Model formulation and determination of in vitro parameters of a noninvasive method to calculate flexor tendon forces in the equine forelimb

OBJECTIVE: To describe a method to calculate flexor tendon forces on the basis of inverse dynamic analysis and an in vitro model of the equine forelimb and to quantify parameters for the model. SAMPLE POPULATION: 38 forelimbs of 23 horses that each had an estimated body mass of > or = 500 kg. PROCEDURE: Longitudinal limb sections were used to determine the lines of action of the tendons. Additionally, limb and tendon loading experiments were performed to determine mechanical properties of the flexor tendons. RESULTS: The study quantified the parameters for a pulley model to describe the lines of action. Furthermore, relationships between force and strain of the flexor tendons and between fetlock joint angle and suspensory ligament strain were determined, and the ultimate strength of the tendons was measured. CONCLUSION AND CLINICAL RELEVANCE: The model enables noninvasive determination of forces in the suspensory ligament, superficial digital flexor tendon, and distal part of the deep digital flexor (DDF) tendon. In addition, it provides a noninvasive measure of loading of the accessory ligament of the DDF tendon for within-subject comparisons. However, before application, the method should be validated. The model could become an important tool for use in research of the cause, prevention, and treatment of tendon injuries in horses.     

Sensitivity analysis and application to trotting of a noninvasive method to calculate flexor tendon forces in the equine forelimb

OBJECTIVE: To test the sensitivity to measurement and modeling errors of a method for noninvasive calculation of flexor tendon forces in the equine forelimb and to calculate tendon forces for Dutch Warmblood horses during trotting. SAMPLE POPULATION: A normative set of kinematic and ground-reaction force (GRF) data obtained from horses during trotting in another study. PROCEDURE: Forces in the flexor tendons were calculated from the data set before and after addition of fixed relative and absolute errors. Amount of error was based on normal accuracy of the variables. A similar analysis was performed for a measure of strain of the accessory ligament of the deep digital flexor tendon. RESULTS: The only errors that had a substantial influence on accuracy were modeling errors in the mechanical properties of the suspensory ligament and measurement errors in the point of application of the GRF and position of the marker on the distal interphalangeal joint. Influence of the measurement errors could be minimized by applying usual correction methods. CONCLUSIONS AND CLINICAL RELEVANCE: After correction of measurement errors, the method can be used to calculate mean tendon forces for a group of horses and to evaluate the influence of factors such as surface properties, type of shoe, speed, and fatigue on tendon forces. The method could become an important tool for use in research on the cause, prevention, and treatment of tendon injuries in horses.     

Kinetics and kinematics of the equine hind limb: in vivo tendon loads and force plate measurements in ponies

Loads on the suspensory ligament, deep digital flexor tendon, superficial digital flexor tendon, and long digital extensor tendon of the equine hind limb were determined in ponies by use of implanted strain gauges consisting of silicone rubber tubes filled with mercury. Recordings were made simultaneously with force plate measurements and high-speed film recordings while the ponies were walking. The relationship between strain gauge signals and tendon loads was obtained from tension-strain tests performed after death of the ponies. The suspensory ligament and the 2 digital flexor tendons were loaded during the stance phase, and the extensor tendon was loaded mainly during the swing phase. The loading pattern of the suspensory ligament, with peak loads of 4.6 N/kg of body weight, correlated well with the vertical component of the ground reaction force. Maximal loading of the deep digital flexor tendon was observed during the second half of the stance phase, with peak values of 6.7 N/kg. The superficial digital flexor tendon was loaded maximally at the beginning of the stance phase, with a peak load of 4.1 N/kg, and the long digital extensor tendon was loaded maximally during the swing phase, with a peak load of 0.3 N/kg. Recordings made from this procedure for calibration of the strain gauge signals to tendon load and tendon strain, in combination with the force plate measurements, enabled verification of the results by torque analysis of the lower portion of the hind limb, using the vector of the ground reaction force, limb conformation, and limb geometric configuration. Torque analysis of the lower extremity indicated that the determined tendon loads were in agreement with the recorded ground reaction forces.     

