Incidence of osteochondrosis (dissecans) in Dutch warmblood horses presented for pre-purchase examination

Data are lacking in the literature regarding the incidence of osteochondrosis (dissecans) [OC(D)] in relation to lameness evaluation in Dutch Warmblood horses. The objective of this retrospective study was to assess the incidence of radiological abnormalities consistent with osteochondrosis or osteochondrosis dissecans in 1,231 sound Dutch Warmblood (DW) horses presented for pre-purchase examination. Standardised (Dutch) pre-purchase examination protocols were evaluated. The pre-purchase examination included a clinical, lameness and radiological evaluation, performed at a private equine clinic in the Netherlands. Radiographical examination included views of the distal (DIP) and proximal (PIP) interphalangeal, metacarpo- and metatarsophalangeal (MCP/MTP), tarsocrural (TC) and femoropatellar (FP) joints. Radiographical evidence of OC(D) was found in 44.3% of clinically sound DW horses. In this study, 443 horses (36%, n = 1,231) had evidence of OCD and 102 horses (8.3%, n = 1,231) had evidence of OC on pre-purchase radiographs. The results also indicated that the TC joints were significantly more likely to be affected. A considerable number of horses did not demonstrate any lameness, although radiographs revealed OC(D).     

Osteochondrosis lesions of the lateral trochlear ridge of the distal femur in four ponies

Lesions of the lateral trochlear ridge (LTR) of the distal femur were investigated in four pony or pony cross horses. The animals were all geldings and were six to 15 months of age. Lesions were bilateral in three ponies and unilateral in one. Femoropatellar joint effusion and lameness were present in two ponies; clinical signs were absent in the others. The proximal LTR was affected in all four animals. The radiographic appearance of the lesions was a subchondral defect containing mineralised bodies. Arthroscopic and postmortem examination findings included an osteochondral flap, a fissured or irregular articular surface and a smooth surface overlying focally thickened cartilage that extended into subchondral bone. Thickened articular cartilage was a histological feature of all the lesions. Among the other histological features, the most common were chondronecrosis, chondrocyte clusters, phenotypically abnormal chondrocytes, horizontal fissures at the osteochondral junction and retained blood vessels. The signalment of the four ponies, their clinical signs and the pathological features of their lesions were consistent with osteochondrosis of the LTR in horses. The use of multiple criteria was considered to be important in making a specific diagnosis.     

Long-Term Outcome in 44 Horses with Stifle Lameness After Arthroscopic Exploration and Debridement

Objective— To (1) examine the outcome in horses with osteoarthritis or intra‐articular soft tissue injuries of the stifle after arthroscopic exploration and debridement and (2) to determine any imaging or surgical findings that may influence prognosis. Design— Case series. Animals— Horses (n=44) with lameness referable to the stifle, diagnosed with osteoarthritis, meniscal tears, or other intra‐articular soft tissue injuries based on arthroscopic examination. Methods— Medical records of horses with stifle lameness that had arthroscopic exploration were reviewed. Horses with osteochondrosis lesions, intra‐articular fractures, or osseous cyst‐like lesions were excluded. Pertinent case information was analyzed and short‐ and long‐term outcome was assessed. Results— There was no association between radiographic score and surgery score. Diagnostic ultrasound had a sensitivity of 79% and a specificity of 56% for identifying meniscal injuries. Follow‐up information was available for 35 horses; 23 horses (60%) improved after surgery, 16 (46%) became sound, and 13 (37%) returned to their previous level of function. A negative association was observed between age and degree of preoperative lameness and outcome. More severe changes observed on preoperative radiographs were also negatively associated with prognosis. No horses with grade 3 meniscal tears improved postoperatively and increasing meniscal pathology was negatively associated with return to previous function. A weak association between surgery grade and outcome was also observed. Degree of chondral damage, location of primary pathology, and microfracture techniques had no effect on outcome. Conclusions— Advanced horse age, severe lameness and preoperative radiographic changes, and presence of large meniscal tears are associated with a negative postoperative outcome for horses with stifle lameness. Appearance of the articular surface at surgery appears to be an inconsistent prognostic indicator. Clinical Relevance— Some horses with extensive cartilage damage may return to athletic function after arthroscopic debridement and lavage. A more pessimistic prognosis may be given to older horses, those with more severe preoperative lameness, and those with severe radiographic changes or large meniscal tears.     

