career. According to the study, the use of AMSCs and PRP suggests promising benefits for treating subchondral bone cysts.
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Affiliation(s)
- Fernando Canonici
- Equine Practice srl, Campagnano, Strada Valle del Baccano 80, 00063 Roma, Italy;
| | - Daniele Marcoccia
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Pamela Bonini
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Valentina Monteleone
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Elisa Innocenzi
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Alessia Zepparoni
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Annalisa Altigeri
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Daniela Caciolo
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Silvia Tofani
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Paola Ghisellini
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Genova University, Corso Europa 30, 16132 Genova, Italy; (P.G.); (C.R.); (R.E.)
| | - Cristina Rando
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Genova University, Corso Europa 30, 16132 Genova, Italy; (P.G.); (C.R.); (R.E.)
| | - Eugenia Pechkova
- Consorzio Interuniversitario INBB, Viale delle Medaglie d’Oro, 305, 00136 Roma, Italy;
- Laboratories of Biophysics and Nanotechnology, Department of Experimental Medicine (DIMES), Genova University, Via Pastore 3, 16132 Genova, Italy
| | - Julietta V. Rau
- Istituto di Struttura della Materia, Consiglio Nazionale delle Ricerche (ISM-CNR), Via del Fosso del Cavaliere 100, 00133 Rome, Italy;
| | - Roberto Eggenhöffner
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Genova University, Corso Europa 30, 16132 Genova, Italy; (P.G.); (C.R.); (R.E.)
| | - Maria Teresa Scicluna
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Katia Barbaro
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
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Comparison of clinical-CT segmentation techniques for measuring subchondral bone cyst volume in glenohumeral osteoarthritis. J Exp Orthop 2023; 10:1. [PMID: 36607513 PMCID: PMC9823169 DOI: 10.1186/s40634-022-00564-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023] Open
Abstract
PURPOSE This study aimed to assess the accuracy and reproducibility of four common segmentation techniques measuring subchondral bone cyst volume in clinical-CT scans of glenohumeral OA patients. METHODS Ten humeral head osteotomies collected from cystic OA patients, having undergone total shoulder arthroplasty, were scanned within a micro-CT scanner, and corresponding preoperative clinical-CT scans were gathered. Cyst volumes were measured manually in micro-CT and served as a reference standard (n = 13). Respective cyst volumes were measured on the clinical-CT scans by two independent graders using four segmentation techniques: Qualitative, Edge Detection, Region Growing, and Thresholding. Cyst volume measured in micro-CT was compared to the different clinical-CT techniques using linear regression and Bland-Altman analysis. Reproducibility of each technique was assessed using intraclass correlation coefficient (ICC). RESULTS Each technique outputted lower volumes on average than the reference standard (-0.24 to -3.99 mm3). All linear regression slopes and intercepts were not significantly different than 1 and 0, respectively (p < 0.05). Cyst volumes measured using Qualitative and Edge Detection techniques had the highest overall agreement with reference micro-CT volumes (mean discrepancy: 0.24, 0.92 mm3). These techniques showed good to excellent reproducibility between graders. CONCLUSIONS Qualitative and Edge Detection techniques were found to accurately and reproducibly measure subchondral cyst volume in clinical-CT. These findings provide evidence that clinical-CT may accurately gauge glenohumeral cystic presence, which may be useful for disease monitoring and preoperative planning. LEVEL OF EVIDENCE Retrospective cohort Level 3 study.