Development and evaluation of a noninvasive marker cluster technique to assess three-dimensional kinematics of the distal portion of the forelimb in horses

OBJECTIVE: To develop and evaluate a marker cluster set for measuring sagittal and extrasagittal movement of joints in the distal portion of the forelimb in ponies. ANIMALS: 4 ponies. PROCEDURES: 5 infrared cameras were positioned on a concrete walkway in a frontal-sagittal arc and calibrated. Four segments were defined: hoof, middle phalanx, proximal phalanx, and metacarpus. Rigid clusters with 4 retroreflective markers were placed on each segment. A static trial was recorded with additional anatomic markers on the medial and lateral joint lines. Those anatomic markers were removed, and kinematic data were recorded at 240 Hz during walking. An ensemble mean was computed from the 4 ponies from 5 replicates of the walks. Joint kinematic variables were calculated by use of the calibrated anatomical system technique. The design and error dispersion of each marker were evaluated. RESULTS: Marker clusters were quasiplanar, but variation in orientation error was reduced because the mean radii were > 10 times the largest error dispersion values. Measurements of sagittal rotations of the distal interphalangeal, proximal interphalangeal, and metacarpophalangeal joints were similar to measurements obtained with bone-fixed triads, but larger discrepancies between the 2 methods were found for extrasagittal rotations. CONCLUSIONS AND CLINICAL RELEVANCE: Development of noninvasive methods for quantifying data pertaining to 3-dimensional motion in horses is important for advancement of clinical analysis. The technique used in the study enabled identification of flexion-extension motions with an acceptable degree of accuracy. Appropriate correction algorithms and improvements to the technique may enable future quantification of extrasagittal motions.     

Three-dimensional kinematics of the equine distal forelimb: effects of a sharp turn at the walk

REASONS FOR PERFORMING STUDY: Sharp turns are suspected to increase expression of several distal forelimb lamenesses even at the walk but the biomechanical consequences of such a movement remain unknown. OBJECTIVE: To quantify the effects of a sharp turn at the walk on the 3-dimensional movements of the distal segments of the forelimb. METHODS: Kinematics of the distal segments were measured in 4 healthy horses invasively with an ultrasonic system. Three-dimensional rotations of the digital joints were calculated by use of a joint coordinate system. Data obtained for a turn at the walk were compared to those obtained in a straight line. RESULTS: During the stance phase in a turn, the inside forelimb underwent an adduction that induced lateromotion and medial rotation in the distal interphalangeal joint and medial rotation in the proximal interphalangeal joint. These movements were maximal at heel-off and decreased during breakover as the hoof underwent a sudden lateral rotation. CONCLUSIONS: Walking in a sharp turn affects the kinematics of the digital joints outside the sagittal plane. POTENTIAL RELEVANCE: This knowledge offers the opportunity to derive hypotheses on biomechanical factors that could contribute to the pathogenesis of digital injuries and on consequences for rational shoeing.     

An in vivo equine forelimb model for short-term recording of peak isometric force in the superficial and deep digital flexor muscles

OBJECTIVE: To develop and test an experimental model for in vivo short-term recording of peak isometric forces of the digital flexor muscles in the forelimb of adult horses. STUDY DESIGN: In vivo experimental study. SAMPLE POPULATION: Four healthy, anesthetized, adult Thoroughbred horses (3 to 7 years old; 527 +/- 87 kg) METHODS: In dorsal recumbency, ulnar and median nerves were exposed and instrumented with insulated bipolar cuff stimulation electrodes for later connection to an electrical stimulator. In left lateral recumbency, a biplanar fixator was applied to the right humerus and a custom-made, rigid, aluminum frame connected to it, to allow loading of muscles distal to the fixator. Threaded transfixation pins through the radial and metacarpal condyles were clamped to the rigid frame so that the humerus, radius, ulna, and metacarpus were fixed in position. Each digital flexor muscle insertion tendon was transected just above the metacarpophalangeal joint, extracted from the carpal canal, and secured in a metal clamp positioned at the distal myotendinous (MT) junction. Distally, the clamp was connected in series to a load cell and a pneumatic actuator to record force and to maintain muscle length during nerve stimulation. A linear potentiometer was connected in parallel to the actuator to record MT junction position. Initial trials were conducted to identify median and ulnar nerve stimulation variables to achieve maximal muscle contraction. Isometric contractions were performed at different muscle lengths and peak forces registered during 3 seconds of supramaximal dual (ulnar and median) nerve stimulation. RESULTS: A stimulation voltage of 2.5 to 5.0 V at 50 Hz usually produced maximal force for both the superficial digital flexor (SDF) and deep digital flexor (DDF) muscles. Single ulnar and median nerve stimulation elicited force development not only in the DDF muscle but also in the SDF muscle. At voltages higher than 1 V, normalized force was greatest with combined median and ulnar nerve stimulation for both the DDF and SDF muscles; however, normalized force was greater for median nerve stimulation than ulnar nerve stimulation in the DDF muscle, and the opposite relationship was observed for the SDF muscle. Final recording of dual supramaximal nerve stimulation of SDF and DDF muscles resulted in peak isometric forces of 716 +/- 192 N and 1,577 +/- 203 N, respectively. CONCLUSIONS: The instrumentation technique and experimental protocol enabled recording of peak isometric forces in the SDF and DDF muscles of anesthetized adult horses. CLINICAL RELEVANCE: Studies using this model will improve knowledge of SDF and DDF muscle mechanics with insight to functional implications of the complex architecture of these muscles. Knowledge of the dynamic performance of the SDF and DDF muscles would also be useful for the development of new treatment strategies for flexor deformities and tendon injuries in horses.     