Subchondral cystic lesions of the proximal extremity of the tibia in horses: 12 cases (1983-2000)

OBJECTIVE: To determine clinical and radiographic features of subchondral cystic lesions (SCL) of the proximal extremity of the tibia in horses that could be used to classify these lesions as being related to osteochondrosis or osteoarthritis and to evaluate results of surgical debridement. DESIGN: Retrospective study. ANIMALS: 12 horses with 14 SCL. PROCEDURE: Medical records and radiographs obtained before and after treatment were reviewed. RESULTS: In 6 young horses (8 lesions), SCL were considered to be related to osteochondrosis; all involved the lateral tibial condyle. The remaining 6 horses were mature and had radiographic evidence of osteoarthritis in addition to SCL. Arthroscopic debridement was performed in 4 horses in which lesions were considered to be a result of osteochondrosis and in 3 horses with osteoarthritis. Three horses in which SCL were considered to be a result of osteochondrosis performed athletically after debridement. Two horses with moderate osteoarthritis returned to work after arthroscopic debridement but at a lower level of athletic performance. One horse with SCL related to osteochondrosis responded to medical treatment and went on to race. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that arthroscopic debridement of SCL is feasible in horses in which lesions involve the cranial portion of the lateral or medial tibial condyle, and that treated horses may be able to perform athletically.     

Surgical arthrodesis of distal tarsal joints in 17 horses clinically affected with osteoarthritis

Objective To evaluate the outcome of 17 horses that underwent surgical arthrodesis of the tarsometatarsal and distal intertarsal joints for treatment of lameness due to osteoarthritis.
Design Retrospective clinical study using client-owned animals.
Procedure Horses with hindlimb lameness were diagnosed with osteoarthritis of the distal tarsal joints following relief of lameness after intra-articular anaesthesia or intra-articular corticosteroid injection. Surgery to stimulate ankylosis was performed on 27 hocks by placing 3 diverging 3.2 mm drill holes approximately 3 cm through the tarsometatarsal and distal intertarsal joints from the medial aspect of the limb. The results of surgery were assessed by postoperative examinations, telephone communication with clients and analysis of race results.
Results In 71% of horses, surgery was considered to be successful as determined by clinical examination or telephone communication with clients: six of these horses had unilateral surgery and six had bilateral surgery. This represented 85% (6/7) of horses undergoing unilateral surgery and 60% (6/10) of horses having bilateral surgery. All (8/8) racing Standardbreds and 67% (4/6) of racing Thoroughbreds were considered a success. The average time between surgery and a return to racing was 9.5 months.
Conclusions The surgical technique used here can provide resolution of lameness from osteoarthritis of distal tarsal joints with a success rate similar to other reported surgical arthrodesis techniques that are more invasive and have a greater morbidity.     

