Incidence of post-anesthetic colic in non-fasted adult equine patients.

The purpose of this study was to determine the incidence of post-anesthetic colic in non-fasted adult horses undergoing isoflurane inhalant anesthesia for an elective, non-abdominal procedure at a single referral center. Medical records were searched from May 1, 2012 to May 31, 2014. Inclusion criteria included non-fasted patients ≥ 2 years of age that were anesthetized for an elective, non-abdominal procedure. The incidence of post-anesthetic colic for this study population was 2.5%. None of the risk factors examined (season, age, gender, breed, surgeon, procedure, recumbency, butorphanol administration, additional surgical complications, and the length of anesthesia) were associated with an increased risk of post-anesthetic colic. Providing food may maintain normal gastrointestinal motility and may decrease the risk of post-anesthetic colic.

Incidence des coliques post-anesthésiques chez des patients équins adultes sans jeûne. Le but de cette étude consistait à déterminer l'incidence des coliques post-anesthésiques chez des chevaux adultes sans jeûne soumis à une anesthésie par inhalation d'isoflurane pour une intervention non abdominale non urgente dans un seul centre spécialisé. On a effectué des recherches dans les dossiers médicaux établis entre le 1er mai 2012 et le 31 mai 2014. Les critères d'inclusion incluaient les patients sans jeûne âgés de ≥ 2 ans qui avaient été anesthésiés pour une intervention non abdominale et non urgente. L'incidence des coliques post-anesthésiques pour cette population à l'étude a été de 2,5 %. Aucun des facteurs de risque examinés (saison, âge, sexe, race, chirurgien, intervention, décubitus, administration du butorphanol, complications chirurgicales additionnelles et durée de l'anesthésie) n'était associé à un risque accru de coliques post-anesthésiques. La nourriture peut préserver la motilité gastro-intestinale et réduire le risque de coliques post-anesthésiques.(Traduit par Isabelle Vallières).

Clinical outcome after intra-articular administration of bone marrow derived mesenchymal stem cells in 33 horses with stifle injury.

OBJECTIVE: To report outcome of horses with femorotibial lesions (meniscal, cartilage or ligamentous) treated with surgery and intra-articular administration of autologous bone marrow derived mesenchymal stem cells (BMSCs). STUDY DESIGN: Prospective case series. ANIMALS: Horses (n = 33). METHODS: Inclusion criteria included horses that had lameness localized to the stifle by diagnostic anesthesia, exploratory stifle arthroscopy and subsequent intra-articular administration of autologous BMSCs. Case details and follow-up were gathered from medical records, owner, trainer or veterinarian. Outcome was defined as returned to previous level of work, returned to work, or failed to return to work. RESULTS: Follow-up (mean, 24 months) was obtained; 43% of horses returned to previous level of work, 33% returned to work, and 24% failed to return to work. In horses with meniscal damage (n = 24) a higher percentage in the current study (75%) returned to some level of work compared to those in previous reports (60-63%) that were treated with arthroscopy alone, which resulted in a statistically significant difference between studies (P = .038). Joint flare post injection was reported in 3 horses (9.0%); however, no long-term effects were noted. CONCLUSIONS: Intra-articular administration of BMSC postoperatively for stifle lesions appeared to be safe, with morbidity being similar to that of other biologic agents. Improvement in ability to return to work may be realized with BMSC treatment compared to surgery alone in horses with stifle injury.

Evaluation of an arthroscopic approach for transection of the equine collateral sesamoidean ligament.

