Treatment of subchondral cystic lesions of the medial femoral condyle of mature horses with growth factor enhanced chondrocyte grafts: a retrospective study of 49 cases

Reasons for performing study: To evaluate the long‐term clinical outcome after allogeneic chondrocyte and insulin‐like growth factor‐I (IGF‐I) grafting of subchondral cystic lesions (SCLs) of the femoral condyle in horses. Objective: To test the hypothesis that chondrocyte and IGF‐I grafts will improve the long‐term clinical outcome in arthroscopically debrided SCLs. Methods: Medical records of 49 horses with SCLs of the femoral condyle treated by debridement and implantation of chondrocytes and IGF‐I were reviewed. Preoperative radiographs were obtained, and caudocranial radiographic projections were used to establish a ratio between cyst and femoral condyle size. Arthroscopic cyst debridement followed by filling of the bone void with autologous cancellous bone (45 horses) or tricalcium phosphate granules (4 horses) was performed. A paired syringe containing a fibrinogen and chondrocyte mixture in one syringe and calcium‐activated bovine thrombin with IGF‐I in the other was used to cover the surface. A successful outcome was defined as a horse that performed to its intended use without lameness. Results: A successful outcome was achieved in 36 of 49 horses (74%). Preoperative radiography was performed in all horses, with 33 horses having unilateral SCLs of the medial femoral condyle, 15 horses having bilateral SCLs of the medial femoral condyle, and one horse having bilateral SCLs of the lateral femoral condyle. Median age of the horses was 3.3 years. Fifteen horses had preoperative radiographic and arthroscopic evidence of osteoarthritis (OA). A successful outcome was not influenced by age of horse, presence of pre‐existing osteoarthritis or preoperative size of the subchondral cyst. Grafting resulted in success for 80% of horses >3 years old, and in 80% of horses with OA. Conclusions: Implantation of allogeneic chondrocytes supplemented with IGF‐I is an effective treatment for horses with SCLs of the femoral condyle, and particularly for older horses and horses with pre‐existing osteoarthritis. Potential relevance: Chondrocyte implantation may offer a greater chance of long‐term success in older horses and horses with osteoarthritis than has been previously reported with cyst debridement alone.     

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.     

Concurrent or sequential development of medial meniscal and subchondral cystic lesions within the medial femorotibial joint in horses (1996–2006)

Reasons for performing study: Medial meniscal injuries and subchondral cystic lesions (SCL) are known to occur independently within the medial femorotibial (MFT) joint in horses. However, there are no reports of a potential clinical relationship between these 2 types of lesions. Objectives: To: 1) document the concurrent presence or sequential development of medial meniscal and SCL of the medial femoral condyle within the MFT joint; and 2) determine the prognosis with both types of lesions. Methods: Retrospective case series of horses with both a medial meniscal and SCL of the medial femoral condyle identified concurrently or sequentially by radiography, arthroscopy or post mortem examination. Case records and radiographs were reviewed, and a telephone survey of referring veterinarians, owners and trainers was conducted. Results: Twenty‐one horses (9.1% of all horses undergoing MFT joint arthroscopy) were identified to have both a medial meniscal injury and SCL of the medial femoral condyle. Thirteen horses had both abnormalities identified concurrently, 6 developed a meniscal lesion subsequent to SCL debridement, and 2 developed a SCL subsequent to a medial meniscal injury. Only 4/19 horses were classified as successful and returned to their intended use. The severity of the meniscal injury was significantly associated with the severity of lameness but not with outcome. Conclusions: A low percentage of horses may develop both a meniscal injury and SCL of the medial femoral condyle within the MFT joint and have a poor prognosis. Potential relevance: Trauma to the MFT joint may lead to both meniscal and subchondral bone damage of the medial femoral condyle that may be recognised concurrently or sequentially.     

