The Effects of a Crosslinked, Modified Hyaluronic Acid (xCMHA-S) Gel on Equine Tendon Healing.

OBJECTIVE: To assess the effects of a crosslinked, modified hyaluronic acid (xCMHA-S) gel on equine tendon healing using an in vivo surgical model. STUDY DESIGN: In vivo experimental study. ANIMALS: Adult horses (n = 5). METHODS: Full thickness bilateral forelimb window tenectomies were surgically created in both forelimb superficial digital flexor tendons and xCMHA-S gel was implanted intraoperatively into the right forelimb lesion of each horse whereas the left forelimb served as the untreated control. Healing was monitored by serial ultrasound examinations every 14 days over the course of the 84 day study. In addition, gross pathology, scanning electron microscopy for fiber diameter, and histological scoring were completed on tendon samples harvested after euthanasia at 84 days. RESULTS: Ultrasound assessment demonstrated a significant decrease in mean lesion size of treated (0%) compared to control (30%) tendons at 84 days. Mean (±SD) cumulative histologic tendon scores for control tendons (17.7 ± 2.7) were significantly higher than treated tendons (13.6 ± 1.9), indicating less advanced healing in the control group. Tendon cell density was increased and neovascularization, intensity of inflammation, and uniformity of fiber diameter were increased in control compared to treated tendons. There were no differences in fibroblast shape, levels of intralesional hemorrhage, linearity of collagen fibers, or collagen fiber diameter or distribution between treated and control tendons. CONCLUSION: Tendons treated with xCMHA-S gel at the time of model induction had superior histologic healing scores and sonographically smaller lesions compared to controls, suggesting that xCMHA-S gel may aid the natural healing process.

Partial carpal arthrodesis in a 2-year-old alpaca.

A 2-year-old alpaca was presented for acute onset right forelimb lameness. Clinical findings included bilateral carpal valgus (more severe in the affected forelimb) and medial instability of the right radio-carpal joint. Surgical treatment consisted of radio-carpal joint arthrodesis, which is presented as a therapeutic option for severe carpal instability secondary to injury to the supporting ligamentous structures of the carpus.

Use of a chain écraseur for excision of a pharyngeal granuloma in a cow.

CASE DESCRIPTION: A 10-year-old Longhorn cow pregnant with a valuable fetus was evaluated because of progressive inspiratory dyspnea of 6 weeks' duration. CLINICAL FINDINGS: Physical examination findings were consistent with upper respiratory tract obstruction. A large pedunculated soft tissue mass was evident in the mid-dorsal aspect of the pharynx during palpation and endoscopic examination. Results of microscopic examination of transendoscopic fine-needle aspirates and a biopsy specimen were suggestive of a bacterial granuloma. TREATMENT AND OUTCOME: Transtracheal intubation was performed, and the mass was excised with a chain écraseur. Results of histologic examination were consistent with a diagnosis of actinobacillosis. The owner reported that the cow was doing well without any recurrence of respiratory distress 8 months after surgery. CLINICAL RELEVANCE: Findings suggested that pharyngeal granuloma resulting from actinobacillosis should be included in the differential diagnoses when examining mature cattle with upper respiratory tract obstruction and that a chain écraseur may be useful for excising soft tissue pharyngeal masses in cattle.

Polypropylene mesh repair of a unilateral, congenital hernia in the inguinal region in a Thoroughbred filly.

A 2-day-old Thoroughbred intact female was presented for a large subcutaneous swelling in the right inguinal region. Surgical repair was performed using a double layer polypropylene mesh. To the authors' knowledge, there have been no previous reports of surgical repair of congenital body wall hernias with polypropylene mesh in foals.

Persistent dorsal displacement of the soft palate attributable to a frenulum of the epiglottis in a racing Thoroughbred.

CASE DESCRIPTION: A 7-year-old sexually intact male Thoroughbred racehorse was evaluated because of exercise intolerance, respiratory tract noise, and coughing when eating. CLINICAL FINDINGS: A persistent dorsal displacement of the soft palate was identified during endoscopic examination of the upper portions of the respiratory tract. Radiography of the pharyngeal and laryngeal regions revealed a hypoplastic epiglottis that was ventral to, and not in contact with, the soft palate. The horse was anesthetized, and an oral endoscopic examination revealed a subepiglottic frenulum that had resulted in the dorsal displacement of the soft palate. TREATMENT AND OUTCOME: The frenulum was transected transendoscopically by use of a diode laser. Twenty-four hours following surgery, repeat endoscopic and radiographic examinations revealed that the epiglottis had returned to its correct anatomic position in relation to the soft palate. Four weeks after surgery, endoscopy of the upper portions of the airway revealed recurrence of the dorsal displacement of the soft palate. CLINICAL RELEVANCE: A subepiglottic frenulum should be considered as a cause of persistent dorsal displacement of the soft palate in horses. An endoscopic examination of the oropharyngeal region should be performed in horses prior to undertaking any surgical interventions to treat persistent dorsal displacement of the soft palate.