OBJECTIVE: To evaluate: (1) an arthroscopic technique for transection of the collateral sesamoidean ligament (CSL); and (2) the healing response using magnetic resonance (MR) and microscopic examination. STUDY DESIGN: Experimental study. ANIMALS: Adult horses (n=6). METHODS: Six sound horses with normal front foot radiographic and MR examinations were used. Lameness examination was performed before surgery and monthly for 12 months. Front foot radiography was performed at 180 and 360 days after surgery. Front foot MR was performed before, and at 7, 90, 180, and 360 days after surgery. Arthroscopic CSL desmotomy was performed on 1 forelimb. Gross and microscopic examination was performed on the CSL from both forelimbs at 360 days after surgery. Lameness scores were compared over time using the nonparametric Friedman's test for paired groups. CSL measurements were compared using paired t-tests with a 2-tailed significance level of P<.05. RESULTS: Radiographs remained normal throughout study period. Surgery resulted in lameness on the operated limb for up to 2 months, after which all horses returned to soundness. CSL transection was confirmed during arthroscopy and with MR examination 7 days after surgery. Gross and microscopic evaluation confirmed ligament healing. CONCLUSIONS: CSL desmotomy resulted in short-term lameness after surgery followed by healing of the CSL confirmed by gross and microscopic analysis.

Desmitis of the distal digital annular ligament in seven horses: MRI diagnosis and surgical treatment.

OBJECTIVE: (1) To describe the clinical signs and abnormalities observed on magnetic resonance imaging (MRI) in 7 horses with desmitis of the distal digital annular ligament (DDAL); (2) to describe the normal magnetic resonance (MR) appearance and thickness of the DDAL in health; and (3) to describe a tenoscopic surgical technique for treating horses with desmitis of the DDAL. STUDY DESIGN: Retrospective study. ANIMALS: Horses (n=7) with desmitis of the DDAL. METHODS: MR examinations of 20 sound horses were reviewed to determine the normal appearance of the DDAL. Dimensions obtained from these images were compared with MR findings from 7 horses with DDAL desmitis. Desmitis of the DDAL was treated by tenoscopic surgery and outcome assessed. RESULTS: Horses with DDAL desmitis had lameness (grade 2-3 out of 5) that improved after a palmar digital nerve block. The affected DDAL was enlarged and had an abnormal signal on MR images of the feet. After tenoscopy and DDAL transection, 5 horses returned to athletic performance, including 2 horses that failed to respond to medical treatment and rest before surgery. CONCLUSION: Primary desmitis of the DDAL is a cause of lameness in horses. Transection of the DDAL allowed 5 horses with this injury to return to athletic performance. CLINICAL RELEVANCE: DDAL desmitis should be included in the differential diagnoses of horses with lameness that improves after a palmar digital nerve block but have no abnormalities observed on radiographs of the feet. Tenoscopic surgical transection of the DDAL is an effective treatment for some horses.

Use of magnetic resonance imaging identify suspensory desmitis and adhesions between exostoses of the second metacarpal bone and the suspensory ligament in four horses.

Four horses were examined because of chronic forelimb lameness. In all horses, the cause of the lameness was localized to the metacarpus by means of physical examination and diagnostic anesthesia, and radiography of the affected limb revealed a small exostosis of the second metacarpal bone. Magnetic resonance imaging revealed suspensory desmitis in the region of this exostosis in all 4 horses. In addition, an abnormal area of low signal intensity, suggestive of an adhesion, was seen between the exostosis and the suspensory ligament. In all horses, an adhesion between the suspensory ligament and the exostosis on the second metacarpal bone was identified and transected at surgery, and the exostosis and distal portion of the second metacarpal bone were removed. All horses were able to return to their previous athletic use following a 6-month rest and rehabilitation program for treatment of the suspensory desmitis. Findings in these horses suggest that adhesions between the suspensory ligament and an exostosis of the second metacarpal bone may be a cause of chronic or recurrent forelimb lameness in horses.

Use of magnetic resonance imaging for identifying subchondral bone damage in horses: 11 cases (1999-2003).