Myofibroblasts in the accessory ligament (distal check ligament) and the deep digital flexor tendon of foals

OBJECTIVE: To demonstrate myofibroblasts in the accessory ligament of the deep digital flexor tendon (ie, distal check ligament) and deep digital flexor tendon of clinically normal foals. SAMPLE POPULATION: Tissue specimens from 25 foals that were necropsied for reasons unrelated to this study and unrelated to musculoskeletal disease. PROCEDURE: The distal check ligament and deep digital flexor tendon of both forelimbs were examined histologically. Myofibroblasts were identified by immunohistochemical staining specific for alpha-smooth muscle actin (alpha-SMA). RESULTS: Most of the cells in the distal check ligament and deep digital flexor tendon of all foals stained positive for alpha-SMA. CONCLUSION AND CLINICAL RELEVANCE: Myofibroblasts made up most of the cells in the distal check ligament and deep digital flexor tendon of clinically normal foals. These cells have contractile ability and therefore, may play a role in flexure contracture of these tendons. The ability of tetracycline to chelate calcium or decrease the expression of the contractile protein alpha-smooth muscle actin could inhibit the myofibroblasts' ability to contract, thus providing a rationale for tetracycline administration as a treatment of distal interphalangeal joint flexor deformity in foals.     

Review of the application and efficacy of extracorporeal shockwave therapy in equine tendon and ligament injuries

Extracorporeal shockwave therapy (ESWT) has been implemented as a treatment for musculoskeletal injuries in horses. ESWT uses acoustic waves applied to a region of injury, and has been shown to improve lameness, decrease time of healing and improve ultrasonographic appearance of tendon and ligament injuries. However, much of the current literature surrounding the use of ESWT in veterinary medicine is positively biased and most studies have lower levels of evidence-based experimental design. Randomised clinical trials are needed to determine specific energy settings, dose, frequency and case selection for different anatomical regions, and to investigate long-term effects of ESWT as well as interactions between ESWT and regenerative biological therapies.     

Desmotomy of the accessory ligament of the deep digital flexor tendon in the forelimb of 24 horses 2 years and older

Objective: To report outcome after desmotomy of the accessory ligament of the deep digital flexor tendon (ALDDFT) in adult horses (≥2 years) for treatment of desmitis of the ALDDFT or flexural deformity of the distal interphalangeal joint (FDDIJ). Study Design: Case series. Animals: Horses with desmitis of the ALDDFT (n=9) and FDDIJ (n=15). Methods: Records (April 1996–July 2008) of 24 adult horses (mean age, 6.7 years) that had ALDDFT desmotomy were reviewed. Follow‐up data was obtained 12–120 months after desmotomy. Results: Outcome was available for 22 horses; 18 (82%; 6 of 8 horses with desmitis of the ALDDFT and 12 of 14 with FDDIJ) returned to their intended use within 6–24 months (mean, 12 months). Conclusion: In mature horses, ALDDFT desmotomy resulted in successful return to intended use in most horses with ALDDFT desmitis (75%) or FDDIJ (86%).     

