Net joint moments and joint powers in horses with superficial digital flexor tendinitis

OBJECTIVE: To determine whether analysis of net joint moments and joint powers is a suitable technique for evaluation of mechanics and energetics of lameness in horses and to measure effects of superficial digital flexor tendinitis. ANIMALS: 6 sound horses. PROCEDURE: Horses were evaluated before (sound evaluation) and after (lame evaluation) induction of superficial digital flexor tendinitis in 1 forelimb by injection of collagenase. Recordings were made with an optoelectronic system and a force plate as horses trotted. Net joint moments and joint powers in the sagittal plane at each joint in the forelimbs during the stance phase were determined. Peak values were determined, and mechanical energy absorbed and generated at each joint was calculated. Comparisons were made between contralateral limbs during sound and lame evaluations. RESULTS: Lame limbs had significant reductions in peak values for net joint moments on the palmar aspect of metacarpophalangeal (fetlock), carpal, and humeroulnar joints. Total energy absorbed was significantly lower at every joint in lame limbs, compared with compensating limbs. CONCLUSIONS AND CLINICAL RELEVANCE: Horses with superficial digital flexor tendinitis had significant differences between lame and compensating limbs for net joint moments and joint powers at all joints, indicating that the gait of horses with superficial digital flexor tendinitis is energetically inefficient. Assessment of net joint moments and joint powers is a useful tool in evaluating equine lameness.     

Calculated forelimb flexor tendon forces in horses with experimentally induced superficial digital flexor tendinitis and the effects of application of heel wedges

OBJECTIVE: To calculate forces in the flexor tendons and the influence of heel wedges in affected and contralateral (compensating) forelimbs of horses with experimentally induced unilateral tendinitis of the superficial digital flexor (SDF) tendon. ANIMALS: 5 Warmblood horses. Procedure-Ground reaction force and kinematic data were obtained during a previous study while horses were trotting before and after induction of tendinitis in 1 forelimb SDF and after application of 6 degrees heel wedges to both forehooves. Forces in the SDF, deep digital flexor (DDF), and the suspensory ligament (SL) and strain in the accessory ligament (AL) of the DDF were calculated, using an in vitro model of the distal region of the forelimb. RESULTS: After induction of tendinitis, trotting speed slowed, and forces decreased in most tendons. In the affected limb, SL force decreased more than SDF and DDF forces. In the compensating limb, SDF force increased, and the other forces decreased. After application of heel wedges, SDF force in both limbs increased but not significantly. Furthermore, there was a decrease in DDF force and AL strain. CONCLUSIONS AND CLINICAL RELEVANCE: The increase in SDF force in the compensating forelimb of horses with unilateral SDF tendinitis may explain the high secondary injury rate in this tendon. The lack of decrease of SDF force in either limb after application of heel wedges suggests that heel wedges are not beneficial in horses with SDF tendinitis. Instead, heel wedges may exacerbate the existing lesion.     

Effect of sodium hyaluronate in collagenase-induced superficial digital flexor tendinitis in horses.

Superficial digital flexor tendinitis was induced in each forelimb of 8 horses by injecting 4,000 U of collagenase into the midmetacarpal region of the tendon. In each horse, each tendon was treated 24 and 96 hours after the collagenase injection with SC injections of sodium hyaluronate (treated limbs) or an equal volume of 0.9% NaCl solution (control limbs). Exercise was restricted for the first 3 weeks of the study, and a controlled exercise program was instituted for the remainder of the study. Horses were evaluated clinically for lameness, tendon swelling, and midmetacarpal limb circumference. Ultrasonographic examinations were performed regularly (11 examinations/horse) throughout the study, and all horses were euthanatized 12 weeks after collagenase injections. Tendons from 4 horses were harvested for biomechanical testing, and samples were obtained from tendons from the remaining 4 horses for biochemical analysis of collagen. Samples were obtained from all tendons for microscopic evaluation. Significant differences between treated and control tendons were not noticed in any of the variables examined in live horses, although trends toward less lameness in treated limbs and toward better healing on ultrasonographic examination in control limbs were recorded. Significant differences were not noticed in biomechanical or biochemical evaluations, and the only significant (P < 0.05) microscopic finding was more severe inflammation in tendons from treated limbs. This study did not reveal significant benefits of treatment with sodium hyaluronate outside a synovial sheath on tendon repair in collagenase-induced tendinitis.     