Arthroscopic injection of corticosteroids into the fibrous tissue of subchondral cystic lesions of the medial femoral condyle in horses: a retrospective study of 52 cases (2001-2006)

REASONS FOR PERFORMING STUDY: There are no published results of subchondral cystic lesions (SCLs) in the medial femoral condyle (MFC) treated with arthroscopic injection of corticosteroids into the lining of the cyst. OBJECTIVES: 1) To determine the success rate for treatment of SCLs in the MFC with arthroscopic injection of the fibrous tissue of the cyst with corticosteroids. 2) To identify any factors that may predict outcome. HYPOTHESES: Injection of the fibrous tissue of SCLs of the MFC with corticosteroids utilising arthroscopic guidance yields a similar or higher chance for intended performance than does arthroscopic debridement as previously reported; this technique will be effective for treating SCLs in older horses. METHODS: Horses with clinical and radiographic evidence of a SCL in the MFC were injected with corticosteroids under arthroscopic guidance, and case records and radiographs were reviewed retrospectively. A telephone survey of referring veterinarians, owners and trainers was conducted. RESULTS: Thirty-five of 52 (67%) cases were classified as successful involving 73 SCLs of which 56 (77%) were classified as successful. There was no significant association between age group (age3 years) and outcome, or cyst configuration and outcome. Significantly more unilateral SCLs (28/31 [90%] SCLs) were classified as successful than bilateral (28/42: 67%). There were significant differences in outcome based on the surgeon operating the case and an association between pre-existing radiographic findings of osteophytes and negative outcome. CONCLUSIONS: Injection of SCLs utilising arthroscopic guidance is an effective alternative method of surgical treatment of SCL. POTENTIAL RELEVANCE: This technique offers a similar chance of success as has been reported with debridement and may allow for a shorter period of convalescence. If unsuccessful, the option remains to debride the cyst in a second surgery.     

Arthroscopic findings in horses with subtle radiographic evidence of osteochondral lesions of the medial femoral condyle: 15 cases (1995-2002)

OBJECTIVE: To determine arthroscopic findings in lame horses with subtle radiographic lesions of the medial femoral condyle. DESIGN: Retrospective study. ANIMALS: 15 horses examined because of lameness that had subtle radiographic evidence of osteochondral lesions involving the medial femoral condyle in at least 1 joint. PROCEDURE: Medical records were reviewed, and results of physical examination, radiography, and arthroscopy were recorded. Follow-up information was obtained through reexamination of the horses or telephone conversations with the referring veterinarians, owners, or trainers. RESULTS: Lameness severity ranged from grade 1 to 3 on a scale from 0 to 5. Radiography and arthroscopy were performed on 28 stifle joints. The 4 unaffected joints in 4 horses with unilateral hind limb lameness that underwent bilateral arthroscopy had no radiographic lesions, but 2 of the 4 had arthroscopic lesions. Of the remaining 24 joints, 20 had radiographic evidence of flattening of the apex of the medial femoral condyle and 4 had minimal subchondral lucency. Lesions were identified arthroscopically in 18 of the 20 joints with flattening of the condyle and in all 4 joints with subchondral lucency. Treatment consisted of abrasion arthroplasty or microfracture. Seven of the 9 horses with focal cartilage lesions and 2 of the 6 horses with generalized cartilage lesions were reportedly sound without any evidence of joint effusion at the time of final follow-up. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that horses with hind limb lameness and subtle radiographic lesions of the medial femoral condyle are likely to have arthroscopically apparent cartilage lesions and subchondral bone defects.     