The propagation of induced tendon lesions in the equine superficial digital flexor tendon: An ex vivo study

Reasons for performing study: Clinical tendon lesions usually enlarge during the first days to weeks after sustaining the injury due to enzymatic and biomechanical influences. Limiting this enlargement would positively influence prognosis related to lesion size. Objectives: To investigate the effect of cyclic loading on the propagation of enzymatically and physically induced tendon lesions and to assess the effect of immobilisation thereon in an ex vivo model. Methods: Equine cadaver limbs with either physically or collagenase‐induced SDFT lesions were placed in a pneumatic loading device. Groups consisted of unloaded limbs, cyclically loaded limbs and cyclically loaded limbs with fibreglass cast immobilisation. Lesion size was evaluated ultrasonographically and macroscopically and load at failure was determined for groups where lesions enlarged. Results: Physically induced lesions did not propagate after cyclical loading and were not further investigated. Collagenase‐induced lesions propagated significantly more after cyclical loading compared to unloaded limbs. This propagation could effectively be reduced by immobilisation through a lower limb cast. Immobilisation did not influence load at failure. Conclusions: The combination of enzymatic and mechanical stimulation caused the lesions to propagate most. Casting appeared effectively to reduce the enlargement of the original tendon lesions in this ex vivo model, while it did not affect ultimate tendon strength. Potential relevance: As prognosis of tendon injuries is related to lesion size, the outcome of this study warrants further investigations in vivo.     

Unusual muscle and tendon disorders of the forelimb in the dog

Five dogs with unusual muscle and tendon disorders of the forelimb are described. In one dog, mineralisation of the tendon of insertion of the supraspinatus muscle was treated surgically but lameness returned following the resumption of exercise. Of two cases of avulsion of the origin of the extensor carpi radialis muscle, one was successfully managed conservatively while the other needed surgical intervention to resolve the lameness. A single case of chronic avulsion/rupture of the tendon of insertion of the extensor carpi radialis muscle was successfully managed conservatively while a case of medial displacement of the biceps brachii tendon was surgically corrected by repair of the transverse humeral ligament. The aetiology, diagnosis and management of the above conditions is discussed.     

Kinetics and kinematics of the equine hind limb: in vivo tendon strain and joint kinematics

Strains of the suspensory ligament and deep digital flexor, superficial digital flexor, and long digital extensor tendons in the equine (pony) hind limb were recorded in vivo, using implanted strain gauges consisting of silicone rubber tubes filled with mercury. The relationship between strain gauge signals and tendon strains was obtained from tension-strain tests performed on isolated tendons after death of the ponies. During normal walking, maximal tendon strain (elongation over initial length, relative to the length of the structures at first ground contact) was 3.1% in the suspensory ligament and 3.4%, 2.3%, and 0.3% in the deep digital flexor, the superficial digital flexor, and the long digital extensor tendons, respectively. Changes (that occurred during walking) in the distance from origin to insertion of these musculotendinous structures were computed from limb geometric configuration and limb conformation. Maximal increase in origin to insertion length was 3.1% in the suspensory ligament and 2%, 1.6%, and 1.5% in the deep digital flexor, superficial digital flexor, and long digital extensor musculotendinous structures, respectively. The differences in strain, comparing the entire musculotendinous structure and its tendon, were explained by muscular contraction or relaxation.     

Effects of 6 degree elevation of the heels on 3D kinematics of the distal portion of the forelimb in the walking horse

REASONS FOR PERFORMING STUDY: Understanding of the biomechanical effects of heel elevation remains incomplete because in vivo studies performed with skin markers do not measure the actual movements of the 3 digital joints. OBJECTIVE: To quantify the effects of 6 degree heel wedge on the 3-dimensional movements of the 4 distal segments of the forelimb in the walking horse. METHODS: Four healthy horses were used. Kinematics of the distal segments was measured invasively with a system based on ultrasonic triangulation. Three-dimensional rotations of the digital joints were calculated by use of a 'joint coordinate system' (JCS). Data obtained with heel wedges were compared to those obtained with standard shoes during the stance phase of the stride. RESULTS: Heel wedges significantly increased maximal flexion of the proximal (PIPJ) and distal (DIPJ) interphalangeal joints and maximal extension (mean +/- s.d. +0.8 +/- 0.3 degrees) of the metacarpophalangeal joint (MPJ). Extension of the PIPJ and DIPJ was decreased at heel-off. Few effects were observed in extrasagittal planes of movement. CONCLUSIONS: Heel wedges affect the sagittal plane kinematics of the 3 digital joints. POTENTIAL RELEVANCE: Controversial effects previously observed on the MPJ may be explained by the substantial involvement of the PIPJ, which was wrongly neglected in previous studies performed on the moving horse.     

