Treatment approaches for equine subchondral lucencies: Clinical considerations and therapeutic decision‐making

Summary Subchondral lucencies, also referred to as subchondral cystic lesions or osseous cyst‐like lesions, are radiographically identifiable defects of subchondral bone that remain an important cause of lameness and reduced athletic performance in horses. Their pathogenesis is multifactorial and incompletely understood, with proposed mechanisms including developmental disturbance of endochondral ossification, biomechanical overload, trauma and focal subchondral bone injury. Our aim was to provide a narrative clinical review of reported treatment approaches for equine SCLs and to discuss therapeutic decision‐making in the context of anatomical location, clinical presentation and limitations of the available literature. Relevant peer‐reviewed literature and selected conference proceedings were reviewed, with emphasis on reports describing conservative, surgical, biological or regenerative treatment of equine SCLs. Reported outcomes were interpreted descriptively because of substantial heterogeneity in lesion location, study design, treatment technique, outcome definitions and follow‐up duration. A wide range of therapeutic approaches has been reported across anatomical locations, including conservative management, arthroscopic or transcortical debridement, drilling, screw placement, bone grafting and biological or regenerative adjuncts. Available reports suggest that surgical intervention may provide more predictable outcomes in clinically lame horses, particularly when lesions involve weight‐bearing regions. However, comparison among treatments is limited by the predominance of retrospective case series, small case numbers and inconsistent definitions of success. Limitations of the review are that the literature is heterogeneous and largely composed of retrospective studies, case series and case reports and outcome measures vary widely among reports, including resolution of lameness, return to intended use, return to racing, pasture soundness and radiographic improvement. We concluded that treatment selection for equine SCLs should be guided by clinical presentation, lesion location, age, chronicity, concurrent pathology and intended athletic use. Current evidence supports individualised decision‐making rather than definitive superiority of any single treatment. Comparative studies using standardised outcome measures are needed to improve evidence‐based recommendations.