Biomechanical and wearability testing of novel legwear for variably limiting extension of the metacarpophalangeal joint of horses.

OBJECTIVE: To evaluate the ability of novel legwear designed to limit extension of the metacarpophalangeal joint (MCPJ) to redirect loading forces from the flexor apparatus during walk, trot, and canter on a treadmill and during unrestrained and restrained activity in a stall. ANIMALS: 6 adult horses without musculoskeletal disease. PROCEDURES: Legwear-derived force data were recorded under 4 conditions: inactive state (unlimited legwear extension) and 3 active (restrictive) states (mild, 30° extension; moderate, 20° extension; or maximum, 10° extension). Associations between peak legwear loads and torques among legwear states and treadmill gaits and stall activities were assessed. The hair coat and skin of the forelimbs were examined for any legwear-induced adverse effects after testing. RESULTS: During the treadmill exercises, moderate restriction of legwear extension resulted in significantly higher peak load and torque than mild restriction, and faster speeds (canter vs walk or trot and trot vs walk) yielded significantly higher peak load and torque. During in-stall activity, maximum restriction of legwear extension yielded significantly higher peak load and torque than moderate restriction. Unrestrained in-stall activity resulted in significantly higher peak load and torque than restrained activity. The legwear caused minimal adverse effects on the hair coat and skin of the forelimbs. CONCLUSIONS AND CLINICAL RELEVANCE: Findings suggested that the legwear variably reduced peak loads on the flexor apparatus. Extension of the MCPJ may be incrementally adjusted through the legwear such that return to activity may be controlled, and controlled return to activity is crucial for rehabilitating flexor apparatus injuries.

Kinematic and kinetic analyses of the gait of horses wearing novel legwear for variably limiting extension of the metacarpophalangeal joint.

OBJECTIVE: To investigate the effects of novel legwear designed to limit metacarpophalangeal joint (MCPJ) extension and redirect loading forces from the flexor apparatus through analyses of 2-D kinematic and kinetic data. ANIMALS: 6 adult horses without musculoskeletal disease. PROCEDURES: Horses were subjected to 4 treatments: control (no legwear), inactive legwear (unlimited legwear extension), and active legwear with mild (30°) and moderate (20°) legwear extension limitation. Two-dimensional kinematic data were collected for the right forelimb (FL) during walk and trot and from leading and trailing FLs during canter on a treadmill. Ground reaction force (GRF) data were collected from FLs during overground walk and trot. Peak MCPJ angle and angular velocity were calculated from kinematic data, and peak force and average loading rate were calculated from vertical GRF data during the stance phase of the gait. Interactions between gait and treatment were determined via ANOVA. RESULTS: Interactions between gait and treatment for peak MCPJ angle were significant. Significant reductions in MCPJ angle were noted between the control treatment and legwear with moderate extension limitation for trot and canter (leading and trailing FL) and between inactive legwear and legwear with moderate extension limitation for trot and leading FL during canter. Interactions among peak MCPJ angular velocity, peak vertical GRF, and average loading rate of the vertical GRF showed nonsignificance. CONCLUSIONS AND CLINICAL RELEVANCE: Significant reductions in MCPJ extension without significant alterations to peak vertical GRF suggested the legwear's ability to redistribute internal forces. Findings suggested that the legwear may be beneficial for horses rehabilitating from flexor apparatus injuries.

Effect of Fatigue on Equine Metacarpophalangeal Joint Kinematics-A Single Horse Pilot Study.

The objective was to validate a scientific method for characterizing equine metacarpophalangeal joint (MCPJ) motion in the nonfatigued and fatigued states using a single horse at trot, slow canter, and fast canter. One healthy Thoroughbred gelding exercised on a treadmill to exhaustion (fatigued state) (heart rate >190 BPM and blood lactate >10 mmol/L) while bilateral MCPJ angular data were acquired using electrogoniometry. Blood lactate and heart rate reflected transition from nonfatigued to fatigued states with increasing exercise duration and treadmill speed. Electrogoniometry consistently demonstrated: increase in mean MCPJ maximum extension angle with onset of fatigue; altered extension and flexion angular velocities with onset of fatigue; and increasing stride duration and decreasing stride frequency with onset of fatigue. The method allowed a preliminary but comprehensive characterization of the dynamic relationship between MCPJ kinematics and fatigue, prompting the need for multisubject studies that may enhance our ability to moderate exercise-related distal limb injury in equine athletes.