The hindlimb in walking horses: 1. Kinematics and ground reaction forces

The objective was to study associations between kinematics and ground reaction forces in the hindlimb of walking horses. Video (60 Hz) and force (2000 Hz) data were gathered for 8 strides from each of 5 sound horses during the walk. Sagittal plane kinematics were measured concurrently with the vertical and longitudinal ground reaction forces. The hindlimb showed rapid loading and braking in the initial 10% stride. The stifle, tarsal and coffin joints flexed and the fetlock joint extended during this period of rapid loading. The vertical ground reaction force showed 2 peaks separated by a dip; this pattern was similar to the fetlock joint angle-time graph. Peaks in the longitudinal ground reaction force did not appear to correspond with kinematic events. Total braking impulse was equal to total propulsive impulse over the entire stride. Flexion and extension of the hip were responsible for protraction and retraction of the entire limb. Maximal protraction occurred shortly before the end of swing and maximal retraction occurred during breakover. During the middle part of stance the tarsal joint extended slowly, while the stifle began to flex when the limb was retracted beyond the midstance position at 28% stride. Flexion cycles of the stifle and tarsal joints were well coordinated during the swing phase to raise the distal limb as it was protracted. The results demonstrate a relationship between limb kinematics and vertical limb loading in the hindlimbs of sound horses. Future studies will elucidate the alterations in response to lameness.     

The forelimb in walking horses: 1. Kinematics and ground reaction forces

Video (60 Hz) and force (2000 Hz) data were collected from 5 sound horses during walking. Forelimb data were analysed for 8 strides (4 left, 4 right) per horse to determine sagittal plane kinematics and ground reaction forces (GRFs). The results suggested that brachial rotation was responsible for protraction and retraction of the limb as a whole, while rotations of the scapula and antebrachium elevated the distal limb during breakover and early swing then lowered it in preparation for ground contact. The coffin joint was flexed maximally at the time of peak longitudinal braking force, which occurred during breakover of the contralateral forelimb. The metacarpus was vertical at 28% stride. This was considerably earlier than the change from a braking to a propulsive longitudinal force (34% stride), which coincided with maximal extension of the fetlock joint. The longitudinal propulsive force peaked just after contact of the contralateral forelimb. During the swing phase the joints distal to the shoulder showed a single flexion cycle that peaked at 76% stride at the carpus, 81% stride at the fetlock and 84% stride at the elbow and coffin joints. The coffin and shoulder joints began to extend in the terminal swing phase and continued to extend through ground contact and early stance. The results provide normative data that will be applied in detecting changes in kinematics and ground reaction forces that are associated with specific lamenesses.     

Instrumented treadmill for measuring vertical ground reaction forces in horses

OBJECTIVE: To develop and validate a novel instrumented treadmill capable of determining vertical ground reaction forces of all 4 limbs simultaneously in horses. SAMPLE POPULATION: Data obtained while a horse was walking and trotting on the treadmill. PROCEDURE: 18 piezo-electric force transducers were mounted between the treadmill frame and supporting steel platform to measure the actual forces at the corresponding bearing points. Each of the 18 sensor forces is equal to the sum of the unknown hoof forces weighted with the transfer coefficients of the corresponding force application points. The 4 force traces were calculated, solving at each time point the resulting equation system, using the Gaussian least-squares method. System validation comprised the following tests: determination of the survey accuracy of the positioning system, determination of the natural frequencies of the system, linearity test of the force transfer to the individual sensors, determination of superimposed forces with the treadmill-integrated force measuring system (TiF) in a static configuration, and comparison of vertical ground reaction forces determined simultaneously by use of TiF and force shoes mounted on the forelimbs of a horse. RESULTS: Comparison between static test loads and TiF-calculated forces revealed deviations of < 1.4%. Force traces of TiF-calculated values and those recorded by use of the force shoes were highly correlated (r > or = 0.998). CONCLUSIONS AND CLINICAL RELEVANCE: This instrumented treadmill allows a reliable assessment of load distribution and interlimb coordination in a short period and, therefore, is suitable for use in experimental and clinical investigations.     