Occult subchondral osseous cyst-like lesions of the equine tarsocrural joint

OBJECTIVE: To report the clinical signs, diagnosis, management, and outcome of horses with occult sub-chondral osseous cyst-like lesions of the tarsocrural joint. DESIGN: Retrospective study. ANIMALS: Twelve horses with subchondral osseous cyst-like lesions (SOCLs) in the tarsocrural joint. METHODS: Information about history, examination findings, diagnostic techniques, and surgical procedures as obtained from medical records. Outcome was determined by patient re-evaluation and telephone communication with the referring veterinarian, owner, or trainer. RESULTS: Horses were aged from 3 to 29 years. Lameness (2 weeks to 1 year) varied from moderate to severe. Synovial fluid analyses (9 horses) yielded changes consistent with suppurative inflammation and positive bacterial culture was obtained in 4 horses. Eight of 9 horses that had intra-articular analgesia had a dramatic reduction in lameness. No abnormalities were detected on tarsal radiographs in 10 horses. Scintigraphy identified foci of increased radiopharmaceutical uptake in the distal tibia or talus of all horses, and the lesion was further characterized by computed tomography in 7 horses. SOCLs were identified in the medial malleolus (5), intertrochlear groove of the talus (4), lateral malleolus (2), and distal intermediate ridge of the tibia (1). One horse was euthanatized, 6 horses had surgical debridement, and 5 horses were managed conservatively. Four horses treated surgically (67%) returned to soundness. Conservatively treated horses continued to exhibit lameness but 2 were sufficiently sound for light pleasure riding. CONCLUSIONS: Occult lesions of the tarsus not visible on radiographs can be detected by computed tomography and scintigraphy and may be a source of lameness. CLINICAL RELEVANCE: SOCL, possibly of septic origin, should be a differential diagnosis for persistent lameness localized to the tarsocrural joint without radiographic abnormalities. Surgical debridement of the lesions may offer the best prognosis for a return to athletic soundness.     

Treatment of temporary upward fixation of the patella in an alpaca by abrasion trochleoplasty and imbrication of the medial retinacular fascia

A two-year-old female alpaca suddenly became lame on its right hindlimb. Eight days later clinical and radiographic examinations showed that the patella had become temporarily fixed within the supratrochlear notch of the femur. Under general anaesthesia an abrasion trochleoplasty followed by fascial imbrication was carried out. After two weeks in supporting slings, the animal put full weight on the leg, and six months after the surgery it showed no signs of lameness or recurrence of the upward fixation.     

Injuries to the cranial cruciate ligament and associated structures: summary of clinical, radiographic, arthroscopic and pathological findings from 10 horses

The clinical, radiographic, arthroscopic and pathological findings of 10 horses with injury to the cranial cruciate ligament are presented. The most consistent clinical signs included moderate to severe distension of the femoropatellar joint and a Grade III to a Grade V out of V lameness. Craniocaudal instability could be elicited in five horses under general anaesthesia and in one conscious horse. Radiographic evaluation of the stifles revealed that avulsion fracture of the medial intercondylar eminence was the most common finding in six out of 10 horses. Arthroscopic examination of the affected femorotibial joints were performed in five horses. This confirmed the presumptive diagnosis of cranial cruciate ligament injury or rupture. Post mortem examinations were performed on two horses which documented partial tears of the cranial cruciate ligament.     

Prevalence and distribution of radiographically evident lesions on repository films in the hock and stifle joints of yearling Thoroughbred horses in New Zealand

AIM: To characterise the prevalence and distribution of radiographic changes in the hocks and stifles of Thoroughbred yearling colts and fillies in New Zealand and compare them with other populations of young horses. METHODS: Repository radiographs taken in New Zealand for the 2003-2006 Thoroughbred national yearling sales were evaluated by two individual readers. The distribution of radiographic changes was classified as left side only, right side only, or bilateral. Lesions were categorised by type, location, and sex of the yearling. Complete sets of hock and stifle radiographs of 1,505 yearlings were evaluated. RESULTS: Osteophytes or enthesophytes were seen radiographically in the distal tarsal joints of 460/1,505 (31%) horses. Osteochondrosis was seen in the tibiotarsal joint of 66/1,505 (4%) horses, and in the femoropatellar joint of 40/1,505 (3%) horses. Radiographic lucency in the distal or axial aspect of the medial femoral condyle was seen in 247/1,505 (16%) horses, and lucencies consistent with subchondral cyst-like lesions were seen in 26/1,505 (2%) horses. No significant difference was seen in the proportion of colts and fillies with radiographic changes in the hock or stifle. The prevalence of osteochondrosis and subchondral cyst-like lesions in the stifles of the yearlings examined were similar to those reported in Thoroughbred yearling sale horses in the United States of America (USA). The prevalence of changes in the distal tarsal joints was similar to those reported in Standardbred and Thoroughbred yearlings from Scandinavia and the USA. CONCLUSIONS: There was no significant difference in the prevalence of osteochondrosis in the hock and stifle, lucencies in the distal medial femoral condyle, or radiographic changes in the distal tarsal joints between colts and fillies. CLINICAL RELEVANCE: Establishment of the normal prevalence and distribution of radiographic changes in the hocks and stifles of Thoroughbred yearlings in New Zealand will allow comparison with populations of young horses in other countries. Knowledge of the normal prevalence will assist veterinarians to identify abnormally high or low prevalences on individual farms, to further investigate the pathogenesis of the lesions.     