Three-dimensional kinematics of the equine metacarpophalangeal joint using x-ray reconstruction of moving morphology - a pilot study.

X-ray reconstruction of moving morphology (XROMM) uses biplanar videoradiography and computed tomography (CT) scanning to capture three-dimensional (3D) bone motion. In XROMM, morphologically accurate 3D bone models derived from CT are animated with motion from videoradiography, yielding a highly accurate and precise reconstruction of skeletal kinematics. We employ this motion analysis technique to characterize metacarpophalangeal joint (MCPJ) motion in the absence and presence of protective legwear in a healthy pony. Our in vivo marker tracking precision was 0.09 mm for walk and trot, and 0.10 mm during jump down exercises. We report MCPJ maximum extension (walk: -27.70 ± 2.78° [standard deviation]; trot: -33.84 ± 4.94°), abduction/adduction (walk: 0.04 ± 0.24°; trot: -0.23 ± 0.35°) and external/internal rotations (walk: 0.30 ± 0.32°; trot: -0.49 ± 1.05°) indicating that the MCPJ in this pony is a stable hinge joint with negligible extra-sagittal rotations. No substantial change in MCPJ maximum extension angles or vertical ground reaction forces (GRFv) were observed upon application of legwear during jump down exercise. Neoprene boot application yielded -65.20 ± 2.06° extension (GRFv = 11.97 ± 0.67 N/kg) and fleece polo wrap application yielded -64.23 ± 1.68° extension (GRFv = 11.36 ± 1.66 N/kg), when compared to naked control (-66.11 ± 0.96°; GRFv = 12.02 ± 0.53 N/kg). Collectively, this proof of concept study illustrates the benefits and practical limitations of using XROMM to document equine MCPJ kinematics in the presence and absence of legwear.

Sustained volume retention in vivo with adipocyte and lipoaspirate seeded silk scaffolds.

Current approaches to soft tissue regeneration include the use of fat grafts, natural or synthetic biomaterials as filler materials. Fat grafts and natural biomaterials resorb too quickly to maintain tissue regeneration, while synthetic materials do not degrade or regenerate tissue. Here, we present a simple approach to volume stable filling of soft tissue defects. In this study, we combined lipoaspirate with a silk protein matrix in a subcutaneous rat model. Silk biomaterials can be tailored to fit a variety of needs, and here were processed silk biomaterials into a porous sponge format to allow for tissue ingrowth while remaining mechanically robust. Over an 18 month period, the lipoaspirate seeded silk protein matrix regenerated subcutaneous adipose tissue while maintaining the original implanted volume. A silk protein matrix alone was not sufficient to regenerate adipose tissue, but yielded a fibrous tissue, although implanted volume was maintained. This work presents a significant improvement to the standard approaches to filling soft tissue defects by matching biomaterial degradation and tissue regeneration profiles.

Pararectal cystotomy for urolith removal in nine horses.

OBJECTIVE: To report outcome of horses after standing pararectal cystotomy for removal of uroliths. STUDY DESIGN: Case series. ANIMALS: Horses (n=9) with cystic calculi. METHODS: Medical records (December 1998-May 2007) of horses with cystic calculi that had standing pararectal cystotomy were reviewed. Signalment; urolith number, size, and type; surgical technique; sedation and analgesia protocols; intra- and postoperative complications and outcome were analyzed. RESULTS: Uroliths (mean diameter, 6.37 cm; median, 6 cm; range, 3-10 cm) were removed intact without need for fragmentation. Eight (89%) horses had no complications and 1 horse (11%) developed persistent drainage from the perineal incision and incisional healing was prolonged. The complications resolved after wound revision, and although cystoscopy showed absence of uroliths, the clinical signs associated with cystitis recurred. CONCLUSIONS: Cystic calculi can be removed safely in standing horses using a pararectal approach. The procedure was well tolerated and no serious complications were encountered. CLINICAL RELEVANCE: Pararectal cystotomy allows removal of cystic calculi in standing sedated horses. The technique may offer an economic advantage over approaches that require general anesthesia.

Evaluation of technetium Tc 99m-labeled biotin for scintigraphic detection of soft tissue inflammation in horses.