Injuries of the calcaneal insertions of the superficial digital flexor tendon in 19 horses

Reasons for performing study: Injuries of the calcaneal insertions of the superficial digital flexor tendon and their relationship to displacement of the tendon from the calcaneus have not previously been reported. Objectives: To describe findings made on clinical cases with disruption of the calcaneal insertions of the superficial digital flexor tendon (SDFT) including observations on their role in horses with unstable subluxation of the tendon. To describe novel surgical techniques and the results of treatment. Hypotheses: Disruption of the calcaneal insertions of the SDFT is associated with lameness and distension of the calcaneal bursa. Unstable displacement of the SDFT from the calcaneus is a more complex injury than incomplete disruption of one of its calcaneal insertions. Methods: The case records and diagnostic images of horses with lesions involving the calcaneal insertions of the SDFT, which were confirmed by endoscopic evaluation of calcaneal bursa between 2005 and 2009, were reviewed. Results: Nineteen horses were identified including 7 that had unstable displacement of the tendon from the calcaneus. Following endoscopic surgery, 9 of 12 horses with stable tendons and 6 of 7 horses with unstable displaced SDFTs returned to work. Conclusion: Tearing of the calcaneal insertions of the SDFT is associated with lameness and distension of the calcaneal bursa; endoscopic removal of the torn tissue carries a good prognosis. Horses with unstable displacement of the tendon have also disruption of the tendon fibrocartilage cap. Removal of this results in stable subluxation and can return horses to athletic activity. Both lesions can be detected by preoperative ultrasonography. Potential relevance: Tearing of the calcaneal insertions of the SDFT should be included in the differential diagnoses of lame horses with distended calcaneal bursae. Tearing of the tendon fibrocartilage cap in horses with unstable displacement of the SDFT is a plausible explanation of the clinical features of the injury and explains previously unreliable results of reconstructive surgeries. Subtotal resection is a technically demanding technique but appears to offer an improved prognosis.     

Tendonitis of the branches of insertion of the superficial digital flexor tendon in horses

Objective To describe clinical findings, ultrasonographic features and outcome of injury to the branches of insertion of the superficial digital flexor (SDF) tendon in horses.
Design Retrospective study of 14 cases.
Procedure Fourteen Thoroughbred horses with tendonitis affecting the branches of insertion of the SDF tendon were examined for lameness, location and amount of swelling, and the presence of other musculoskeletal abnormalities. The flexor tendons were assessed by ultrasonographic examination, and recommendations were made for management of the cases. Outcome was assessed by re-examination of some horses, direct communication with the owner or trainer, and examination of race records.
Results The lateral SDF branch was affected in 10 horses; the medial branch in three, and both branches in one horse. Two horses had concurrent injuries to the SDF tendon in the metacarpal region of the contralateral limb. Ultrasonographic findings included swelling of the affected SDF branch, peritendinous fluid accumulation, disruption of normal fibre alignment on sagittal scan, and variable loss of echogenicity. As healing occurred, there was return of normal echogenicity, but normal fibre alignment did not return completely and apparent adhesions formed between the affected SDF branch and adjacent structures. Seven of 10 horses which returned to their previous use were able to compete without further tendon injury. Recurrence of injury occurred in one case, and another two horses developed tendonitis in the metacarpal region. One horse was retired from racing but was able to compete at dressage without recurrence of injury. Two horses were retired for breeding without returning to training, and one horse was sold and lost to follow up but did not race.
Conclusion The prognosis is fair for return to previous use following injury to the branches of insertion of the SDF tendon in athletic horses.     

Active expression of matrix metalloproteinase-13 mRNA in the granulation tissue of equine superficial digital flexor tendinitis

The DNA microarray analysis for matrix metalloproteinase (MMP)-related mRNA expression in equine superficial digital flexor tendinitis indicated that mRNA level of MMP-13 was apparently up-regulated in the tendinitis as compared to normal tendon. In situ hybridization also revealed that fibroblastic cells proliferated in the granulation tissue generated in the tendinitis actively expressed MMP-13 mRNA. On the other hand, in normal tendon, a few fibroblastic cells and vascular components lied in the endotenon barely expressed its mRNA, but other cellular components in the tendon bundle were not positively hybridized. As mentioned above, MMP-13 but not other collagenases or gelatinases, may play an important role in tendon injuries in the racehorses.     

Superior check ligament desmotomy for treatment of superficial digital flexor tendonitis in Thoroughbred and Standardbred horses

Summary Bilateral superior check ligament desmotomy was performed on 31 Thoroughbred and 17 Standardbred horses as the sole method of treatment for superficial digital flexor tendonitis. Horses resumed racing between 6 and 19 months after surgery. Horses that were able to compete in 5 or more races without injury to the tendon again were considered to have had a successful return to racing. Twenty-five Thoroughbreds were suitable for later study and 13 of these (52%) raced on 5 or more occasions. Fifteen Standardbreds were suitable for later study and 10 of these (66%) raced on 5 or more occasions. Within the racing industry it is generally thought that about 20 to 30% of horses with superficial digital flexor tendonitis can return to racing after a prolonged rest. The results of this study suggest that bilateral superior check ligament desmotomy may improve the prognosis for a horse returning to racing after injury to the superficial digital flexor tendon.     

