Outcome of arthroscopic debridement of cartilage injury in the equine distal interphalangeal joint.

The purpose of this study was to report long-term outcome following arthroscopic debridement of articular cartilage lesions of the distal interphalangeal joint, diagnosed with high-field magnetic resonance imaging. Diagnosis was based on the results of diagnostic anesthesia, magnetic resonance imaging (MRI), and arthroscopy. Ten horses underwent arthroscopic evaluation for cartilage injury and received various intra-articular therapies after surgery. Three of ten horses had lesions that were surgically inaccessible. Four horses became sound and returned to their preoperative level of athleticism, and 1 horse returned to performance with continued intermittent lameness. None of the horses with an inaccessible lesion achieved soundness. Duration of lameness before surgery, preoperative evidence of degenerative joint disease, and surgical accessibility of cartilage injury did not exhibit clear influence on outcome. As a primary cause of lameness, articular cartilage injury of the distal interphalangeal joint carries a guarded prognosis for soundness with surgical therapy.

Résultat d'un débridement arthroscopique d'une blessure du cartilage dans l'articulation interphalangienne distale. Le but de cette étude consistait à signaler les résultats à long terme après un débridement arthroscopique des lésions du cartilage articulaire de l'articulation interphalangienne distale, diagnostiqués par résonance magnétique de haute résolution. Le diagnostic s'est fondé sur les résultats de l'anesthésie diagnostique, de l'image par résonance magnétique (IRM) et de l'arthroscopie. Dix chevaux ont subi une évaluation arthroscopique d'une blessure du cartilage et reçu diverses thérapies intra-articulaires après la chirurgie. Trois des dix chevaux avaient des lésions qui étaient inaccessibles par chirurgie. Quatre chevaux se sont rétablis et sont retournés à leur niveau préopératoire de constitution athlétique et un cheval est retourné à la performance avec une boiterie intermittente persistante. Aucun des chevaux avec une lésion inaccessible ne s'est rétabli. La durée de la boiterie avant la chirurgie, les signes préopératoires de maladie articulaire dégénérative et l'accessibilité chirurgicale d'une blessure du cartilage n'ont pas eu une influence claire sur les résultats. Comme cause principale de boiterie, la blessure du cartilage articulaire de l'articulation interphalangienne distale comporte un pronostic réservé pour le rétablissement avec une thérapie chirurgicale.(Traduit par Isabelle Vallières).

Treatment of subchondral lucencies in the medial proximal radius with a bone screw in 8 horses.

OBJECTIVE: To describe the results of screw placement through subchondral lucencies (SCL) of the proximal radius in 8 horses. STUDY DESIGN: Retrospective clinical study. ANIMALS: Horses with cubital SCL causing lameness (n=8). METHODS: Medical record review and clinical follow-up. RESULTS: Eight horses with SCL in the proximal radius causing lameness were treated with a screw placed across the lucency. The horses range in age from 1 to 20 years. In 4 of 8 horses, the lameness had been intermittently severe (apparent at the walk). Lameness was isolated to the cubital joint by intra-articular anesthesia in 5 horses and diagnosed radiographically in all 8. All horses had a 4.5 mm cortical bone screw placed from medial to lateral (6 lag, 2 neutral) across the SCL using fluoroscopic or radiographic control. Postoperative care included stall confinement with hand walking for 30-60 days, followed by an additional 30-60 days of pasture turnout. Radiographic SCL healing (reduction in SCL size) was demonstrated at 3-4 months after surgery in all horses, and 7/8 horses (87.5%) were used as intended (4 performance, 3 pasture turn-out) within 6 months. Lameness in the remaining horse improved initially (dressage) but returned. CONCLUSIONS: A screw placed through the SCL of the proximal-medial radius was effective in reducing or resolving lameness associated with the elbow joint in 7/8 horses (88%). Screw placement in the proximal radius should be considered for horses with lameness caused by an SCL when a quick return to exercise is desired or conservative therapy is ineffective.

A randomized, controlled trial of the effects of resveratrol administration in performance horses with lameness localized to the distal tarsal joints.

