Arthroscopic autologous osteochondral mosaicplasty for the treatment of subchondral cystic lesion in the medial femoral condyle in a horse

An 11-year-old, Hungarian half-bred stallion was presented with a history of mixed left hindlimb lameness of 6 months duration. Subchondral bone cyst of the medial femoral condyle and injury of the medial meniscus were diagnosed. Osteochondral autograft transplantation (mosaic arthroplasty) was performed, taking grafts from the less weight-bearing medial border of the medial femoral trochlea of the affected limb, and transplanting them into the cyst during arthroscopy. The lameness was evaluated prior to and one year after the operation with a motion analysis system during treadmill exercise. Considerable improvement of the lameness and the clinical signs as well as successful transplantation of the grafts, and a new hard joint cartilage surface of the medial femoral condyle could be detected during follow-up arthroscopy. Osteochondral autograft transplantation seems to bee a possible alternative for treating subchondral cystic lesions of the medial femoral condyle in horses. A new technique for the surgical treatment of a subchondral cystic lesion of the medial femoral condyle in the horse is described.     

Treatment of coxofemoral luxation in a mature Welsh pony by femoral head ostectomy: Long‐term outcome

A 233 kg, 4‐year‐old Welsh pony stallion presented with a unilateral coxofemoral luxation and a history of previous upward fixation of the patella. This condition was surgically managed by femoral head ostectomy using a craniodorsal approach to the luxated coxofemoral joint, without greater trochanteric osteotomy. Immediate improvement in weightbearing was observed after surgery and primary intention healing was recorded. Long‐term outcome, 4 years after surgery, was assessed by radiographic, ultrasonographic and lameness examination. The pony was in good body condition and the initial weight of this patient was restored. Despite fetlock hyperlaxity of the contralateral hindlimb, amyotrophy and mechanical lameness of the affected hindlimb, the pony showed evident comfort without apparent signs of pain and was able to trot and gallop. Bone callus was observed at imaging examination.     

Multiple skeletal metastases from a penile squamous cell carcinoma in a horse

A 21‐year‐old gelding with ventral abdominal and preputial oedema was evaluated for right hindlimb lameness. Partial phallectomy had been performed 3 years prior for treatment of squamous cell carcinoma. Regional analgesia did not localise the source of lameness and nuclear scintigraphy was recommended. The results of the scan revealed severe increased radiopharmaceutical uptake in the proximal femur. Radiographic and ultrasound examinations were inconclusive. The horse was discharged with recommendations of stall confinement and a 2 week course of nonsteroidal anti‐inflammatory drugs. Four weeks later the horse presented for an inability to elevate his neck and persistent hindlimb lameness. The owner elected humane euthanasia. Post mortem examination revealed metastatic squamous cell carcinoma in the proximal femur and fifth cervical vertebrae consistent with metastasis from the penile squamous cell carcinoma. To the authors’ knowledge, multiple site bone metastasis of squamous cell carcinoma has not been reported previously in the horse.     

OSTEOCHONDROSIS IN THE LATERAL FEMORAL CONDYLES OF A HORSE

Osteochondrosis of the lateral femoral condyles was diagnosed radiographically in an 8-month-old, female Arabian horse, which had been presented with a hindlimb lameness. The diagnosis was confirmed by gross and microscopic pathology. The location of the lesions was considered unusual for osteochondrosis in the horse.     

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.     

An unusual cyst‐like lesion in the metaphysis of the tibia in a horse

A 6‐year‐old Haflinger gelding was presented with a chronic right hindlimb lameness. Scintigraphy, radiography and computed tomography confirmed an active large cyst‐like lesion in the distal metaphysis of the right tibia. A transcortical surgical approach was used to curette the lesion and fill it with an autologous bone graft and a calcium phosphate bone substitute material. Histopathology revealed mild histiocytic inflammatory changes, mild fibrosis and bone necrosis. This case report describes an unusual cyst‐like lesion in the tibial metaphysis of a horse.     

Osteosarcoma of the middle phalanx in a horse

An 11‐year‐old Thoroughbred gelding was presented for lameness investigation following acute onset hindlimb lameness, which developed during a period of paddock turnout. Clinical examination revealed a swelling over the dorsolateral aspect of the pastern that was painful on digital palpation. Radiography of this area was consistent with an aggressive bone lesion involving both joint surfaces of the middle phalanx with pathological fracture and distal collapse of this bone. On this basis, the horse was subjected to euthanasia. Post mortem histopathological examination revealed presence of an osteosarcoma without involvement of the articular cartilage. This bone tumour is extremely rare in horses and has not been reported in this anatomical location.     