Effect of age at presentation on outcome following arthroscopic debridement of subchondral cystic lesions of the medial femoral condyle: 85 horses (1993--2003)

REASONS FOR PERFORMING STUDY: Subchondral cystic lesions of the medial femoral condyle (SCMFC) are well documented in horses < or =3 years; arthroscopic debridement or enucleation of the cyst is currently the surgical treatment of choice. However, studies of occurence and outcome following surgery in older horses are lacking. OBJECTIVE: To identify factors important in outcome for horses with SCMFC treated by arthroscopic debridement. HYPOTHESIS: Age of horse at presentation has a significant influence on return to work following arthroscopic treatment for SCMFC. Clinical and diagnostic findings are also significant with respect to prognosis. METHODS: A retrospective review of medical records from 6 equine referral centres identified 85 horses that underwent arthroscopic debridement of SCMFC. Clinical examination, radiographic and arthroscopic findings were analysed together with follow-up data. Univariable analysis and multivariable logistic regression models were used to determine factors affecting return to soundness. Event-time analysis was performed to evaluate return to work. RESULTS: Older horses (>3 years) were less likely to return to soundness (P = 0.02) or to work (P = 0.04) than younger horses (< or = 3 years). Of 39 horses age 0-3 years, 25 (64%, 95% CI 49-79%) returned to soundness. Of 46 horses age >3 years, 16 (35%,95% CI 21-49%) returned to soundness. In addition, cartilage damage at sites other than the SCMFC negatively affected prognosis (P = 0.05). The hospital where treatment was performed had no influence on return to soundness. CONCLUSIONS: Older horses carry a worse prognosis for both return to soundness and return to work. Potential relevance: It is important for clients to be made aware of the difference in outcome between age groups.     

Progression of Femoropatellar Osteochondrosis in Nine Young Horses Clinical, Radiographic and Arthroscopic Findings

The clinical and radiographic progression, and arthroscopic findings for nine young horses (<1 year of age) with femoropatellar osteochondrosis (OCD) are presented. Horses had a 2 to 12 week history of bilateral (8 horses) or unilateral (1 horse) hindlimb lameness. The most consistent clinical signs included femoropatellar joint distention and bilateral hindlimb lameness. At the onset of clinical signs, radiographic lesions were not present (4 horses) or subtle (5 horses), but were easily identified on radiographs taken 4 to 24 weeks later. Arthroscopic surgery was delayed until radiographic changes became obvious. Surgical findings in 20 femoropatellar joints were most commonly osteochondral "flaps" located on the proximal lateral trochlear ridge of the femur and were larger than had been indicated by the radiographs. Eight horses were being used for their intended purpose, which was racing (3 horses were racing and 3 were in race training), dressage (1 horse) or pleasure riding (1 horse). One horse required a second surgery when similar lesions developed in the opposite stifle, and was euthanatized 2 months later because of persistent lameness. Once clinical signs are observed, osteochondrosis lesions of the distal femur can progress in foals younger than 9 months of age and the full extent of the radiographic lesion may take several weeks to develop.     

Diagnostic and Surgical Arthroscopy of the Equine Shoulder Joint

An arthroscopic technique for examination and surgical treatment of conditions of the shoulder joint was evaluated in eight normal horses and two horses with osteochondrosis lesions. A single arthroscope entry point caudal to the infraspinatus tendon allowed inspection of the cranial, lateral, and caudal surfaces of the shoulder joint. With the humeral head and glenoid cavity distracted by a curved forceps, the entire cartilage surface of the shoulder could be examined. The caudomedial portion of the humeral head was seen better with a 70 degree angled arthroscope. Instruments for intra-articular manipulation were introduced through a separate skin incision 2 to 4 cm caudal to the arthroscope entry point. Two horses with osteochondrosis lesions of the shoulder were examined arthroscopically and debrided with instrument triangulation. Five normal horses and both horses with osteochondrosis lesions were euthanized immediately after the procedure and a necropsy was performed. Minor iatrogenic damage to the cartilage surfaces and joint capsule resulted from the technique. Three horses recovered from anesthesia and were killed 3, 30, or 60 days after surgery. Subcutaneous fluid that accumulated during surgery had resorbed by 3 days and lameness was evident for 12 to 24 hours. Gross examination and histopathologic findings of specimens collected at 30 and 60 days showed several small nonhealing partial-thickness cartilage defects attributed to instrument insertion. Arthroscopy is a satisfactory method to examine the joint surfaces and to evaluate and treat osteochondrosis lesions of the shoulder joint in horses.     