OBJECTIVE To determine the effect of resveratrol administration in performance horses with lameness localized to the distal tarsal joints. DESIGN Randomized, blinded, placebo-controlled clinical trial. ANIMALS 45 client-owned horses with lameness localized to the distal tarsal joints. PROCEDURES All horses received injections of triamcinolone acetonide in the centrodistal and tarsometatarsal joints of both hind limbs. A placebo or a supplement containing resveratrol was fed twice daily by owners for 4 months. Primary outcomes were horse performance as determined by rider opinion (better, worse, or the same) and change in lameness severity from the enrollment examination. RESULTS Complete data were obtained for 21 horses that received resveratrol and 20 that received the placebo. Percentage of riders who reported that the horse's performance was better, compared with worse or the same, was significantly higher for the resveratrol group than for the placebo group after 2 (20/21 [95%] vs 14/20 [70%]) and 4 (18/21 [86%] vs 10/20 [50%]) months. The change in A1:A2 ratio between the enrollment and 4-month recheck examinations was significantly better for horses in the resveratrol versus placebo group. However, subjective lameness scores and degree of asymmetry of pelvis movement did not differ between groups. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that in performance horses with lameness localized to the distal tarsal joints, injection of triamcinolone in the centrodistal and tarsometatarsal joints of both hind limbs followed by oral supplementation with resveratrol for 4 months resulted in reduced lameness, compared with triamcinolone injection and supplementation with a placebo.

Response to injection of the navicular bursa with corticosteroid and hyaluronan following high-field magnetic resonance imaging in horses with signs of navicular syndrome: 101 cases (2000-2008).

OBJECTIVE: To determine treatment outcome on the basis of pathological changes identified on MRI and lameness duration in horses with navicular syndrome that underwent injection of corticosteroid and hyaluronan into the navicular bursa. DESIGN: Retrospective case series. ANIMALS: 101 horses with navicular syndrome. PROCEDURES: Medical records of horses with signs of navicular syndrome evaluated between January 2000 and December 2008 were reviewed. Data on signalment, use of the horse, history, affected limbs, duration of lameness, findings on lameness examination, radiographic findings, MRI findings, treatment, and outcome were collected from the medical records. Follow-up information was obtained a minimum of 10 months after navicular bursa injection. RESULTS: Following navicular bursa injection, 76 of 101 (75%) horses returned to their intended use for a mean of 9.66 months, and 35 (35%) were sound at follow-up. Horses that had been lame for < 6 months before treatment were significantly more likely to return to their intended use, have a longer positive response to treatment, and be sound at follow-up, compared with horses that had a longer lameness history. Horses with primary deep digital flexor (DDF) tendonitis responded best to navicular bursa injection with rest and rehabilitation, followed by horses with navicular bursitis and horses with DDF tendonitis and adhesions to the collateral sesamoidean ligament of the distal sesamoid (navicular) bone. Horses with scar tissue in the proximal portion of the navicular bursa, adhesions from the navicular bone to the DDF tendon, or multiple abnormalities did not respond as well to treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Response to navicular bursa injection with corticosteroid and hyaluronan in horses with navicular syndrome was dependent on the disease process detected on MRI and duration of lameness.

Intrathecal deep digital flexor tenectomy for treatment of septic tendonitis/tenosynovitis in four horses.

OBJECTIVE: To describe partial removal of the intrathecal component of the deep digital flexor tendon (DDFT) in horses with chronic septic DDF tendonitis and tenosynovitis unresponsive to conventional therapy, and to report long-term outcome. STUDY DESIGN: Case series. ANIMALS: Horses (n=4). METHODS: Four horses with chronic septic DDF tendonitis and tenosynovitis were treated by surgical tenectomy of the intrathecal component of the DDFT, followed by stabilization in casts and subsequent corrective shoeing. All horses were previously managed unsuccessfully with combinations of conventional therapy consisting of systemic antibiotics, through and through tendon sheath lavage/open drainage, regional limb perfusions, tenoscopy with debridement and transection of the palmar/plantar annular ligament, and intrathecal antibiotics. RESULTS: Time from initial injury/diagnosis to tenectomy ranged from 10 to 210 days. Mean hospitalization time after surgery was 82 days. Long-term follow-up (>1.5 years; mean, 3.8 years) was available. All 4 horses were able to walk comfortably at pasture and were used as broodmares. CONCLUSIONS: Intrathecal tenectomy is a viable surgical procedure for treatment of chronic septic tenosynovitis of the digital sheath that is complicated by septic tendonitis of the DDFT.

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.