Lateral luxation of the superficial digital flexor tendon from the calcaneal tuber in two horses

Lateral luxation of the superficial digital flexor tendon from the calcaneal tuber occurs in horses as a result of tearing or rupture of the medial retinaculum of the tendon. This report describes the repair of this condition in 2 Thoroughbred race horses, using a surgical technique in which 2 cancellous bone screws were placed in the calcaneus lateral to the tendon, along with suturing the medial retinaculum.     

Ultrasonographic anatomy of the accessory ligament of the superficial digital flexor tendon in horses.

The ultrasonographic anatomy of the accessory ligament of the superficial digital flexor tendon (AL-SDFT) in the horse is presented. Comparison between anatomical sections of isolated limbs and ultrasound scans of the distal antebrachium in sound horses enabled the authors to establish the normal reference ultrasonographic images of this structure. The AL-SDFT inserts 7-14 cm above the antebrachiocarpal joint on the palmaromedial aspect of the radius. Ultrasonographically it appears as an uniformly echogenic structure located deep to the median artery. The knowledge of ultrasonographic anatomy is essential for identification of abnormal images and assessment of AL-SDFT damage.     

Tenectomy of the superficial digital flexor tendon as a treatment of suspected septic tendinitis and tenosynovitis of the digital flexor tendon sheath followed by rehabilitation with an orthotic device

A 15-year-old Sports horse gelding was referred for nonweightbearing lameness of the left hindlimb. Septic cellulitis was diagnosed and managed medically. After 14 days, septic tenosynovitis of the digital flexor tendon sheath (DFTS), with septic tendinitis of the superficial (SDFT) and deep (DDFT) digital flexor tendons, became evident. Surgical resection of the intrathecal portion of the septic SDFT was performed. Post-operatively, a half-limb cast was placed on the operated limb for 10 weeks followed by an articulated orthotic support boot during a rehabilitation period of 6 weeks. The horse recovered and regained long-term pasture soundness. Ultrasonography demonstrated the presence of bridging connective tissue in the location of the resected SDFT.     

Influence of electrode placement on effective field strength in the superficial digital flexor tendon of horses

OBJECTIVE: To determine the relationship between the output of an electrical treatment device and the effective field strength in the superficial digital flexor tendon of horses. SAMPLE POPULATION: Cadaver horse forelimbs without visible defects (n = 8) and 1 live pony. PROCEDURE: Microcurrents were generated by a microcurrent electrical therapy device and applied in proximodistal, dorsopalmar, and mediolateral directions in the entire forelimbs, dissected tendons, and the pony with various output settings. Corresponding field strengths in the tendons were measured. RESULTS: A linear relationship was detected between current and field strength in all conditions and in all 3 directions. In dissected tendons, significant differences were detected among all 3 directions, with highest field strength in the proximodistal direction and lowest in the dorsopalmar direction. In the entire forelimbs, field strength in the proximodistal direction was significantly lower than in the mediolateral direction. Results in the pony were similar to those in the entire forelimbs. CONCLUSIONS AND CLINICAL RELEVANCE: Electrode placement significantly affected field strength in the target tissue. Many surrounding structures caused considerable reduction of field strength in the target tissue. These factors should be taken into account when establishing protocols for electrical current-based therapeutic devices if these devices are proven clinically effective.     

Microdamage in the equine superficial digital flexor tendon

The forelimb superficial digital flexor tendon (SDFT) is an energy-storing tendon that is highly susceptible to injury during activities such as galloping and jumping, such that it is one of the most commonly reported causes of lameness in the performance horse. This review outlines the biomechanical and biothermal effects of strain on the SDFT and how these contribute to the accumulation of microdamage. The effect of age-related alterations on strain response and subsequent injury risk is also considered. Given that tendon is a slowly healing and poorly regenerative tissue, prompt detection of early stages of pathology in vivo and timely adaptations to training protocols are likely to have a greater outcome than advances in treatment. Early screening tools and detection protocols could subsequently be of benefit in identifying subclinical signs of degeneration during the training programme. This provides an opportunity for preventative strategies to be implemented to minimise incidences of SDFT injury and reduce recovery periods in elite performance horses. Therefore, this review will focus on the modalities available to implement early screening and prevention protocols as opposed to methods to diagnose and treat injuries.     