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.     

Fibrous tissue of subchondral cystic lesions in horses produce local mediators and neutral metalloproteinases and cause bone resorption in vitro

OBJECTIVES: To define the release of nitric oxide (NO), prostaglandin E2 (PGE2), and the neutral metalloproteinases (NMPs) in horses with subchondral cystic lesions (SCL) and to study bone resorption triggered by conditioned media of fibrous tissue of SCL in vitro. STUDY DESIGN: Equine explant cultures of fibrous tissue of SCL, and synovial membrane and articular cartilage of normal horses and horses affected with moderate and severe osteoarthritis were performed. NO, PGE2, and NMP concentrations of media samples were measured, and osteoclast formation and activation was studied in vitro. ANIMALS: Experiment 1: 32 horses with SCL (n = 8), normal joints (7), and joints with moderate (7) and severe (10) osteoarthritis (OA). Experiment 2: 22 horses with SCL (n = 3), normal joints (7), and chip fractures (12). Experiment 3: Conditioned media of fibrous tissue from 3 horses with SCL of the medial femoral condyle (n = 1), distal metacarpal bone (1), and tarsal bone (1). METHODS: Determinations of local mediator concentrations were made with the Griess assay for NO and an enzyme immunoassay kit for PGE2 concentrations in biological fluids. Enzyme activities were assessed with radiolabeled substrates indicating collagenolytic, gelatinolytic, and caseinolytic activities. The resorption pit assay was used to assess osteoclast recruitment and activity. RESULTS: Fibrous tissue of SCL produced NO, PGE2, and NMPs. Of all the variables measured, PGE2 concentrations were the highest in cystic tissue of SCL compared with synovial membrane and articular cartilage from normal joints and joints with chip fractures, indicating that this mediator may play an important role in pathological bone resorption associated with SCL. These findings were supported by the observation that conditioned media of SCL tissue were capable of recruiting osteoclasts and increasing their activity. CONCLUSION: Fibrous tissue of SCL released NO, PGE2, and NMPs into the culture media. It is suspected that intralesional fibrous tissue may play an active role in the pathological process of bone resorption occurring in SCL in horses and may be partly responsible for the maintenance, slow healing rate, and expansion of these lesions. CLINICAL RELEVANCE: Understanding the pathogenesis of SCL will help to establish successful therapy in horses affected with SCL.     

DIAGNOSTIC SENSITIVITY AND INTEROBSERVER AGREEMENT OF RADIOGRAPHY AND ULTRASONOGRAPHY FOR DETECTING TROCHLEAR RIDGE OSTEOCHONDROSIS LESIONS IN THE EQUINE STIFLE

Osteochondrosis lesions commonly occur on the femoral trochlear ridges in horses and radiography and ultrasonography are routinely used to diagnose these lesions. However, poor correlation has been found between radiographic and arthroscopic findings of affected trochlear ridges. Interobserver agreement for ultrasonographic diagnoses and correlation between ultrasonographic and arthroscopic findings have not been previously described. Objectives of this study were to describe diagnostic sensitivity and interobserver agreement of radiography and ultrasonography for detecting and grading osteochondrosis lesions of the equine trochlear ridges, using arthroscopy as the reference standard. Twenty‐two horses were sampled. Two observers independently recorded radiographic and ultrasonographic findings without knowledge of arthroscopic findings. Imaging findings were compared between observers and with arthroscopic findings. Agreement between observers was moderate to excellent (κ 0.48–0.86) for detecting lesions using radiography and good to excellent (κ 0.74–0.87) for grading lesions using radiography. Agreement between observers was good to excellent (κ 0.78–0.94) for detecting lesions using ultrasonography and very good to excellent (κ 0.86–0.93) for grading lesions using ultrasonography. Diagnostic sensitivity was 84–88% for radiography and 100% for ultrasonography. Diagnostic specificity was 89–100% for radiography and 60–82% for ultrasonography. Agreement between radiography and arthroscopy was good (κ 0.64–0.78). Agreement between ultrasonography and arthroscopy was very good to excellent (κ 0.81–0.87). Findings from this study support ultrasound as a preferred method for predicting presence and severity of osteochondrosis lesions involving the femoral trochlear ridges in horses.     