OBJECTIVE: To assess the use of magnetic resonance (MR) imaging for identifying subchondral bone damage in the distal limbs of horses. DESIGN: Retrospective study. ANIMALS: 11 horses. PROCEDURE: Medical records of horses with lameness and subsequent evidence of subchondral bone damage as determined by MR imaging were reviewed. Severity and duration of lameness, results of diagnostic local anesthesia and diagnostic testing, surgical and necropsy findings, and treatment were recorded. Outcome was determined by follow-up information obtained from the owner or referring veterinarian. RESULTS: Lameness was localized by physical examination and diagnostic local anesthesia. Lameness was localized to the metacarpophalangeal or metatarsophalangeal joint in 4 horses, distal interphalangeal joint in 5 horses, and tarsocrural joint in 2 horses. The duration of lameness ranged from 2 weeks to 20 months. Magnetic resonance imaging of the affected joints revealed abnormal fluid accumulation within the subchondral bone. None of the abnormalities observed by MR imaging were detected by radiography. Subchondral bone damage was diagnosed in all horses. Arthroscopy of the affected joint was performed in 4 horses. Communication with the articular surface of the affected bone was suspected on the basis of results of MR imaging in 4 horses and was confirmed by arthroscopy in 1 horse and by necropsy in 1 horse. CONCLUSIONS AND CLINICAL RELEVANCE: Magnetic resonance imaging was useful for providing a diagnosis when other imaging techniques did not definitively identify the cause of lameness. Subchondral bone damage was clearly identified by MR imaging and should be considered as a cause of lameness in horses in which radiographic findings are unremarkable.

MRI findings in 232 horses with lameness localized to the metacarpo(tarso)phalangeal region and without a radiographic diagnosis.

Two hundred and thirty-two horses with lameness localized to the metacarpo(tarso)phalangeal (MCP/MTP) region without a radiographic diagnosis were evaluated. All horses had high-field magnetic resonance (MR) imaging of the MCP/MTP region performed for the lame limb and the contralateral limb for comparison. There were 46 horses that had bilateral abnormalities in the forelimbs; 27 of these horses were not lame in the contralateral limb at the time of examination. Bilateral hind limb abnormalities were observed in 37 horses; 22 horses were not lame in the contralateral limb. Soft tissue abnormalities alone were observed in 218 limbs (162 horses). Subchondral bone and articular cartilage abnormalities alone were observed in 43 limbs (34 horses). A combination of soft tissue, subchondral bone, and cartilage abnormalities were observed in 64 limbs (36 horses). The distribution of primary abnormalities was as follows; oblique distal sesamoidean ligament desmitis (73 limbs in 56 horses), straight distal sesamoidean ligament desmitis (44 limbs in 38 horses), chronic subchondral bone injuries (15 limbs in 12 horses), suspensory ligament branch desmitis (14 limbs in 12 horses), collateral ligament desmitis (12 limbs in 12 horses), tendonitis of the superficial and deep digital flexor tendons (10 limbs in 10 horses), osteochondral defects greater than 1 cm (nine limbs in six horses), osteochondral defects less than 1 cm (eight limbs in seven horses), bone marrow lesions (six limbs in five horses), intersesamoidean ligament desmitis (five limbs in four horses). MR imaging is useful in diagnosing bone and soft tissue injuries when radiographs and ultrasound fail to yield a diagnosis.

Magnetic resonance imaging findings in horses with septic arthritis.

Fourteen horses with septic arthritis underwent high-field (1.5 T) magnetic resonance imaging (MRI). Septic arthritis was diagnosed based on results from historical and clinical findings, synovial fluid analyses and culture, and radiographic, ultrasonographic, arthroscopic, and histopathologic findings. MR findings included diffuse hyperintensity within bone and extracapsular tissue on fat-suppressed images in 14/14 horses (100%), joint effusion, synovial proliferation, and capsular thickening in 13/14 horses (93%), bone sclerosis in 11/14 horses (79%), and evidence of cartilage and subchondral bone damage in 8/14 horses (57%). Intravenous gadolinium was administered to five of the 14 horses and fibrin deposition was noted in all horses. Other findings after gadolinium administration included synovial enhancement in 4/5 (80%) horses, and bone enhancement in 1/5 (20%) horses. The MR findings of septic arthritis in horses were consistent with those reported in people. MRI may allow earlier and more accurate diagnosis of septic arthritis in horses as compared with other imaging modalities, especially when the clinical diagnosis is challenging. It also provides additional information not afforded by other methods that may influence and enhance treatment.