Gait abnormalities caused by selective anesthesia of the suprascapular nerve in horses.

OBJECTIVE: To assess gait abnormalities associated with selective anesthesia of the suprascapular nerve (SSN) achieved by use of perineural catheterization and thereby determine the function of that nerve as it relates to gait in horses. ANIMALS: 3 adult horses with no preexisting clinically apparent lameness at a walk. PROCEDURE: Each horse was anesthetized; the right SSN was exposed surgically for placement of a perineural catheter to permit delivery of 1 mL of 2% mepivacaine hydrochloride. Six hours after recovery from anesthesia, each horse was videotaped while walking (50-step data acquisition period) before and after administration of mepivacaine. Videotapes were reviewed and the proportion of abnormal steps before and after selective SSN anesthesia was assessed. A step was considered abnormal if a marked amount of scapulohumeral joint instability (ie, lateral luxation of the proximal portion of the humerus) was observed during the weight-bearing phase of the stride. RESULTS: Clinically apparent gait dysfunction was detected in all 3 horses following perineural administration of the local anesthetic agent. Anesthesia of the SSN resulted in scapulohumeral joint instability as evidenced by consistent lateral excursion of the shoulder region during the weight-bearing phase of gait at a walk. The proportion of abnormal steps before and after SSN anesthesia was significantly different in all 3 horses. CONCLUSIONS AND CLINICAL RELEVANCE: These data support the role of the SSN in shoulder joint stability in horses and define SSN dysfunction as 1 mechanism by which the syndrome and gait dysfunction clinically referred to as sweeny may develop.

Quantitative comparison of three commonly used treatments for navicular syndrome in horses.

OBJECTIVE: To quantitatively compare 3 commonly used treatments for navicular syndrome (NS) in horses: heel-elevation shoeing alone, heel-elevation shoeing and phenylbutazone administration, heel-elevation shoeing and injection of the distal interphalangeal joint (DIPJ) with triamcinolone acetonide (TA), and all 3 treatments in combination. ANIMALS: 12 horses with NS. PROCEDURE: A force plate was used to measure baseline peak vertical ground reaction force (PVGRF) of the forelimbs. Each horse's forelimbs were shod with 3 degrees heel-elevation horseshoes; PVGRF was measured 24 hours and 14 days after shoeing. Fourteen days after shoeing (following data collection), phenylbutazone (4.4 mg/kg, i.v., q 12 h) was administered (5 treatments). Two hours after the fifth treatment, PVGRF was measured; TA (6 mg) was injected into the DIPJ of the forelimb that generated the lower baseline PVGRF Fourteen days later, PVGRF was measured. Phenylbutazone was administered as before, and PVGRF was measured. Percentage body weight of force (%BWF) was calculated from PVGRF measurements and used for comparisons. RESULTS: 14 days after shoeing, mean %BWF in both forelimbs significantly increased from baseline; additional administration of phenylbutazone significantly increased %BWF applied from the more lame forelimb. Compared with shoeing alone, there was no significant change in %BWF after injection of the DIPJ with TA in shod horses. CONCLUSIONS AND CLINICAL RELEVANCE: Heel-elevation shoeing alone and in combination with phenylbutazone administration quantitatively decreased lameness in horses with NS. Although not significant, additional DIPJ injection with TA resulted in further quantitative decrease in lameness, compared with that achieved via shoeing alone.

Quantitative effect of tenorrhaphy on intrinsic vasculature of the equine superficial digital flexor tendon.