Short incomplete sagittal fractures of the proximal phalanx in ten horses not used for racing

Objective— To describe short incomplete sagittal fractures of the proximal phalanx (type Ia P1 fractures) in horses not used for racing and report outcome.
Study Design— Retrospective study.
Animals— Horses (n=10) with type Ia P1 fractures.
Methods— Retrieved data of horses with type Ia P1 fractures were signalment, history and results of orthopedic examination. Radiographs were re-evaluated for position and length of the fracture line, presence of osteoarthritis or subchondral cystic lesions (SCL), periosteal new bone formation and subchondral sclerosis. Conservative treatment (n=4) included box confinement for 2 months followed by 1 month of hand walking. Surgical therapy (n=6) consisted of internal fixation by screws inserted in lag fashion in 5 horses. Concurrent SCL were debrided by curettage via a transcortical drilling approach. In 1 horse, only SCL curettage but not internal fixation was performed. Outcome was assessed on a clinical and radiographic follow-up examination in all horses.
Results— Mean follow-up time was 27 months (median, 13.5 months; range, 9 months to 9 years). All horses treated with internal fixation were sound at follow-up and had radiographic fracture healing. Of the 4 horses managed conservatively, 3 remained lame and only 1 horse had radiographic evidence of fracture healing. Catastrophic fracture propagation occurred in 2 horses not treated by internal fixation, 20 and 30 months after diagnosis, respectively.
Conclusions— Horses with a type Ia P1 fracture treated surgically had a better outcome than those managed conservatively and lack of fracture healing seemingly increases the risk of later catastrophic fracture.
Clinical Relevance— Surgical repair of type Ia P1 fractures should be considered to optimize healing and return to athletic use.     

Multiple Osteochondral Autografts for Treatment of a Medial Trochlear Ridge Subchondral Cystic Lesion in the Equine Tarsus

Objective— To adapt the multiple osteochondral autograft technique for treatment of a subchondral cystic lesion (SCL) of the proximal medial trochlear ridge (MTR) of the equine talus and assess long term outcome.
Study Design— Case report.
Animals— Quarter horse stallion with SCL of the proximal MTR of the talus.
Methods— Osteochondral autograft techniques used in dogs and humans were adapted and optimized in equine cadavers. A horse with a SCL of the MTR of the talus was treated by osteochondral autografting. Three osteochondral autografts were harvested from the distal lateral trochlear ridge of the talus in the affected tarsus. No curettage or debridement of the osteochondral lesion was performed. Three recipient beds were predrilled and osteochondral autografts were press-fit into the proximal MTR of the talus. Outcome was assessed by radiography, telephone interview of the owner, and direct observation during training.
Results— Postoperative radiographs indicated excellent filling of the osteochondral defect and graft-articular surface congruency. No complications were encountered after surgery. At 10 months after surgery, the horse successfully re-entered reining training, and continued to be sound and performing athletically 2 years after surgery.
Conclusion— Osteochondral autografting deserves consideration and further evaluation as a primary treatment option for SCL of the proximal MTR of the talus in horses.
Clinical Relevance— Based on the outcome of this case, osteochondral autografting appears to be a safe, valuable and realistic option for treating SCL of the proximal MTR of the talus in equine athletes.     