Age-related differences in collagen crimp patterns in the superficial digital flexor tendon core region of untrained horses

Objective To measure collagen fibril crimp angles and lengths as well as collagen fibril mass-average diameters in central and peripheral regions of the superficial digital flexor tendon of wild horses, to ascertain any age-related changes in either region in the absence of imposed galloping exercise.
Design Measurements from a random cull of wild horses.
Sample population Superficial digital flexor tendon samples were taken from 23 wild horses ranging in age from two to ten years.
Procedure Horses were divided into 'young' (< 5 years, n = 10), 'middle-aged' (5 to < 10 years, n = 9) and 'old' groups (10+ years, n = 4) and the mean crimp angle, mean crimp length and collagen fibril mass-average diameter calculated for the central region, and for the peripheral region of each group. Differences between groups and regions were analysed using two-tailed t tests.
Results The crimp angle for the central region was found to decrease with age, so that in old horses it was smaller than that for the tendon periphery (P < 0.05). The crimp angle for the latter region did not alter significantly with age. Crimp period lengths and collagen fibril mass-average diameters did not show significant changes with age in either region.
Conclusion Reduction of the crimp angle in the core of the superficial digital flexor tendon occurs normally with age, as tendons of older animals would have undergone a higher number of loading cycles. It is possible that athletic training increases the frequency and/or the magnitude of high loading cycles experienced by the tendon, and may accelerate and worsen the normal load-related ageing process in the superficial digital flexor tendons of young performance horses, particularly in the central regions where lesions usually occur.     

Control of the collagen fibril diameter in the equine superficial digital flexor tendon in horses by decorin

The distribution pattern of collagen fibril diameter in the equine superficial digital flexor tendon (SDFT) is known to differ in central and peripheral areas of some regions. This study reports the essence of collagen fibril differences among different regions of the equine SDFT by transmission electron microscopic (TEM) and high-voltage electron microscopic observations and biochemical analysis. The distribution of large collagen fibrils increased but the density of collagen fibrils decreased from the proximal metacarpal region to the distal metacarpal region. Large collagen fibrils with an irregular cross-sectional profile were found more frequently in the middle metacarpal region than in other regions. Three-dimensional reconstruction of images of irregularly shaped collagen fibrils revealed that these fibrils are formed through fusion of small collagen fibrils with large ones. The amount of decorin, which reportedly inhibits the lateral fusion of collagen fibrils, decreased in the direction of the distal metacarpal region. On the other hand, the size of decorin gradually increased in the direction of the distal metacarpal region. These results suggest that regional differences in collagen fibril distribution and density of collagen fibrils in the SDFT are due, at least in part, to fusion of collagen fibrils and the concomitant regional differences in the amount and size of decorin.     

Determination of passive mechanical properties of the superficial and deep digital flexor muscle-ligament-tendon complexes in the forelimbs of horses

OBJECTIVE: To determine the relative contributions of the muscles, tendons, and accessory ligaments to the passive force-length properties of the superficial (SDF) and deep digital flexor (DDF) myotendinous complexes. SAMPLE POPULATION: 8 cadaveric forelimbs from 6 adult Thoroughbreds. PROCEDURE: In vitro, limb configurations during slack position and myotendinous lengths during subsequent axial loading of forelimbs were recorded before and after transection of accessory ligaments. Expressions were derived to describe the force-length behavior of each muscle, tendon, and accessory ligament-tendon unit; linear stiffness was computed for these components. The elastic modulus was established for the SDF and DDF tendons. RESULTS; Linear stiffness was 2.80 +/- 0.38 kN/cm for the SDF muscle, 3.47 +/- 0.66 kN/cm for the DDF muscle, 2.73 +/- 0.18 kN/cm for the SDF tendon, 3.22 +/- 0.20 kN/cm for the DDF tendon, 6.46 +/- 0.85 kN/cm for the SDF accessory ligament, 1.93 +/- 0.11 kN/cm for the SDF accessory ligament-tendon unit, and 2.47 +/- 0.11 kN/cm for the DDF accessory ligament-tendon unit. The elastic modulus for the SDF and DDF tendons was 920 +/- 77 and 843 +/- 56 MPa, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Both the muscle-tendon and ligament-tendon portions of SDF and DDF myotendinous complexes had important roles in supporting the forelimb of horses. Although muscle tension can be enhanced by elbow joint flexion and active contraction, the accessory ligaments transmitted more force to the distal tendons than did the muscles under the conditions tested.