Evaluation of the caudal cervical articular process joints by using a needle arthroscope in standing horses.

OBJECTIVE: To determine the safety and efficacy of caudal cervical articular process joint arthroscopy by using needle arthroscopy in standing sedated horses. STUDY DESIGN: Prospective experimental case series. ANIMALS: Six adult horses. METHODS: Three horses underwent exploration of bilateral C5-6 vertebral articular process joints and three bilateral C6-7 articular process joints by using a 1.2 × 65-mm needle arthroscope under standing sedation. The 16-gauge arthroscopic trocar and canula assembly was inserted in the desired articular process joint under ultrasonographic guidance without distention of the joint. RESULTS: All 12 articular process joints were successfully explored. Entering the joint on the first attempt was achieved in 10 of 12 joints. A craniodorsal approach for arthroscope insertion allowed evaluation of the most cranial aspect of the articular cartilage surface. Triangulation with a spinal needle was determined to be difficult and resulted in a limited space for movement. CONCLUSION: Needle arthroscopy of the caudal cervical facet joints was performed safely and efficiently in standing sedated horses. CLINICAL SIGNIFICANCE: Standing cervical articular process needle arthroscopy is a minimal morbidity technique with the potential to be an advantageous technique for the diagnosis and treatment of cervical articular process pathology.

Diagnostic tenoscopy of the carpal sheath with a needle arthroscope in standing sedated horses.

OBJECTIVE: To investigate the use of a needle arthroscope for diagnostic tenoscopy of the carpal sheath in standing horses. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Six forelimbs for the cadaveric part of the study and six horses for the in vivo part of the study. METHODS: Six cadaveric limbs were used to perform carpal sheath tenoscopy with a 1.2-mm-diameter needle arthroscope (65 and 100 mm long), followed by tenoscopy with a 4-mm arthroscope through a standard proximolateral approach. Then, unilateral standing carpal sheath tenoscopy was performed in six healthy sedated horses with a 65-mm-long needle arthroscope. Limbs were maintained in flexion during the procedure by using a custom-made splint and base. Degree of tenoscopic evaluation, safety, horse tolerance, and complications were recorded. RESULTS: Visibility at the most distal aspect of the sheath was absent for the needle arthroscopes vs a standard arthroscope. The maneuverability with a 65-mm needle arthroscope was excellent and allowed exhaustive visualization of the proximal region of the carpal sheath in cadaveric limbs and standing horses (six of six). However, visualization of the intertendinous recess was partial in most horses (four of six) vs cadavers (complete in six of six) because of remaining flexor tendon tension in standing horses. No major complications were encountered. CONCLUSION: Standing carpal sheath tenoscopy allowed a safe and thorough evaluation of most structures in the proximal region of the sheath and offers an alternative diagnostic technique. CLINICAL SIGNIFICANCE: Horses with unrewarding results after traditional imaging or that require an accurate diagnosis before treatment may benefit from this alternative procedure.

The cranial instrument port in arthroscopy of the canine shoulder joint.

We describe the creation of a cranial instrument portal for shoulder joint arthroscopy in the dog using a target device that has been successfully employed for the caudal access. We compared the method with a conventional triangulation technique. The shoulder joints of 60 dog cadavers were investigated by arthroscopy and the two methods were compared on the basis of pre-defined parameters of outcome. Time, the number of trials, success, damage to cartilage and the accessibility of intra-articular structures were assessed. The anatomical localisation of the working cannula in muscles was also documented. In general, the new method permitted more successful insertion of the working cannula. This was achieved in a shorter period of time and was associated with fewer insertion attempts as well as less damage to joint cartilage. Intra-articular structures could be readily approached through the working cannula with both methods. Predetermined, clinically relevant points were comparatively more accessible with the new technique. Independent of the method, in only a few cases, the working cannula perforated neither muscles nor tendons when accessing the joint. It may be concluded that the new method using a target device is simpler and safer and offers a standardised technique to establish a cranial instrument port.