Hind limb skeletal lesions in 12-month-old bulls of beef breeds

In the present study, right hind limb bones from 46 12-month-old bulls with no clinical signs were examined to identify and describe lesions that could predispose the stifle and tarsal joints to osteoarthritis. The bulls came from a performance testing station and were slaughtered due to a low index at the end of the testing period 1996-97. Differences in frequency of lesions among breeds as well as the relationship between lesions and growth rate were evaluated. Forty-five (97.8%) of the 46 bulls had lesions in the joints and/or growth plates. Prevalence of lesions was 100% in the Charolais (22/22), the Hereford (8/8), and the Limousin (4/4) breeds, and 85.7% (6/7) in the Simmental breed. The stifle was affected in 37, the tarsus in 33, and the growth plates in 34, of the 46 bulls. Lesions found in the stifle joint were: osteochondrosis of the articular-epiphysical cartilage complex (AECC) (25), subchondral bone cyst of the distal femur (1), fragmentation of the medial intercondylar eminence of the tibia (20), cleft in the distal part of the patellar groove (28), and an avulsion fracture of the lateral condyle together with a partial tear of the cranial cruciate ligament (1). Lesions found in the tarsal joint were: osteochondrosis of the AECC (23), ulcerative lesions of the articular cartilage of the talus (25), and fracture of the medial malleolus (4). Twenty-eight bulls had lesions of osteochondrosis at the AECC and 37 at the growth plates. When osteochondrosis at the AECC and thickening of the growth plates were combined, 44 of the 46 bulls had at least one lesion at the AECC and/or the growth plate. Prevalence of bulls with at least one lesion was similar between breeds, but the number of lesions per bull was significantly higher in Charolais followed by Simmental, Hereford, and Limousin. Number of lesions per bull was significantly correlated with daily weight gain, carcase weight, and the width of the proximal tibial epiphysis. Lesions were statistically independent, indicating that local biomechanical factors within the joints are important in the pathogenesis. In conclusion, we suggest that the high incidence of hind limb osteoarthritis reported in the Swedish beef bull population can be explained by the high prevalence of skeletal lesions found in the present material. The lesions appeared to be related to high growth rate and to the breed.     

Comparison of radiography and ultrasonography to detect osteochondrosis lesions in the tarsocrural joint: A prospective study

Reasons for performing study: Lesions located on the medial malleolus of the tarsocrural joint can be difficult to image radiographically. Ultrasonography allows evaluation of articular cartilage and subchondral bone. Objectives: To compare dorso30° lateral‐plantaromedial‐oblique (DL‐PlMO) and dorso45° views to detect lesions on the medial malleolus, to validate the use of ultrasonography to show lesions in the tarsocrural joint and to compare its sensitivity to radiography. Methods: Tarsocrural joints (n = 111) with osteochondrosis were evaluated ultrasonographically and radiographically prior to arthroscopic lesion debridement. A complete radiographic examination was made and the best view to detect each lesion recorded. Longitudinal and transverse ultrasonography of the dorsal aspect of the joint was performed and the best scan plane to image each lesion recorded. Results: There were 94 joints with lesions on the distal intermediate ridge of tibia, 24 with lesions on the medial malleolus, and 4 with lesions on the lateral trochlear ridge. The sensitivity of radiography to detect lesions on the medial malleolus and distal intermediate ridge of tibia was 71 and 96%, respectively. Eighty‐two percent of lesions on the medial malleolus were better imaged on dorso30° view. The sensitivity of ultrasonography to detect lesions on the medial malleolus and distal intermediate ridge of tibia was 83 and 98%, respectively. Ultrasonography was significantly more sensitive than radiography to detect lesions on the medial malleolus and distal intermediate ridge of tibia. Conclusion: Dorso30° lateral‐plantaromedial‐oblique view was the best to image lesions on the medial malleolus. Ultrasonography was a valuable diagnostic tool to diagnose lesions in the tarsocrural joint and was more sensitive than radiography for lesions located on the medial malleolus and distal intermediate ridge of tibia. Clinical relevance: Radiographic examination should include a dorso30° view for detection of lesions on the medial malleolus and ultrasonography should be considered to diagnose osteochondrosis in the tarsocrural joints.     