Simultaneous presence of a seminoma and a leiomyoma in the testes of a horse

An 18‐year‐old stallion was presented for castration because of insidious, bilateral scrotal enlargement of one year's duration. The left testis was firm, while the right was soft and lobulated; both were larger than normal. Palpation of the scrotum and its contents did not cause the horse to show signs of discomfort. Ultrasonography of scrotal contents revealed abnormal, heterogeneous tissue with ill defined regions of hyper‐ and hypoechogenity throughout both testes. Several hours after admission the horse developed severe signs of colic. On the basis of anamnesis, clinical findings, and results of ultrasonography and transrectal palpation bilateral testicular neoplasia and incarcerated inguinal hernia were tentatively diagnosed. Because the horse's owner did not consent to surgical treatment, the stallion was subjected to euthanasia. Histological and immunohistochemical examination of the testicular tissue collected post mortem revealed a seminoma in the left testis and a leiomyoma in the right testis. The post mortem examination also revealed incarceration of the small intestine in addition to the testicular tumours. To our knowledge, this is the first report of the simultaneous presence of bilateral, yet different testicular tumour types in a stallion.     

Surgical management of proximal articular fracture of the patella in a horse

A patellar fracture was identified radiographically in the right stifle of a mature Tennessee Walking Horse stallion. The horse was markedly lame (grade IV/V) on the right hindlimb. Due to the articular nature and small size of the fragment, surgical removal via arthrotomy was selected. A dorsomedial approach to the femoropatellar joint was used. The horse recovered well and has returned to training as a show horse by 8 months following surgery.     

Bilateral hypoplasia of the minor tubercle of the humerus with medial luxation of the biceps tendon in two Quarter Horses

Two Quarter Horses were examined at the Washington State University Veterinary Teaching Hospital with forelimb lameness. Case 1 was a 4‐year‐old female with a 4 month history of intermittent forelimb lameness that had partially responded to oral anti‐inflammatories. The horse was in full training and actively competing in cutting. Case 2 was a one‐year‐old filly bred for cutting that presented with a right forelimb lameness of 3 weeks’ duration, which was not responsive to oral anti‐inflammatories. The horse was not in training. On lameness examination, Case 1 was grade 1/5 (American Association of Equine Practitioners scale) lame in the left forelimb in a straight line on a hard surface, extension and flexion of the shoulder was resented and exacerbated the lameness. Case 2 was grade 3/5 lame in the right forelimb in a straight line on a hard surface, flexion and extension of the shoulder was resented and exacerbated the lameness. Both horses had a characteristic dished appearance to the dorsal aspect of the shoulder, with prominence of the proximal aspect of the humerus. Ultrasound and proximodistal oblique (skyline) radiographic views of the scapulohumeral joints demonstrated bilateral hypoplasia of the minor tubercle of the humerus with bilateral medial luxation of the proximal biceps tendon in both cases. To the authors' knowledge this is the first report of 2 cases of bilaterally affected horses, as well as the first report of the condition in the Quarter Horse breed.     

Arthroscopic removal of a palmar radial osteochondroma causing carpal canal syndrome in a horse.

A 5-year-old Arabian stallion with moderate effusion in the right carpal canal and intermittent lameness in this limb was diagnosed to have an osteochondroma projecting from the distal portion of the radius into the carpal canal. oral phenylbutazone treatment over the next 3 years allowed the stallion to continue its show career. Right forelimb lameness returned at that time, and ultrasonography revealed the osteochondroma impinging on the dorsal surface of the deep digital flexor tendon. The owner elected to have the osteochondroma surgically removed. The horse was anesthetized, and the carpal sheath was distended with balanced polyionic solution. A 4-mm arthroscope was inserted into the carpal sheath, and the osteochondroma projecting into the sheath was identified. The osteochondroma was removed by use of a Ferris-Smith bone rongeur, which was inserted into the carpal sheath through a stab incision over the osteochondroma. The effusion in the carpal sheath and the lameness resolved by 2 months, and the horse was returned to training 4 months after surgery.     