OBJECTIVE: To evaluate the use of technetium Tc 99m-labeled EDTA-biotin monomer ((99m)Tc-EB1) as a scintigraphic imaging agent for soft tissue inflammatory lesions in horses. ANIMALS: 6 healthy adult horses. PROCEDURES: First (phase 1), the agent's safety and blood-tissue clearance and an appropriate imaging protocol were determined in 6 horses. Each horse was injected with (99m)Tc-EB1 (1.1 GBq, IV, once); images were acquired at intervals during the following 24-hour period. Subsequently (phase 2), inflammation was induced via injection of 200 mg (10 mL) of mepivacaine (0.4 mg/kg) into the right neck musculature and perineurally in the proximal palmar metacarpal region of the right forelimb of 2 horses. Six hours after mepivacaine injection, (99m)Tc-EB1 (2.2 GBq, IV, once) was administered; 8 hours after injection, comparative soft tissue images were acquired after administration of technetium (99m)Tc-hydroxymethylene diphosphonate ((99m)Tc-HDP; 7.4 GBq, IV, once). RESULTS: After injections of (99m)Tc-EB1, physical examinations, CBCs, and serum biochemical analyses revealed no abnormalities in any horse. Blood clearance of (99m)Tc-EB1 was rapid (A phase, 2.2 minutes; beta phase, 58 minutes). Soft tissue uptake of (99m)Tc-EB1 was immediate and persisted for as long as 4 hours after injection. At 6 hours after IM and perineural mepivacaine injections, mepivacaine-induced inflammation was detectable by use of (99m)Tc-EB1. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that (99m)Tc-EB1 is safe for use in horses and can identify soft tissue inflammation without concurrent uptake in bone. Compared with (99m)Tc-HDP administration, use of (99m)Tc-EB1 extended the duration of soft tissue scintigraphic image acquisition.

Surgical management of small intestinal incarceration through the gastrosplenic ligament: 14 cases (1994-2006).

OBJECTIVE: To determine prevalence, clinical findings, and long-term survival rate after surgery associated with incarceration of the small intestine through the gastrosplenic ligament (ISIGL) in horses. DESIGN: Retrospective case series. ANIMALS: 14 horses with ISIGL. PROCEDURES: Medical records of horses with ISIGL examined between January 1994 and December 2006 were reviewed. Signalment, initial physical examination findings, results of abdominal fluid analysis, and clinical laboratory values were recorded, along with surgical findings, including segment of incarcerated intestine and surgical procedures performed. Long-term survival data were obtained through client interviews. RESULTS: Clinical findings included small intestinal distention identified via rectal palpation (10/14 horses) or transabdominal ultrasonography (8/11), nasogastric reflux (4/14), and abnormal abdominal fluid (9/9). All horses required intestinal resection and anastomosis. Postoperative complications included adynamic ileus (5/14 horses), incisional infection (4/14), diarrhea (3/14), and laminitis (1/14). No breed or age predilection was detected, although geldings were at increased risk for ISIGL. Long-term survival rate was 79% (11/14 horses). CONCLUSIONS AND CLINICAL RELEVANCE: ISIGL was an uncommon cause of colicin this hospital population. With appropriate surgical intervention and postoperative management, the long-term prognosis for surgically treated horses was fair to good.

Use of bone morphogenetic proteins for augmentation of bone regeneration.

A large body of preclinical and clinical data now documents that recombinant BMPs can be used for skeletal regeneration in humans and animals. Recombinant human BMP-2 and BMP-7 have been approved for use in human patients with long-bone fractures and nonunions and in patients undergoing lumbar fusion or various maxillofacial and dental regenerative procedures. These products have also been made available for veterinary use.

Safety of, and biological and functional response to, a novel metallic implant for the management of focal full-thickness cartilage defects: Preliminary assessment in an animal model out to 1 year.