Osteolytic lesions of the tuber calcanei in two horses

Two adult horses were evaluated for chronic hind limb lameness. Nonseptic calcanean bursitis with associated focal osteolytic lesions at the point of insertion of the gastrocnemius tendon was diagnosed in each horse by physical and lameness examinations, radiography, ultrasonography, and synovial fluid analysis. Both horses underwent arthroscopic exploration and lavage of the affected bursa, and one horse also underwent surgical debridement of the osseous lesion. Both horses remained lame for 13 months after the surgical procedures. To our knowledge, osseous lesions of the calcaneus in horses with nonseptic calcanean bursitis have not been reported. The flexed proximoplantar-to-distoplantar tangential radiographic view of the calcaneus was essential in localizing the lesions, as was the sonogram in one horse. Arthroscopy provided a thorough evaluation of the bursa and associated tendons. On the basis of the outcome of these 2 horses, the prognosis for complete recovery for horses with this condition appears to be unfavorable. Surgical debridement of the osseous lesion was of no benefit and may have been detrimental.     

Arthroscopic Surgery for the Treatment of Osteochondritis Dissecans in the Equine Femoropatellar Joint

Forty limbs with femoropatellar osteochondritis dissecans in 24 horses were treated with arthroscopic surgery. Lesions were bilateral in 16 horses and unilateral in eight horses. Diagnostic examination and surgical treatment were performed through a single arthroscopic portal; five different instrument portal locations and six instrument approaches were used. Lesions were localized to the lateral trochlear ridge of the femur in 31 affected joints, medial trochlear ridge in two joints, lateral and medial trochlear ridges together in two joints, lateral trochlear ridge plus patella in four joints, and patella alone in one joint. The lesions consisted of subchondral defects containing chondral or osteochondral flaps or fragments, or were seen as dimpling, cracking, fibrillation, or erosion of articular cartilage, or intact cartilage over a subchondral defect. Loose bodies were found in three joints. There was a poor correlation between radiologic and arthroscopic findings. Surgical manipulations included removal of flaps, fragments, and undermined articular cartilage, and debridement of the subchondral defect. Three horses were euthanized: one electively to assess the joint grossly, one because of complications following surgery and salmonellosis, and one because of unrelated forelimb abnormalities. Immediate clinical improvement after surgery was seen in the 22 horses permitted to survive. Long-term follow-up on seven of 10 racehorses revealed that two have raced successfully, two are "ready to race," three are training sound, two are sound at pasture (still in convalescence), and one has been reoperated. Of six horses used for show or pleasure, three are being shown sound, one is sound for pleasure, and two are training sound. The remaining horses are convalescing.     

The effect of compacted cancellous bone grafting on the healing of subchondral bone defects of the medial femoral condyle in horses

Objective— To compare the quality of second-intention healing and that of compacting sternally harvested cancellous bone into subchondral bone defects of the medial femoral condyle in horses.
Study Design— A controlled experiment using a surgical technique that minimizes soft tissue trauma, customized for consistency among horses.
Animals or Sample Population— Ten horses, aged 2 to 5 years, free of hindlimb lameness and with radiographically normal stifles.
Methods— After a 12.7-mm-diameter × 19-mm-deep defect was created into randomly selected medial femoral condyles, bone and cartilage healing was evaluated over a 6-month period in control horses (  n = 5  ) and horses receiving a compacted cancellous bone graft (  n = 5  ). Healing was evaluated using lameness assessment, radiographic and microradiographic interpretation, arthroscopic appearance, percent bone fill, proteoglycan content, and histology.
Results— Six months after surgery, there was no significant difference between grafted and ungrafted defects with respect to lameness, radiographic score, or percent bone fill. Histologically, grafted defects were characterized by the presence of dead graft and secondary cyst formation in four defects. Ungrafted defects filled with fibrous tissue and no cyst formation were identified.
Conclusions— Grafted defects do not heal better than ungrafted defects, and lameness was not affected by surgical technique.
Clinical Significance— Cartilage healing is similar in grafted and ungrafted defects in the equine medial femoral condyle at 6 months, suggesting that surgical debridement alone of cystic structures remains the treatment of choice.