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Wright L, Hernlund E, Fjordbakk C, Ytrehus B, Law E, Uhlhorn M, Rhodin M. Patellar ligament desmopathy in the horse – a review and comparison to human patellar tendinopathy (‘Jumper’s knee’). COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep220011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patellar ligament desmopathy in horses is regarded as an uncommon condition with unclear aetiology. Of the three patellar ligaments in the horse, the intermediate is the one most often diagnosed with desmopathy in horses presenting with chronic lameness. This structure corresponds to the patellar tendon in humans. As diagnostic imaging modalities continuously improve, changes in echogenicity of the patellar ligaments are identified ultrasonographically with increasing frequency. However, disruption of the normal fibre pattern may be present also in patellar ligaments in horses that show no signs of lameness. Similarly, there is a poor correlation between pain and diagnostic imaging findings in human patellar tendinopathy. Consequently, there appears to be a knowledge gap pertaining to normal ultrasonographic variation and diagnostic criteria for disease of the patellar ligaments in horses. Furthermore, local anaesthetic techniques to verify the diagnosis are poorly described, and due to the low number of treated cases, no specific treatment modality can be recommended on a scientific basis. The aim of this paper is to review the current knowledge regarding the pathogenesis, diagnosis and management of patellar ligament desmopathy in horses, compare this condition with patellar tendinopathy in humans, and identify areas for further research to increase the diagnostic accuracy in horses. We conclude that there is a profound need for better descriptions of ultrasonographic variation and pathological changes of the equine patellar ligaments. Identification of areas of maximal ligament strain and descriptions of early histopathological changes could render more information on the possible aetiology, preventive measurements and treatment options of desmopathy. Description of regional innervation could aid in development of methods for diagnostic anaesthesia to verify pain originating from the ligaments.
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Affiliation(s)
- L. Wright
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
| | - E. Hernlund
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
| | - C.T. Fjordbakk
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oluf Thesens vei 24, 1432 Ås, Norway
| | - B. Ytrehus
- Department of Biomedicine and Veterinary Public Health, Swedish University of Agricultural Sciences, P.O. Box 7028, 750 07 Uppsala, Sweden
| | - E. Law
- University Animal Hospital, P.O. Box 7040, 750 07 Uppsala, Sweden
| | - M. Uhlhorn
- University Animal Hospital, P.O. Box 7040, 750 07 Uppsala, Sweden
| | - M. Rhodin
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
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Ammann L, Ohlerth S, Fürst AE, Jackson MA. Differences of morphological attributes between 62 proximal and distal subchondral cystic lesions of the proximal phalanx as determined by radiography and computed tomography. Am J Vet Res 2022; 83:ajvr.22.04.0071. [DOI: 10.2460/ajvr.22.04.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
OBJECTIVE
To determine morphological characteristics of subchondral cystic lesions (SCLs) in the proximal phalanx (PP) of adult horses.
SAMPLE
Radiographs and/or CT scans of PP from 46 horses.
PROCEDURES
There were horses with a SCL in PP, which was diagnosed by radiography and/or computed tomography, included. Additional data (signalment, history, orthopedic examination) were collected retrospectively for each case.
RESULTS
Forty-six horses met the required inclusion criteria, with a total of 62 SCLs. Forty-three SCLs (70.5%) were located in the proximal PP (group A). Forty-four percent of these were associated with short, incomplete fractures, while 30 of the proximal PP SCLs (69.7%) were found mid sagittal. Proximal SCLs mostly showed a blurred, irregular shape (62.8%) and long, as well as wide, but shallow shapes in CT. Eighteen SCLs (29.5%) were found in the distal PP, near the proximal interphalangeal joint (group B). In contrast to the described proximal SCLs, the distal SCLs were of circular or oval shape, well delineated (77.8%), and distinctly larger. Horses of group A were significantly older (mean age, 11.47 years) than horses of group B (mean age, 6.72 years).
CLINICAL RELEVANCE
The distribution and morphological attributes of proximal PP SCLs as well as their association to subchondral bone lesions and short, incomplete proximal fractures indicate more recently developed lesions due to chronic stress factors, such as repetitive trauma to the cartilage and subchondral bone. In contrast, morphology and distribution of distal SCLs showed high accordance with developmental bone cysts originating from a failure of endochondral ossification.
