Desmitis of the accessory ligament of the deep digital flexor tendon in the forelimb: A retrospective case study of 91 horses.

BACKGROUND: Desmitis of the accessory ligament of the deep digital flexor tendon (ALDDFT) is a commonly reported injury. Despite the commonality of this injury, the literature is limited to small case series, with the reported success following treatment varying from 18% to 75%. OBJECTIVES: To identify the prognosis and factors associated with a return to work following ALDDFT injury. STUDY DESIGN: Retrospective case series. METHODS: Medical records of horses from four equine hospitals (January 2000 and December 2018) with a diagnosis of desmitis of ALDDFT were reviewed. Data retrieved included case detail, use, history, lameness treatment and follow-up. Success was defined as returning to work. Backward stepwise logistic regression was used to identify variables significantly associated with return to work. RESULTS: Ninety-one horses were included. The mean age was 13.5 years (standard deviation 4.9 years). Thirty-four percent (28/91) of horses were sound at the initial presentation. Sixty-eight percent (62/91) of horses were managed using controlled exercise alone, 28% (29/91) were treated with intra-lesional injection, therapeutic ultrasound, extracorporeal shockwave therapy or desmectomy of the ALDDFT and 3% (3/91) were euthanased without treatment. Sixty-four percent (54/85) of horses returned to work. Horses that were lame at follow-up were less likely to return to work (odds ratio [OR] 107.93, 95% confidence interval [CI] 20.06-580.61, p < 0.001) than those that returned to soundness. Identification of adhesions on ultrasonography was also associated with having reduced odds for return to work when compared to horses without adhesions (OR 0.10, 95% CI 0.01-0.76, p = 0.03). MAIN LIMITATIONS: Retrospective nature of the study, the potential of selection bias with regards to follow-up. CONCLUSION: Sixty-four percent (54/85) of horses returned to work following injury of the ALDDFT. Persistence of lameness and adhesion formation were significantly associated with a poor outcome.

Training related risk factors for exercise induced pulmonary haemorrhage in British National Hunt racehorses.

BACKGROUND: Exercise induced pulmonary haemorrhage (EIPH) is an important condition of horses performing high intensity exercise, with reported prevalence among racehorses of up to 95%, based on the detection of blood on tracheobronchoscopy. Previously identified risk factors include age, sex, season, race type, years spent in racing and lower airway inflammation. OBJECTIVES: To estimate the prevalence of EIPH in British National Hunt racehorses as indicated by two outcome measures: presence of tracheal blood on tracheobronchoscopy, and presence of moderate-large (significant) proportions of haemosiderophages in tracheal wash (TW) fluid; and to identify training-related risk factors for these indicators of EIPH. STUDY DESIGN: Prospective longitudinal study. METHODS: Data from tracheobronchoscopy and TW cytology were analysed using univariable and multivariable mixed-effects logistic regression. RESULTS: 1184 observations, from 177 horses, were analysed. The prevalence of tracheal blood was 7.2% (95%CI: 5.8, 8.8) and significant haemosiderophages in TW fluid was 36% (95%CI: 33.3, 38.8). Increased time in training was significantly associated with increased odds of EIPH. For each additional year spent in training the odds of tracheal blood and presence of significant proportions haemosiderophages increased approximately 1.5-fold (OR = 1.5; 95%CI: 1.1-2.0; P = .005; and OR = 1.5; 95%CI: 1.3, 1.8; P < .001, respectively). Current inflammation was associated with previous haemorrhage, but not current haemorrhage. MAIN LIMITATIONS: There are no standardised measures for quantification of TW cytological parameters for EIPH diagnosis. Few horses were examined following jumping. Recent racing dates were not included in analysis. CONCLUSIONS: Increasing time in training was a risk factor for both indicators of EIPH. Current inflammation was associated with previous haemorrhage, but not current or future haemorrhage, suggesting that haemorrhage leads to inflammation but not that inflammation leads to haemorrhage. Overall, our findings are consistent with the capillary stress failure theory of EIPH. The development of standardised measures for TW cytological diagnosis of EIPH is warranted.

Comparison of immunofluorescence and chemiluminescence assays for measuring ACTH in equine plasma.

BACKGROUND: The chemiluminescence (CL) and immunofluorescence (IF) assays yield different results for basal adrenocorticotropin hormone concentrations [ACTH] in pony plasma. It is unclear whether this difference also occurs in basal samples from horses or samples from ponies following thyrotropin-releasing hormone (TRH) stimulation. OBJECTIVES: To compare the results of [ACTH] analysis by CL and IF methods in basal samples from horses and pony samples following TRH stimulation. STUDY DESIGN: Method comparison. METHODS: Plasma [ACTH] was measured concurrently using CL and IF methods in 12 ponies (basal and post-TRH stimulation) in November and basal samples from horses (n = 45; November and May). RESULTS: CL and IF methods yielded different results (P < .01). The median difference (CL-IF) (95% CI) for ponies was 5.9 (0.1-7.5) pg/mL at baseline and 227.9 (61-1001) pg/mL post TRH; and horses 1.9 (1.1-5.4) pg/mL in November and 9.4 (8.2-11.5) pg/mL in May, at baseline. Correlation was good in ponies at baseline (R = 0.80, P = .003) but not post-TRH, and good in horses in November and May (R = 0.68 and 0.71, P < .001). Bland-Altman analysis demonstrated moderate bias and wide 95% limits of agreement (95% LOA) in ponies at baseline (bias 5.5 pg/mL; 95% LOA -9.9 to 20.9 pg/mL) and horses in May (bias 10.6 pg/mL; 95% LOA -9 to 30.3 pg/mL) and very large bias and wide 95% LOA in ponies post-TRH (bias 477 pg/mL; 95% LOA -633 to 1587 pg/mL). Using CL cut-offs of >29 and >110 pg/mL, agreement was moderate (ƙ = 0.67) and very good (ƙ = 0.82) for binary classification of PPID in ponies at baseline and post-TRH; and good (ƙ = 0.73) for horses in November, but poor (ƙ = 0.40) in May. MAIN LIMITATIONS: Limited numbers of horses with [ACTH] above threshold values. CONCLUSIONS: The assays yielded different absolute values, particularly in post-TRH samples from ponies, suggesting TRH stimulates secretion of cross-reacting peptides other than ACTH. Agreement for binary classification for PPID was moderate to good, except in basal samples from horses in May.