Arthroscopic removal and curettage of osteochondrosis lesions on the lateral and medial trochlear ridges of the talus in two dogs

Osteochondrosis lesions in the tibiotarsal joint were treated arthroscopically in two dogs. One dog had unilateral osteochondrosis of the dorsal aspect of the lateral trochlear ridge of the talus. The second dog had bilateral osteochondrosis of the plantar aspect of the medial trochlear ridge of the talus. Removal of all osteochondral fragments (i.e., joint mice) and debridement and curettage of the remaining talar defects were accomplished arthroscopically. Both dogs had excellent short-term outcomes.     

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.     

Use of a flexed dorsoplantar radiographic view of the talocrural joint to evaluate lameness in two dogs.

A flexed dorsoplantar radiographic view of the talocrural joint was a useful additional view to diagnose abnormalities of the lateral trochlear ridge of the talus of 2 dogs. This view outlined the subchondral bone of both trochlear ridges of the talus and the apposing cochlea tibiae of the distal portion of the tibia. The tarsus was flexed at the level of the talocrural joint, and an x-ray beam was centered on the joint. With this additional view, fractures of the lateral trochlear ridge were readily diagnosed. This view would help to demonstrate osteochondral lesions of the lateral trochlear ridge.     

Osteochondrosis of the Lateral Trochlear Ridge of the Talus in Seven Rottweiler Dogs

Eleven lesions of osteochondrosis in the lateral trochlear ridge of the talus were diagnosed in seven young Rottweiler dogs. Diagnosis was based on clinical and radiographic evaluations. Defects in the lateral trochlear ridge and osteochondral fragments arising from the dorsal and proximal margins of the ridge were visible radiographically. The dorsal 45 degrees lateral-plantaromedial oblique (D45 degrees L-P1MO) projection was the most useful in identifying the lesions. Exploratory arthrotomies were performed in six affected tarsi. In three cases, histologic examination revealed mineralized osteochondral fragments consistent with a diagnosis of osteochondrosis.     

Osteochondral Defects of the Lateral Trochlear Ridge of the Distal Femur of the Horse Clinical, Radiographic, and Pathological Examination and Results of Surgical Treatment

Osteochondral defects of the lateral trochlear ridge of the distal femur were identified in 15 joints of 10 horses. Lesions were bilateral in five horses and unilateral in five horses. Thirteen of these 15 defects were treated by curettage through a craniolateral femoropatellar arthrotomy. Subcutaneous seroma formation and partial skin dehiscence occurred in nine stifles. Lameness attributable to the stifle joint was no longer apparent at 6 and 12 months after surgery. The normal subchondral bony contour of the lateral trochlear ridge was altered in all joints after surgery. The subchondral bone was uniformly increased in density in all joints, and six lateral trochlear ridges had small focal radiolucent regions within the subchondral bone, which suggested that complete removal of the original lesion had not been achieved. Healing of the surgical site between 2 weeks and 14 months was evaluated in four joints. Granulation tissue from mesenchymal elements in subchondral marrow spaces gradually filled the defects with fibrocartilage.     

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.     

Heterotopic Transfer of Fresh and Cryopreserved Autogenous Articular Cartilage in the Horse

Two 10 mm thick osteochondral grafts were harvested from the lateral aspect of the lateral trochlear ridge of the left talus in each of 10 anesthetized horses. The grafts were frozen in a 7.5% DMSO solution and stored in liquid nitrogen. The horses were anesthetized again on day 14 and the thawed grafts were press-fitted into drill holes in the trochlear ridges of the right stifle. A fresh graft was transferred from the right hock to the left stifle. To control for the effects of surgery, another fresh graft was transferred from the right stifle to the left stifle. The result was two grafts in each femoropatellar joint. Fresh and frozen osteoarticular autografts appeared to maintain a durable weight-bearing surface for 3 months; however, the fresh grafts were clearly superior. Frozen grafts had fewer living chondrocytes, decreased safranin-O staining, and decreased SO435 uptake. Graft stability and articular surface congruency were determining factors in the outcome of all grafts. Since the availability of osteochondral autografts is limited, further work on the use of preserved allogeneic osteochondral tissue is warranted.     