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Affiliation(s)
- Liliane Ammann
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Stefanie Ohlerth
- Clinic of Diagnostic Imaging, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Anton E. Fürst
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Michelle A. Jackson
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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6
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Jenner F. Treatment of osseous cyst‐like lesions. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- F. Jenner
- Equine Surgery University of Veterinary Medicine Vienna Vienna Austria
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7
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Frazer LL, Santschi EM, Ring SJ, Hewitt RE, Fischer KJ. Impact of Size and Shape of Equine Femoral Subchondral Bone Cysts With a Transcondylar Screw on Predicted Bone Formation Area in a Finite Element Model. J Biomech Eng 2020; 142:061010. [PMID: 31901159 DOI: 10.1115/1.4045892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Indexed: 11/08/2022]
Abstract
Equine subchondral bone cysts (SBCs) develop most often in the medial femoral condyle (MFC) of yearlings intended for performance. SBCs often cause lameness and can cause secondary injuries to the meniscus and tibial cartilage. A novel surgical technique using a transcondylar lag screw (TLS) across an MFC SBC has shown success in lameness resolution and radiographic healing of MFC SBC. In a previous study using finite element analysis, our lab showed that a TLS stimulated bone formation on the inner surface of the SBC and altered third principal stress vectors to change the direction of surface compression to align with the screw axis. This work extended the previous study, which was limited by the use of only one idealized SBC. Our objective was to test SBCs of several sizes and shapes in a newly developed equine stifle FEM with a TLS to determine how cyst size affects bone formation stimulation. This study found that a transcondylar screw is most effective in stimulating bone formation in cysts of greater height (proximal-distal). The TLS increases stress stimulus in the bone around the cyst to promote bone apposition and directs compression across the cyst. If full penetration of the screw through the cyst is possible, it is recommended that the transcondylar screw be used to treat subchondral bone cysts. For the treatment of smaller cysts that are not accessible by the current screw surgical approach, future work could study the efficacy of a dual-pitch headless screw that may reach smaller cysts.
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Affiliation(s)
- Lance L Frazer
- Bioengineering Program, University of Kansas, Lawrence, KS 66045
| | | | - Scott J Ring
- Department of Mechanical Engineering, University of Kansas, Lawrence, KS 66045
| | - Ross E Hewitt
- School of Management, University of Missouri-Kansas City, Kansas City, MO 64110
| | - Kenneth J Fischer
- Department of Mechanical Engineering, University of Kansas, Lawrence, KS 66045; Bioengineering Program, University of Kansas, Lawrence, KS 66045
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8
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Maturation of the equine medial femoral condyle osteochondral unit. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100029. [DOI: 10.1016/j.ocarto.2020.100029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/16/2020] [Indexed: 12/15/2022] Open
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9
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Frazer LL, Santschi EM, Fischer KJ. Impact of a void in the equine medial femoral condyle on bone stresses and peak contact pressures in a finite element model. Vet Surg 2018; 48:237-246. [DOI: 10.1111/vsu.13139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/30/2018] [Accepted: 11/03/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Lance L. Frazer
- Bioengineering Program, University of Kansas Lawrence Kansas
| | - Elizabeth M. Santschi
- Department of Clinical Sciences, Kansas State University College of Veterinary Medicine Manhattan Kansas
| | - Kenneth J. Fischer
- Department of Mechanical Engineering, University of Kansas Lawrence Kansas
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Bilmont A, Mathon D, Autefage A. Arthroscopic Management of Osteochondrosis of the Glenoid Cavity in a Dog. J Am Anim Hosp Assoc 2018; 54:e54503. [PMID: 30040000 DOI: 10.5326/jaaha-ms-6584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 5 mo old English setter dog was presented with mild left forelimb lameness. Physical examination revealed pain upon shoulder palpation and extension. Mediolateral radiographs of both shoulders showed a subchondral bone defect in the mid-portion of the glenoid cavity. Computed tomography arthrography and arthroscopy revealed a cartilage flap, suggesting osteochondritis dissecans of the glenoid cavity. Subchondral bone cysts of the glenoid cavity and incomplete fusion of the supraglenoid tubercle were also observed. Arthroscopic removal of the fragment led to a favorable outcome.
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Affiliation(s)
- Alexis Bilmont
- From Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Didier Mathon
- From Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - André Autefage
- From Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
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11
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Nelson BB, Kawcak CE, Barrett MF, McIlwraith CW, Grinstaff MW, Goodrich LR. Recent advances in articular cartilage evaluation using computed tomography and magnetic resonance imaging. Equine Vet J 2018; 50:564-579. [DOI: 10.1111/evj.12808] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/09/2018] [Indexed: 12/18/2022]
Affiliation(s)
- B. B. Nelson
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - C. E. Kawcak
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - M. F. Barrett
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
- Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins Colorado USA
| | - C. W. McIlwraith
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - M. W. Grinstaff
- Departments of Biomedical Engineering, Chemistry and Medicine Boston University Boston Massachusetts USA
| | - L. R. Goodrich
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
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