OBJECTIVE: To compare effects of the locking-loop suture pattern (LLP) and 3-loop pulley (3LP) suture pattern for tenorrhaphy on the intrinsic vasculature of the superficial digital flexor tendon (SDFT) of horses in vitro after surgery. SAMPLE POPULATION: 16 forelimbs obtained from 8 mature horses. PROCEDURE: Tenotomy and subsequent tenorrhaphy was performed in anesthetized horses. Following systemic administration of heparin, horses were euthanatized and the limbs were removed and placed under tension to load the flexor tendons. The intrinsic vasculature was then perfused with a mixture of barium sulfate and water. Four-millimeter sections of the SDFT were prepared for microangiographic analysis. Mean vessel density was calculated for each section by use of a grid consisting of 1.5-mm2 vascular assessment squares (VAS). Comparisons were made among the control, LLP and 3LP groups. RESULTS: Mean +/- SD vessel density was 3.11 +/- 0.38, 1.47 +/- 0.47, and 2.01 +/- 0.63 perfused vessels/1.5 mm2 for control, LLP and 3LP groups, respectively. Significant differences in vascular density were detected between the control and 3LP groups, control and LLP groups, and LLP and 3LP groups. CONCLUSIONS AND CLINICAL RELEVANCE: Use of the LLP and 3LP pattern has deleterious effects in vitro on the intrinsic vasculature of the SDFT. However, the 3LP pattern was less disruptive to the intrinsic vasculature, compared with the effects for the LLP. Use of the 3LP tenorrhaphy suture pattern in clinical situations may result in less damage to the intrinsic vasculature of the SDFT of horses during convalescence.

Comparison of flat-panel digital to conventional film-screen radiography in detection of experimentally created lesions of the equine third metacarpal bone.

Radiographic diagnosis of equine bone disease using digital radiography is prevalent in veterinary practice. However, the diagnostic quality of digital vs. conventional radiography has not been compared systematically. We hypothesized that digital radiography would be superior to film-screen radiography for detection of subtle lesions of the equine third metacarpal bone. Twenty-four third metacarpal bones were collected from horses euthanized for reasons other than orthopedic disease. Bones were dissected free of soft tissue and computed tomography was performed to ensure that no osseous abnormalities were present. Subtle osseous lesions were produced in the dorsal cortex of the third metacarpal bones, and the bones were radiographed in a soft tissue phantom using indirect digital and conventional radiography at standard exposures. Digital radiographs were printed onto film. Three Diplomates of the American College of Veterinary Radiology evaluated the radiographs for the presence or absence of a lesion. Receiver operator characteristic curves were constructed, and the area under these curves were compared to assess the ability of the digital and film-screen radiographic systems to detect lesions. The area under the ROC curves for film-screen and digital radiography were 0.87 and 0.90, respectively (P = 0.59). We concluded that the digital radiographic system was comparable to the film-screen system for detection of subtle lesions of the equine third metacarpal bone.

An evaluation of two autologous tendon grafting techniques in ponies.

OBJECTIVE: To compare the healing and mechanical strength of a multiple split autologous tendon graft (MG) to a whole autologous tendon graft (WG) in the deep digital flexor tendon of ponies. STUDY DESIGN: In vitro evaluation of two different tendon-grafting techniques. ANIMALS OR SAMPLE POPULATION: Six ponies of mixed gender and age. METHODS: Tenotomies performed in forelimb deep digital flexor tendons (DDFT) distal to the insertion of the accessory ligament (AL-DDFT) were repaired with free autologous grafts from the hindlimb lateral digital extensor tendon (LDET). Grafts were either whole (WG) or split into three longitudinal strips (multiple graft, MG). Tendons and graft sites were collected and loaded (2.54 cm/s) to failure at either 4 or 8 weeks after surgery. Cross-sectional area was determined by both impression cast (IC) and an inkblot (IB) method. Tissue maturity and inflammation were evaluated by microscopy. RESULTS: Gap formation was a consistent finding in all repair sites. No statistical differences were found in healing or mechanical variables between MG and WG techniques. The failure stress for the 8-week repairs (15.51 +/- 3.1 MPa IB and 11.73 +/- .77 MPa IC, 16.13 +/- 2.2 MPa IB and 10.22 +/- .76 MPa IC for MG and WG, respectively) were significantly greater (P <.0005) than for 4-week repairs (3.71 +/- 1.7 MPa IB and 2.68 +/- 1.44 MPa IC, 2.81 +/- 1.46 MPa IB and 2.3 +/- 1.7 MPa IC for MG and WG, respectively). The repair tissue was more mature (P <.05) at 8 weeks than at 4 weeks, but there was no significant difference in inflammatory responses at 4 and 8 weeks. CONCLUSIONS: There was a sixfold increase in strength between 4 and 8 weeks of healing, but no significant difference in healing or strength between the MG and WG techniques. CLINICAL RELEVANCE: In ponies, autologous tendon grafting contributes to a strong repair during the early convalescent period, but splitting a tendon graft seemingly offers no appreciable advantage over use of a whole graft.