Risk factors associated with hindlimb lameness and degenerative joint disease in the distal tarsus of Icelandic horses

The aim of this study was to evaluate potential risk factors associated with hindlimb lameness and radiographic signs of degenerative joint disease (DJD) in the distal tarsus in Icelandic horses. The material consisted of riding horses (n = 420) age 6-12 years sired by 17 selected sires representing all major breeding lines, and of riding horses (n = 194) in the same age range sired by other sires. The examination protocol included the following: interview with owners/trainers, assessment of conformation, motion evaluation and radiographic examination. At the interview, data related to factors outside the horse (environmental variables) and data associated directly with the horse (intrinsic variables) were obtained. Data analysis was performed in 2 steps: screening using bivariate analysis, followed by testing with a multivariate logistic regression model. In the multivariate analysis, the factors of sire, age when broken to saddle and stud show participation were strongly associated with the prevalence of lameness. Height at the croup and ability to perform different gaits were also associated with the prevalence of lameness, but to a lesser degree. The risk factors of age, tarsal angle and birthplace were significantly associated with radiographic signs of DJD in the distal tarsus. Neither the variation in applied training intensity, the use of a professional or amateur trainer nor the temperament or front limb action of the individual horse was significantly associated with the prevalence of hindlimb lameness and/or radiographic signs of DJD in the distal tarsus in the Icelandic horse.     

Injection of corticosteroids, hyaluronate, and amikacin into the navicular bursa in horses with signs of navicular area pain unresponsive to other treatments: 25 cases (1999-2002)

OBJECTIVE: To determine history, clinical and radiographic abnormalities, and outcome in horses with signs of navicular area pain unresponsive to corrective shoeing and systemic nonsteroidal anti-inflammatory drug administration that were treated with an injection of corticosteroids, sodium hyaluronate, and amikacin into the navicular bursa. DESIGN: Retrospective study. ANIMALS: 25 horses. PROCEDURE: Data collected from the medical records included signalment, history, horse use, severity and duration of lameness, shoeing regimen, results of diagnostic anesthesia, radiographic abnormalities, and outcome. RESULTS: 17 horses had bilateral forelimb lameness, 7 had unilateral forelimb lameness, and 1 had unilateral hind limb lameness. Mean duration of lameness was 9.2 months. All horses had been treated with corrective shoeing and nonsteroidal anti-inflammatory drugs for at least 6 months; 18 had previously been treated by injection of corticosteroids and sodium hyaluronate into the distal interphalangeal joint. Fourteen horses had mismatched front feet, and 21 horses had signs of pain in response to application of pressure over the central aspect of the frog. Palmar digital nerve anesthesia resulted in substantial improvement in or resolution of the lameness in all horses. Twenty horses (80%) were sound and returned to intended activities 2 weeks after navicular bursa treatment; mean duration of soundness was 4.6 months. Two horses that received numerous navicular bursa injections had a rupture of the deep digital flexor tendon at the level of the pastern region. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that navicular bursa treatment may provide temporary improvement in horses with signs of chronic navicular area pain that fail to respond to other treatments.     