Focal full-thickness cartilage lesions of the human medial femoral condyle (MFC) can cause pain and functional impairment. Affected middle-aged patients respond unpredictably to existing treatments and knee arthroplasty may be required, prompting risk of revision. This study assesses the safety of, and biological and functional response to, a metallic resurfacing implant which may delay or obviate the need for traditional arthroplasty. The anatomic contour of the surgically exposed MFC of six adult goats was digitally mapped and an 11 mm diameter full-thickness osteochondral defect was created. An anchor-based Co-Cr resurfacing implant, matching the mapped articular contour, was implanted. Each goat's contralateral unoperated femorotibial joint was used as a control. Postoperative outcome was assessed by lameness examination, radiography, arthroscopy, synoviocentesis, necropsy, and histology up to 26 (n = 3) or 52 (n = 3) weeks. By postoperative week (POW) 4, goats demonstrated normal range of motion, no joint effusion, and only mild lameness in the operated limb. By POW 26 the animals were sound with only occasional very mild lameness. Arthroscopy at POW 14 revealed moderate synovial inflammation and a chondral membrane extending centrally across the implant surface. Radiographs at POWs 14 to 52 implied implant stability in the operated joints, as well as subchondral bone remodeling and mild exostosis formation in the operated and contralateral unoperated joints of some goats. By POW 26, histology revealed new trabecular bone abutting the implant. At POWs 26 and 52 MFC cartilage was metachromatic and intact in the operated and unoperated femorotibial joints. Proximal tibiae of some operated and unoperated limbs demonstrated limited subchondral bone remodeling and foci of articular cartilage fibrillation and thinning. The chondral membrane crossing the prosthesis possessed a metachromatic matrix containing singular and clustered chondrocytes. Our data imply the safety, biocompatibility, and functionality of the implant. Focal articular damage was documented in the operated joints at POWs 26 and 52, but lesions were much reduced over those previously reported in untreated defects. Expanded animal or preclinical human studies are justified.

Occult subchondral osseous cyst-like lesions of the equine tarsocrural joint.

OBJECTIVE: To report the clinical signs, diagnosis, management, and outcome of horses with occult sub-chondral osseous cyst-like lesions of the tarsocrural joint. DESIGN: Retrospective study. ANIMALS: Twelve horses with subchondral osseous cyst-like lesions (SOCLs) in the tarsocrural joint. METHODS: Information about history, examination findings, diagnostic techniques, and surgical procedures as obtained from medical records. Outcome was determined by patient re-evaluation and telephone communication with the referring veterinarian, owner, or trainer. RESULTS: Horses were aged from 3 to 29 years. Lameness (2 weeks to 1 year) varied from moderate to severe. Synovial fluid analyses (9 horses) yielded changes consistent with suppurative inflammation and positive bacterial culture was obtained in 4 horses. Eight of 9 horses that had intra-articular analgesia had a dramatic reduction in lameness. No abnormalities were detected on tarsal radiographs in 10 horses. Scintigraphy identified foci of increased radiopharmaceutical uptake in the distal tibia or talus of all horses, and the lesion was further characterized by computed tomography in 7 horses. SOCLs were identified in the medial malleolus (5), intertrochlear groove of the talus (4), lateral malleolus (2), and distal intermediate ridge of the tibia (1). One horse was euthanatized, 6 horses had surgical debridement, and 5 horses were managed conservatively. Four horses treated surgically (67%) returned to soundness. Conservatively treated horses continued to exhibit lameness but 2 were sufficiently sound for light pleasure riding. CONCLUSIONS: Occult lesions of the tarsus not visible on radiographs can be detected by computed tomography and scintigraphy and may be a source of lameness. CLINICAL RELEVANCE: SOCL, possibly of septic origin, should be a differential diagnosis for persistent lameness localized to the tarsocrural joint without radiographic abnormalities. Surgical debridement of the lesions may offer the best prognosis for a return to athletic soundness.

Vascular-mineral spatial correlation in the calcifying turkey leg tendon.

Certain avian tendons are known to mineralize normally in a gender-related manner. These tendons have unique properties, as well as several features common to calcifying cartilage and bone in other vertebrate species. In cartilage and bone, mineralization has been associated with a vascular and microvascular origin, but such a relationship has not been established in the avian tendon. Here the vasculature and mineral deposition in the calcifying leg tendon of the turkey have been documented for the first time utilizing a combination of histology, immunochemistry, radiology, and novel three-dimensional image reconstruction methods based on computed tomography. The data describe the blood supply to turkey leg tendon and show that the vascularity of this tissue is correlated with the onset of mineralization: At local levels of structural hierarchy, a vascular bed precedes mineral formation and the sites of vascular invasion correspond spatially with those of mineral deposition. Relatively unvascularized tendon regions remain uncalcified. These results support the concept that vascularization and mineralization are functionally related in the tendon, and they suggest that vascular invasion provides a mechanism underlying subsequent mineral deposition in this tissue.