Primary haemangiosarcoma in the proximal humerus of a Clydesdale gelding

An 11‐year‐old Clydesdale gelding was presented for investigation of left forelimb lameness of 2 weeks' duration. The use of scintigraphic imaging helped to localise the source of lameness to the left proximal humerus. In this report, the clinical and diagnostic imaging features of a primary osseous haemangiosarcoma in a horse are described, along with the challenges of establishing a definitive diagnosis ante mortem. In addition, neoplasia of the appendicular skeleton should be considered a differential cause of lameness in the horse.     

Iliopsoas abscess with iliac and femoral vein thrombosis in an adult Siberian husky

A nine-year-old, male Siberian husky was presented with fever, decreased appetite and activity, non-weightbearing lameness, and oedematous swelling of the right inguinal and preputial area and the right hindlimb. An abscess within the right iliopsoas muscle, with severe thrombosis of the iliac and femoral vein, was diagnosed by haematology and diagnostic imaging. The abscess and adjoining lymph node were removed surgically through a median coellotomy. The isolated pathogen was Staphylococcus intermedius. Clinical signs resolved completely after surgery. Antimicrobial therapy was continued for four weeks. Within the follow-up period of six months, no recurrence of the clinical signs was detected.     

Treatment of a subchondral cystic-like lesion in the distal scapula with a translesional bone screw in a horse

A 2-year-old French Warmblood stallion was presented for lameness investigation. The diagnostic procedures identified the reason for lameness as being a subchondral cystic-like lesion (SCL) in the glenoid cavity of the scapula. The horse was surgically treated with a translesional 4.5 mm cortical bone screw inserted through the SCL under radiographic guidance. Sixty days after surgery, the horse was sound and the SCL showed significant radiographic signs of healing. Radiographs obtained 180 days after surgery showed further radiographic healing, with the SCL presenting a radiodensity similar to the surrounding bone. At 4 years post-operative follow-up, the horse is sound and competing successfully as a 6-year-old in Concours de Saut International (CSI) competitions.     

Closed reduction of coxofemoral luxation in a goat: case report

Hip luxations have been reported in many ruminants, and several treatments have been described for them. However, successful closed reduction of hip joint luxation has not been reported in goats to date. This case report describes the closed reduction of coxofemoral luxation in a three-month-old male Saanen dairy goat. The goat showed non-weightbearing lameness and abnormal mobility of the proximal right hindlimb. Luxation of the right coxofemoral joint in craniodorsal direction was diagnosed by radiography. The femoral head was repositioned under sedation, and physiotherapy including non-weightbearing hindlimb movement and supported walking exercise was performed. Fifteen days after closed reduction the animal was discharged from the clinic. At that time the animal was sound at a slow walk but lameness was still present at faster gaits. Follow-up examinations revealed normal development of the animal, which subsequently showed no lameness and served successfully as a breeding goat.     

Surgical repair of a comminuted femoral gunshot fracture in a dog

A three-year-old beagle was presented with a hindlimb lameness following a gunshot wound. Radiographs revealed a grade II open, femoral fracture with severe comminution. Repair was made with an intercalary composite graft stabilised by a double hook plate.     

Collateral ligament reconstruction in two horses following traumatic avulsion fracture using a knotless suture anchor construct

This case report describes a technique for repair of medial collateral ligament avulsions in two horses. Both horses sustained traumatic injuries resulting in avulsion fractures at the origin of their medial tarsal and carpal collateral ligaments. This report describes the use of a knotless suture anchor to mechanically reconstruct medial collateral ligament avulsion injuries in two horses. The first horse, a 9‐year‐old Hannovarian Warmblood gelding presented for an acute nonweightbearing lameness in the right hindlimb. The injury was localised to the medial malleolus of the tibia and an avulsion fracture of the origin of the short medial collateral ligament of the tibiotarsal joint with disruption of the ligament was found on radiographs and ultrasound. The horse was taken to surgery and a reconstruction of the short medial collateral ligament was performed with a modified single row construct using a biocompatible, multistrand, long chain ultra‐high molecular weight polyethylene braided composite suture tape (2 mm Fibertape) and a single knotless suture anchor (5.5 × 19.1 mm PEEK SwivelLock C). The second horse, a 5‐year‐old Thoroughbred gelding presented for an acute nonweightbearing lameness in the left forelimb. The injury was localised to the medial styloid process of the radius and an avulsion fracture of the origin of the medial collateral ligament of the antebrachial carpal joint was found on radiographs and ultrasound. The horse was taken to surgery and a similar reconstruction procedure was performed to the collateral ligament. Both horses were recovered in a Robert Jones bandage without the use of casts or splints and recovered without incident. Both horses are sound and returned to previous level of athletic performance at 18 months and 8 months, respectively.     