IMAGING DIAGNOSIS—ENOSTOSIS-LIKE LESION IN THE FEMUR OF A HORSE

An enostosis-like lesion was diagnosed in the left femur of a Swedish Warmblood horse that had a left hindlimb lameness of 3 weeks duration. With scintigraphy using technetium 99m-hydroxymethylene diphosphonate (^99m Tc-HDP) a marked regional focal increase in radioactivity was identified in the medullary cavity of the left femur. Radiographically there was a corresponding focal increase in bone opacity in the middiaphysis of the left femur. Histopathologically, a 5 cm area of bone matrix was present in the diaphysis of the left femur and confirmed as an enostosis-like lesion. Enostosis-like lesions should be considered as a source of pain in horses with difficult to localize, moderate to severe chronic lameness.     

Problems associated with the interpretation of the results of regional and intra-articular anaesthesia in the horse

The difficulties associated with the interpretation of the results of regional and intra-articular anaesthesia are discussed with reference to eight lame horses. The clinical and radiographic features of each horse are described, together with the results of anaesthesia. One horse had clinical and radiographic signs consistent with navicular disease but it was not possible to relieve the lameness. Two horses had fractures of bones within the foot but lameness was not improved by palmar (abaxial sesamoid) nerve blocks. One horse had more than one cause of lameness. Four horses had joint pathology but none responded to intra-articular anaesthesia.     

Metacarpophalangeal Joint Synovial Pad Fibrotic Proliferation in 63 Horses

Medical records, radiographs, and sonograms of 63 horses with metacarpophalangeal joint synovial pad proliferation were examined retrospectively. All horses had lameness, joint effusion, or both signs associated with one or both metacarpophalangeal joints. Bony remodeling and concavity of the distodorsal aspect of the third metacarpal bone (Mc3) just proximal to the metacarpal condyles was identified by radiography in 71 joints (93%); 24 joints (32%) had radiographic evidence of a chip fracture located at the proximal dorsal aspect of the proximal phalanx. Fifty-four joints (71%) were examined by ultrasound. The mean ± SD sagittal thickness of the synovial pad was 11.3 ± 2.8 mm. Seventy-nine percent of the horses had single joint involvement with equal distribution between the right and left forelimbs. Sixty-eight joints in 55 horses were treated by arthroscopic surgery. Sixty joints (88%) had debridement of chondral or osteochondral fragmentation from the dorsal surface of Mc3 beneath the synovial pad and 30 joints (44%) had a bone chip fracture removed from the medial or lateral proximal dorsal eminence of the proximal phalanx. Complete or partial excision of both medial and lateral synovial pads was completed in 42 joints. Only the medial synovial pad was excised or trimmed in 21 joints, and 5 joints had only the lateral pad removed. Eight joints in eight horses were treated by stall rest, administration of intra-articular medication and systemic nonsteroidal anti-inflammatory drugs. Follow-up information was obtained for 50 horses treated surgically and for eight horses treated medically. Forty-three (86%) that had surgery returned to racing; 34 (68%) raced at an equivalent or better level than before surgery. Three (38%) of the medically treated horses returned to racing; only one horse raced better than the preinjury level. Horses that returned to racing at a similar or equal level of performance were significantly younger in age than horses returning at a lower level or not racing (P≤.05). Overall, horses with synovial pad proliferation treated by arthroscopic surgery had a good prognosis for return to racing at a level equal or better than before injury.     