Arthroscopic Anatomy of the Equine Femoropatellar Joint and Approaches for Treatment of Osteochondritis Dissecans

Arthroscopic approaches to the femoropatellar joint were developed to determine their usefulness for evaluation and surgical treatment of osteochondritis dissecans. It was found that the articular cartilage of the lateral trochlear ridge, medial trochlear ridge, intertrochlear groove, patella, and the lateral and medial reflections of the joint capsule could be examined from an infrapatellar arthroscopic portal. The suprapatellar pouch could be examined partially. Lateral and medial instrument portals were evaluated to determine the accessibility of the lateral and medial trochlear ridges of the femur in the areas where osteochondritis dissecans lesions frequently occur. Sliding the arthroscope sleeve beneath the patella when entering the joint was associated with iatrogenic cartilage lesions. A new technique that directed the arthroscope lateral to the lateral trochlear ridge eliminated iatrogenic cartilage damage.     

Mapping of donor and recipient site properties for osteochondral graft reconstruction of subchondral cystic lesions in the equine stifle joint

REASONS FOR PERFORMING STUDY: To improve osteochondral graft reconstruction of subchondral cystic lesions in the medial and lateral femoral condyles by matching the material properties of donor and recipient sites. OBJECTIVES: To measure biomechanical and biochemical parameters that influence the function and healing of osteochondral grafts used to reconstruct subchondral cystic lesions. HYPOTHESIS: Suitable donor sites are available within the stifle joint for reconstructing the femoral condyles, despite considerable regional property variation. METHODS: Fifty-six osteochondral cores were harvested from 6 distal femurs for initial studies that determined subchondral bone modulus of elasticity and ultimate stress. In a second study, 28 osteochondral cores were harvested from 6 distal femurs to measure cartilage aggregate modulus, thickness and sulphated glycosaminoglycan (sGAG) content. Using micro-CT imaging, subchondral bone mineral density and bone volume fraction were also measured. In both studies 2-dimensional contour plots using a bicubic interpolation method and normalised data were generated to allow visual comparison of joint surface characteristics. Statistical comparisons between donor and recipient site raw data were made using an ANOVA for repeated measures with a post hoc Tukey test. RESULTS: Material properties of cartilage and bone vary considerably over the surface of the stifle joint but the central region of the medial condyle, where subchondral cystic lesions freqdently occur, typically demonstrated bone strength and modulus values of the highest observed. Cartilage thickness and aggregate modulus were highest in the medial femoral condyle and axial aspect of the lateral condyle. CONCLUSIONS: Material properties of the grafts from the trochlear groove and axial aspect of the lateral trochlear ridge were the closest match for those found in the medial condyle, whereas properties of the lateral condyle were most similar to those found in the trochlear groove and axial aspect of the medial trochlear ridge.     

Incorporation of Fresh and Cryopreserved Bone in Osteochondral Autografts in the Horse

The structural integrity of subchondral bone in fresh and frozen osteochondral autografts was investigated at month 3 in 10 horses. Two osteochondral autografts were harvested from the lateral aspect of the lateral trochlear ridge of the left talus in each of 10 anesthetized horses. Grafts were frozen in 7.5% DMSO. After 14 days, the thawed grafts were press-fitted into drill holes in the trochlear ridges of the right stifles. A fresh graft from the right hock was implanted in each left stifle. To control for the effects of surgery, a fresh graft was transferred from the right stifle to the left stifle. The end result was two grafts in each femoropatellar joint. Fresh and frozen bone grafts maintained a structurally intact support for the cartilage surface. Graft stability and surface congruency were determining factors in the outcome of the grafts. Incorporation of both types of graft was complete at month 3, but remodeling of the fresh grafts was more active.     

Unusual osteochondral lesions of the talus in a horse

A 2-year-old Thoroughbred gelding was evaluated for a grade 3 out of 5 unilateral hind limb lameness. Flexion of the right hock and stifle joints (spavin test) exacerbated the lameness. Response to intra-articular and perineural anaesthesia isolated the source of lameness to the tarsocrural area, despite an absence of tarsocrural joint effusion. Routine radiographic examination of the hock did not reveal any significant abnormalities. Skeletal nuclear scintigraphic evaluation revealed a focal region of increased bone activity in the proximal medial trochlear ridge of the talus. Flexed lateromedial radiographic views identified three discrete semicircular lytic lesions at the proximal articular margin of the medial trochlear ridge of the talus. Conservative management of the lesions was associated with a successful return to racing. The location and appearance of the osteochondral lesions of this report have not been previously reported and may be a manifestation of developmental orthopaedic disease and abnormal endochondral ossification. Nuclear scintigraphy and flexed lateromedial radiographic views facilitated identification of the lesions. This radiographic view is recommended when lameness is isolated to the tarsocrural joint and standard radio-graphic projections fail to identify a cause.     