Magnetic resonance imaging features of oblique and straight distal sesamoidean desmitis in 27 horses.

Injury to the oblique and straight distal sesamoidean ligaments is becoming recognized as a more common cause of lameness in horses than was previously thought. The purpose of this study was to review the magnetic resonance (MR) imaging findings of 27 horses affected with desmitis of the oblique and/or straight distal sesamoidean ligament and determine long-term prognosis for horses with this diagnosis. Imaging was performed with horses in right lateral recumbency in a high-field 1 T magnet. All horses had lameness localized to the digit or metacarpophalangeal/metatarsophalangeal joint region with diagnostic local anesthetic blocks. Ten horses had forelimb lameness and 17 horses had hind limb lameness. MR imaging revealed abnormalities in the oblique distal sesamoidean ligaments in 18 horses, in the straight distal sesamoidean ligament in three horses, and in both the oblique and straight distal sesamoidean ligament in six horses. Treatment consisted of a 6-month rest and rehabilitation program in all horses. The digital flexor tendon sheath was injected with methylprednisolone acetate and hyaluronic acid in 22 horses to decrease inflammation in the injured ligaments before starting the rest and rehabilitation program. Two horses had ligament splitting performed, one in the oblique distal sesamoidean ligament and one in the straight distal sesamoidean ligament. MR imaging is an effective method for diagnosing injury to the oblique and straight distal sesamoidean ligaments in horses. Treatment, primarily a 6-month rest and rehabilitation program, allowed 76% of the horses to successfully resume performance.

Arthrodesis techniques in horses.

When medical therapy and surgical treatments of an injured joint fail to return the animal to athletic performance or comfortable use of the limb, arthrodes is is a final option for some joints. Arthrodesis refers to the surgical fusion of a joint, resulting in bony ankylosis. Successful arthrodesis requires debridement of the articular cartilage through the calcified cartilage layer, exposing the subchondral bone; alignment of the joint into a weight-bearing position; and stabilization. The methods by which these steps are accomplished are variable, depending on the individual joint. There are currently accepted methods for arthrodesis of several joints in the horse; however, not all joints are amenable to arthrodesis. Case selection is an important aspect of performing arthrodesis procedures in horses.

Injury of the collateral ligaments of the distal interphalangeal joint diagnosed by magnetic resonance.

We describe the clinical, imaging, and necropsy findings of two horses with severe injury of the collateral ligaments of the distal interphalangeal (DIP) joint diagnosed using magnetic resonance (MR) imaging. In MR images it was possible to examine the collateral ligaments of the DIP joint from the origin at the middle phalanx to the insertion on the distal phalanx. Both horses in this report had abnormal high signal intensity within the collateral ligaments of the DIP joint, and one horse had abnormal high signal intensity within the bone of the distal phalanx on short tau inversion recovery (STIR) and T2-weighted imaging sequences. High signal intensity on STIR and T2-weighted images represents abnormal fluid accumulation indicative of inflammation, within ligament, tendon, or bone on these imaging sequences. Abnormalities were confirmed on necropsy in both horses. Injury of the collateral ligaments of the DIP joint should be considered as a source of pain in horses with lameness localized to the foot.

Comparison of three methods for arthrodesis of the distal intertarsal and tarsometatarsal joints in horses.