Repeatability of subjective evaluation of lameness in horses

Reasons for performing study: Previous studies have suggested that agreement between equine veterinarians subjectively evaluating lameness in horses is low. These studies were limited to small numbers of horses, evaluating movement on the treadmill or to evaluating previously‐recorded videotape. Objectives: To estimate agreement between equine practitioners performing lameness evaluations in horses in the live, over ground setting. Methods: 131 mature horses were evaluated for lameness by 2–5 clinicians (mean 3.2) with a weighted‐average of 18.7 years of experience. Clinicians graded each limb using the AAEP lameness scale by first watching the horse trot in a straight line only and then after full lameness evaluation. Agreement was estimated by calculation of Fleiss' (κ). Evaluators agreed if they picked the same limb as lame or not lame regardless of the severity of perceived lameness. Results: After only evaluating the horse trot in a straight line clinicians agreed whether a limb was lame or not 76.6% of the time (κ= 0.44). After full lameness evaluation clinicians agreed whether a limb was lame or not 72.9% of the time (κ= 0.45). Agreement on forelimb lameness was slightly higher than on hindlimb lameness. When the mean AAEP lameness score was >1.5 clinicians agreed whether or not a limb was lame 93.1% of the time (κ= 0.86), but when the mean score was ≤1.5 they agreed 61.9% (κ= 0.23) of the time. When given the task of picking whether or not the horse was lame and picking the worst limb after full lameness evaluation, clinicians agreed 51.6% (κ= 0.37) of the time. Conclusions: For horses with mild lameness subjective evaluation of lameness is not very reliable. Potential relevance: A search for and the development of more objective and reliable methods of lameness evaluation is justified and should be encouraged and supported.     

A large cyst in the distal femur of a horse

A 10-year-old Warmblood gelding presented with a left hindlimb lameness. Diagnostic analgesia located the lameness to the stifle. Radiography showed an unusually large cyst in the distal femur. Diagnostic arthroscopy of the stifle did not reveal any significant abnormalities. An extra-articular transcortical approach to the cyst was performed for drainage, curettage, and provision of an autologous, cancellous bone graft, gentamicin-impregnated collagen fleeces and injectable steroid. The horse returned to a higher level of competitive dressage than prior to surgery. This report describes a large cyst in the distal femur of a horse.     

Evaluation of discriminant analysis based on dorsoventral symmetry indices to quantify hindlimb lameness during over ground locomotion in the horse

Reasons for performing study: Advances in gait analysis techniques have led to assessment tools that can aid in detecting and quantifying lameness; here, bilateral tuberà coxae and pelvic movement during over ground locomotion are compared in order to investigate a practical method to assess hindlimb lameness in the horse. Objectives: To evaluate which parameters from anatomical landmarks on trunk and proximal hindlimbs are the best indicators of degree and side of hindlimb lameness. Methods: Fifteen horses (age 11–23 years, 6 nonlame and 9 unilaterally hindlimb lame horses 1/10 to 2/10 lame) were fitted with 4 inertial sensors: tuber sacrale, left and right tubera coxae and withers; 889 strides were collected from 6 trot trials per horse. Horses were assessed for lameness by a qualified equine orthopaedic surgeon from videos. Vertical displacement data for each sensor were used to calculate symmetry indices as well as published Fourier analysis based parameters. Linear discriminant analysis was used to determine the most discriminative parameters for 2 scenarios: grading of severity of lameness and identification of the affected limb. Results: Pelvic energy ratio gave the best indication for the degree of lameness. Directional symmetry index of the tubera coxae sensors yielded the highest discriminative power for identification of the lame limb. Conclusions and potential relevance: A good indication of the degree of hindlimb lameness can be obtained from vertical displacement data of the pelvic midline, collected from inertial sensors during over ground locomotion. The trunk mounted inertial sensor system allows for a time efficient collection of a representative database from horses with differing grade and site of lameness in a clinical setting. This is crucial for future work on a robust definition of the best parameters for lameness classification under practical conditions.