Artroscopia do joelho de ovinos / Arthroscopy of the stifle joint in sheep

O trabalho teve por objetivo avaliar artroscopicamente a articulação do joelho de ovinos hígidos em diferentes idades, com o intuito de determinar, de acordo com os portais estabelecidos, a capacidade de observação das estruturas. Utilizaram-se 18 animais da raça Santa Inês, divididos em três grupos experimentais eqüitativos, conforme a idade cronológica, sendo: Grupo I, 6-8 meses (peso médio de 25 kg); Grupo II, 2 anos (peso médio de 50 kg); e Grupo III, 3,5-5 anos (peso médio de 55 kg). Foram estabelecidos três portais: (1) portal artroscópico primário, craniolateral; (2) portal para fluxo de drenagem; e (3) portal instrumental, craniomedial. Identificaram-se com facilidade a patela, sulco e bordas trocleares, côndilos medial e lateral do fêmur, e tendão do músculo extensor longo dos dedos. Após a remoção da maior parte do coxim gorduroso infrapatelar com emprego do "shaver" foram visibilizados, ainda com dificuldade, os ligamentos cruzados e os meniscos. Para a identificação dos primeiros foram necessárias movimentos de flexão e extensão e para os meniscos manobras de varo e valgo. O grau de dificuldade foi inversamente proporcional ao tamanho da articulação. Sendo assim, foi possível concluir que os portais artroscópicos utilizados possibilitaram a identificação das principais estruturas articulares, independente da idade, e o método em si teve por vantagem a rápida recuperação pós-operatória dos animais.

The aim of this study was to evaluate arthroscopically the stifle joint of healthy Santa Ines sheep with different ages, and observe the joint elements according to the established portals. Eighteen Santa Ines sheep were divided into 3 equal groups according to the chronological age: GI - 6 to 8 months old (mean weight 25 kg), G II - 2 years old (mean weight 50 kg), and G III - 3.5 to 5 years old (mean weight 55 kg). Three arthroscopic portals were established: craniolateral primary arthroscopic portal, drainage outflow portal, and craniomedial instrumental portal. The patella, the trochlear groove and ridges, the medial and lateral femoral condyles, and the long digital extensor tendon were easily identified. After removing a great portion of the infrapatellar fat pad using a shaver, the cruciate ligaments and the menisci could be observed, even though with some difficulty. The limbs were flexed and extended to identify the cruciate ligaments. Varus and valgus stress of the joint was used to improve meniscal observation. The difficulty level was inversely proportional to the joint size. In conclusion, the arthroscopic portals allowed identification of the main elements of the knee joint, regardless of animal age, and the arthroscopic method had as advantage early postoperative recovery of the animals.

In situ and ex vivo evaluation of an arthroscopic indentation instrument to estimate the health status of articular cartilage in the equine metacarpophalangeal joint.

OBJECTIVE: To evaluate an arthroscopic indentation instrument (Artscan 200) for assessment of the health status of equine articular cartilage. STUDY DESIGN: In vitro experiment using equine isolated proximal phalanx (P1) specimens. SAMPLE POPULATION: P1 specimens from 39 horses (aged 1.5-22 years). METHODS: Reproducibility was tested by determination of the coefficient of variation (CV). Dynamic modulus and cartilage degeneration index (CDI) values were measured at 2 predefined sites (site 1, joint margin; site 2, joint center) to assess the accuracy and to evaluate the relation with surface integrity. RESULTS: CV was 9.0%. A significant decrease in indenter force was identified when dynamic modulus values decreased to <2.5 MPa (range of tested samples 0.9-8.1 MPa) and when CDI values at site 1 increased to >50% (range 5.4-72.8%). CONCLUSIONS: Technique reproducibility was adequate but accuracy was limited. The device identified degeneration-associated decreases in cartilage stiffness only when the mechanical properties of the cartilage were considerably changed. CLINICAL RELEVANCE: Usefulness of this indentation instrument during arthroscopic surgery would be limited in the initial phase of OA-like cartilage degeneration, but may yield important information in more advanced OA.

Arthroscopy of the antebrachiocarpal joint in dogs.

A technique for arthroscopy of the antebrachiocarpal joint in dogs is described. Both antebrachiocarpal joints in 9 dog cadavers were examined arthroscopically and grossly to refine the technique and determine structures that could be seen. Two arthroscope portals were evaluated in each joint. The antebrachiocarpal synovium, ulnar carpal bone, distal portion of the ulna, medial and lateral collateral ligaments, accessory carpal bone, intercarpal ligament of the radial and ulnar carpal bone, distal portion of the radius, radial carpal bone, palmar process of the radial carpal bone, ligaments of the accessory carpal bone, palmar radiocarpal ligament, and palmar ulnocarpal ligament were visible and accessible to instruments. Arthroscopy was also performed in 5 client-owned dogs, allowing diagnosis of hyperextension injuries (n = 2), septic arthritis (2), and immune-mediated arthropathy (1). Arthroscopy of the antebrachiocarpal joint was found to be a useful adjunct to standard diagnostic modalities.