OBJECTIVE: To evaluate the effects of diode laser surgery (LS), surgical drilling (SD), and intraarticular sodium monoiodoacetate (MIA) as methods for fusing the distal intertarsal (DIT) and tarsometatarsal (TMT) joints in horses. STUDY DESIGN: Experimental study. ANIMALS: Adult horses (15) without radiographic signs of osteoarthritis (OA) of the DIT and TMT joints. METHODS: Group 1 (n=3) had LS performed bilaterally on DIT and TMT joints; 1 horse was evaluated for 1 week and 2 horses were evaluated for 2 weeks. Group 2 (n=6) had LS on DIT and TMT joints of 1 tarsus and MIA administration into the contralateral DIT and TMT joints and were evaluated for 6 months. Group 3 (n=6) had LS performed on DIT and TMT joints of 1 tarsus and SD of the contralateral DIT and TMT joints and were evaluated for 12 months. Postoperative comfort, lameness, radiography, microradiography, and histology scores were compared using repeated measures ANOVA, and paired or 2 sample t-tests; significance was set at P<.05. RESULTS: LS caused the least postoperative morbidity. In group 2, horses were less lame in 4 LS-treated limbs and 2 MIA-treated limbs at 6 months when compared with the contralateral limb. In group 3, horses were less lame in 5 LS-treated limbs and 1 SD-treated limb at 6 and 12 months compared with the contralateral limb. On microradiography, 11 MIA joints and 2 LS joints had bone bridging the joint at 6 months whereas 8 SD joints and 5 LS joints had bone bridging at 12 months. Significantly more joint space was bridged by bone in MIA- (51.4%) and SD (46.2%)-treated joints compared with LS joints at 6 (30.6%) and 12 (28.5%) months, respectively (P<.05). CLINICAL RELEVANCE: SD and MIA resulted in more bone bridging of the distal 2 tarsal joints, than LS. However, LS seemingly caused less pain and discomfort to horses in the immediate postoperative period; horses were generally less lame in the LS limb. More laser energy may need to be applied to these joints to promote fusion; however, it may also have beneficial effects beyond fusion. Further research on horses with OA of the distal 2 tarsal joints is needed to determine whether LS can cause soundness without facilitating bony fusion.

Evaluation of arthrocentesis site bacterial flora before and after 4 methods of preparation in horses with and without evidence of skin contamination.

OBJECTIVE: To evaluate the effectiveness of four methods of povidone-iodine preparation on skin bacterial flora of arthrocentesis sites, in horses, with and without evidence of skin contamination. STUDY DESIGN: Prospective randomized study. ANIMALS: Twenty-four adult horses. METHODS: Horses were assigned to either the clean or contaminated group based on housing environment and visual evidence of contamination. Using a moist sterile swab, microbial culture samples were obtained from the skin over the distal interphalangeal joints immediately before and after preparation. Each site was aseptically prepared with 1 of 4 povidone-iodine techniques: 10-minutes scrub, 5-minutes scrub, three 30-second scrubs, or commercial one-step iodophor surgical solution. Colony forming units (CFUs) were determined for each sample, 24 hours after inoculation, on blood agar plates. RESULTS: Mean (+/-SD) pre-scrub CFUs/mL was significantly higher in the contaminated group (9588.33+/-1223.65) compared with the clean group (4489.00+/-3842.03) (P<.01). After preparation of the arthrocentesis sites, there were no significant differences in post-scrub CFUs/mL among the 10 minutes (mean clean, 46.00+/-64.36; mean contaminated, 28.67+/-18.04), 5 minutes (mean clean, 84.17+/-109.80; mean contaminated, 40.33+/-44.52), three 30 seconds povidone-iodine scrubs (mean clean, 95.50+/-172.29; mean contaminated, 46.67+/-56.94), or application of a commercial one-step iodophor surgical solution (mean clean, 102.17+/-161.78; mean contaminated 117.67+/-143.78); or between the clean (81.96+/-131.69) and contaminated groups (58.33+/-85.90) (P<.01). CONCLUSIONS: Preparation of the distal interphalangeal joint arthrocentesis site with each of these techniques significantly reduces the bacterial flora to a similar level for arthrocentesis in horses with and without evidence of skin contamination. Clinical Relevance- Aseptic preparation of the skin over the distal interphalangeal joint may be accomplished with any of these techniques.