Sclerosis of the third carpal bone. A prospective study of its significance in a group of young standardbred trotters

To assess the significance of radiographic signs of sclerosis of the third carpal bone (C3) in young Standardbred trotters in relation to performance, lameness and bone turnover both carpi in 14 Standardbred trotters were radiographically and scintigraphically examined 6 times, from the beginning of speed training until the beginning of racing, between the mean ages of 20 and 42 months. At the end of the study 8 horses had raced in official qualifying races and 14 limbs in 11 horses had been diagnosed with carpal lameness. All horses but 2 developed sclerosis and all but one had increased bone turnover in the C3 area by scintigraphy. C3 sclerosis increased continuously over time and with increased performance. Carpal lameness was significantly associated with progression of sclerosis but in most cases sclerosis developed without concomitant signs of carpal lameness. No association between carpal lameness and increased scintigraphic uptake was found, but horses that had qualified for racing had significantly higher C3 to carpus ratio of radiopharmaceutical uptake. We conclude that there is a continuous increase in C3 radiographic sclerosis with time in young Standardbred trotters in professional training, but radiographic sclerosis appears to be of limited value as an indicator of clinical carpal disease or level of performance in Standardbred trotters.     

The use of CT and CT arthrography in diagnosing equine stifle injury in a Rheinlander gelding

A 5‐year‐old Rheinlander gelding was evaluated for left hindlimb stifle lameness. The lameness was localised to the stifle, but source of the lameness was not specifically diagnosed from the physical, radiographic and ultrasonographic examinations. Computed tomography (CT) and CT arthrography were therefore used for further investigation since these imaging techniques image bony structures, cartilage and soft tissues. This examination showed multiple lesions in the stifle: an osteochondrosis dissecans like lesion of the medial femoral condyle, bony fragments, cartilage trauma and caudal cruciate ligament injury. The prognosis for continuing use as a sports horse was regarded as unfavourable. Therefore, the horse was subjected to euthanasia. All CT findings were confirmed by gross pathology. The CT and CT arthrography examination in this case provided a diagnosis not achieved with other conventional imaging techniques.     

Osteochondrosis-like lesion of the anconeal process in two horses

A suspected lesion of osteochondrosis dissecans involving the anconeal process of the humeroradial joint (elbow) was found in 2 horses. In horse 1, the lesion was found during routine lameness examination, during which alleviation of the lameness was achieved after intra-articular anesthesia of the elbow. In horse 2, the lesion was found at necropsy. Horse 1 responded satisfactorily to intra-articular treatment with hyaluronic acid. Both horses also had other joints affected with osteochondrosis dissecans.     

Lameness due to pain associated with the distal interphalangeal joint: 45 cases

This paper describes the clinical and radiographic features, and response to treatment, of 45 horses which showed lameness that was improved by intra-articular anaesthesia of the distal interphalangeal (DIP) joint. Although many horses had poor conformation of the foot of the lame limb, the majority showed no localising clinical signs suggestive of involvement of the DIP joint. Lameness was usually unilateral. No horse with bilateral lameness responded to treatment. Palmar digital nerve blocks frequently improved or alleviated lameness, although in some horses palmar (abaxial sesamoid) nerve blocks were required to eliminate lameness. This difference in response did not affect response to treatment. Intra-articular anaesthesia of the DIP joint usually resulted in resolution of lameness within 5 mins; a partial improvement in lameness or a slow response were poor prognostic indicators. None of the horses had radiographic abnormalities compatible with navicular disease. Radiographic changes of the distal interphalangeal joint per se were generally detectable only in lateromedial views and were identified in less than one third of the horses. Success rates were low following treatment of cases with radiographic abnormalities. In those with no radiographic abnormalities the response to corrective trimming and shoeing and intra-articular administration of sodium hyaluronate, once or repeatedly, was variable and no parameters could be used to predict the likely outcome. Treatment was successful in approximately 30 per cent of cases. Subsequent treatment of horses which remained lame, by intra-articular administration of polysulphated glycosaminoglycans, was not helpful; only a small proportion became sound following prolonged (nine months) rest.(ABSTRACT TRUNCATED AT 250 WORDS)