Development of a technique for continuous perineural blockade of the palmar nerves in the distal equine thoracic limb

Objective To develop a technique for placing continuous peripheral nerve block (CPNB) catheters adjacent to palmar nerves in horses and to evaluate the effect of low‐volume local anesthetic (LA) infusion on nociception in the distal equine thoracic limb. Study design In vitro and in vivo laboratory investigation. Study material and animals Forty‐two thoracic limbs from 22 equine cadavers and five horses. Methods Thoracic limb specimens were dissected to find landmarks for catheter insertion adjacent to medial and lateral palmar nerves. Based on the anatomy of the proximal metacarpus, a technique for placing palmar CPNB catheters was developed and the potential for catheter dislodgement studied in vitro by fluoroscopic visualization during passive carpal flexion and dye injection following simulated limb motion. The feasibility of CPNB catheter instrumentation in standing, sedated horses was tested in five animals, with ultrasound control. Electrical and mechanical stimulation thresholds and response latencies for hoof withdrawal responses (HWR) were determined following saline or LA infusion. Results Medial and lateral CPNB catheters were inserted percutaneously 2 and 4–5 cm, respectively, distal to the accessory carpal bone and advanced for ～7 and 10 cm, respectively, to place the tip just proximal to the communicating branch of the nerves. Catheters were placed correctly in 88% and 85% of cadaver limbs. In the standing horses, LA infusion not only increased HWR thresholds and latencies to noxious mechanical or electrical stimulation but also caused vasodilation and limb swelling over time. Conclusion The technique, developed in vitro, for placing and maintaining palmar CPNB catheters in the equine thoracic limb was successfully applied in vivo. Catheters were well tolerated but LA infusion may cause limb swelling, suggesting a need for further exploration of drug and infusion regimens. Clinical relevance Continuous perineural LA infusion along palmar nerves may develop into an effective analgesic technique in horses suffering from lower limb pain.     

Molecular characterization of the equine herpesvirus 1 strains RacL11 and Kentucky D

The pathogenicities of RacL11 and Kentucky D strains of equine herpesvirus 1 in the hamster infection model are different from those of Ab4p and the Japanese isolates. Virus genome restriction fragment length polymorphism analysis and sequence comparison of an intergenic region, glycoproteins and tegument genes showed higher conservation but with some strain-specific differences. These results indicate that point nucleotide differences in RacL11 and Kentucky D might be responsible for their pathogenicity in rodent models.     

Microanatomic characteristics of the insertion of the distal sesamoidean impar ligament and deep digital flexor tendon on the distal phalanx in healthy feet obtained from horses

OBJECTIVE: To describe microanatomic characteristics of the insertion of the aistal sesamoidean impar ligament (DSIL) and deep digital flexor tendon (DDFT) on the distal phalanx in horses. SAMPLE POPULATION: Healthy feet obtained from 62 horses of various breeds. PROCEDURE: Feet from 23 horses were used to histologically examine the insertion of the DSIL and DDFT (n = 7), its vasculature (10), and neural elements (6). In 39 other horses, the insertion zone was examined for proteoglycan. RESULTS: The insertion of the DSIL and dorsal half of the DDFT contained bundles of collagen fibers with intervening loose connective tissue septa with arteriovenous complexes (AVC) and nerve fibers. Microscopic examination revealed adaptive changes in the insertion with regard to proteoglycan content. In young adult horses, little or no staining for proteoglycans was evident, whereas in middle-aged horses, moderate proteoglycan staining was seen. Six older horses had slight proteoglycan staining at the insertion. CONCLUSIONS AND CLINICAL RELEVANCE: The study revealed that this region contained a rich neurovascular complex between the collagen bundles. A gradual increase in production of proteoglycan, evident at the insertion of the DSIL and DDFT on the distal phalanx, indicates that adaptive responses to stress rather than age alone may be the primary determining factor. These observations indicate that this insertion site may be susceptible to stress during stance and impact loading, because this region appears to be strategically situated to regulate important neurovascular functions of the foot.