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

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

Rotation of the femoral trochlea for treatment of medial patellar luxation in a dog

A crossbreed dog was presented with non-weight bearing on the right hindlimb and a semi-flexed stifle. Clinical examination and radiographic investigation showed a grade 3 medial patellar luxation, characterised by hypoplasia of the medial trochlear ridge. No other significant skeletal abnormalities were detected. A 180 degrees rotation of the femoral trochlea was the surgical technique chosen to treat the trochlear dysplasia, the aim being to move the normal lateral ridge to the medial side and thereby prevent patellar luxation. This technique was able to restore correct conformation of the femoral trochlea and preserve the integrity of the trochlear groove cartilage, thus potentially retarding the progression of degenerative joint disease. The dog recovered fully and postoperative radiographic examinations showed healing of the rotated trochlea with only mild signs of degenerative joint disease.     

Fate and effect of autogenous osteochondral fragments implanted in the middle carpal joint of horses.

Four autogenous osteochondral fragments removed from the lateral trochlear ridge of the talus were arthroscopically placed as loose bodies in a randomly selected middle carpal joint in each of 10 horses. The contralateral middle carpal joint, subjected to a sham procedure, served as control. Postoperative treatment was consistent with that for clinical arthroscopic patients. Lameness evaluation, radiographic examination, carpal circumference measurement, and synovial fluid analysis were performed before and at scheduled intervals after surgery. After a 2-month confinement, horses were subjected to an increasing level of exercise. Horses were euthanatized at intervals through 6 months. Gross and microscopic evaluations were performed on remaining fragments, articular cartilage, and synovial membrane of each middle carpal joint. Increased joint circumference, effusion, lameness, and degenerative joint disease distinguished implanted from control joints over the 6-month period. Implanted joints were characterized by grooved, excoriated cartilage surfaces, and synovium that was thick, erythematous, and irregular. At 4 weeks, implants were found to have adhered to synovium at their subchondral bone surface. The bone within fragments was undergoing necrosis, while cartilage was preserved. At 8 weeks, fragments were radiographically inapparent, grossly evident as pale plaques on the synovial surface, and composed of dense fibrous connective tissue. Synovial membrane specimens from implanted joints had inflammatory change characterized by mononuclear cell infiltration 2 months after implantation. Physical damage was apparent within articular cartilage of implanted joints at 2 months, and was significant (P less than 0.05) at 6 months after surgery. Chondrocyte degenerative change was significant (P less than 0.05) at 6 months after surgery. Focal reduction in safranin-O uptake was observed in cartilage layers adjacent to physical defects. Osteochondral loose bodies of the size implanted in the middle carpal joint of horses in this study were resorbed by the synovium within 2 months. Synovitis and significant articular cartilage damage were associated with the implanted fragments. Regardless of origin, free osteochondral fragments within the middle carpal joint should be removed, and methods to prevent residual postoperative debris should be implemented to reduce potential for articular pathologic change.     

ULTRASONOGRAPHIC EVALUATION OF TARSOCRURAL JOINT CARTILAGE IN NORMAL ADULT HORSES

Ultrasonographic examination of the tarsus was performed on four clinically and radiographically normal limbs of adult horses. Particular attention was paid to the articular cartilage surfaces of the trochlear ridges of the talus and the distal intermediate ridge of the tibia. Two separate measurements of articular cartilage thickness were acquired from a longitudinal view at each site. Anatomy was confirmed with post mortem dissection. Ultrasonography was found to be a practical method for imaging the articular cartilage over the trochlear ridges of the talus and distal intermediate ridge of the tibia. The cartilage appeared as a hypoechoic band overlying the hyperechoic subchondral bone. The mean cartilage thickness over the lateral and medial trochlear ridges of the talus and the distal intermediate ridge of the tibia were 0.57 mm, 0.58 mm and 0.7 mm respectively. These measurements may have value for comparison to thickened cartilage and lesions of osteochondrosis and abnormally thinned cartilage of osteoarthritis. Ultrasound examination was not helpful in evaluating the proximal and distal intertarsal and tarsometatarsal joints, the close proximity of the articular surfaces obscured visualization of the articular cartilage.     

Osteochondritis dissecans on the lateral femoral trochlear ridge in a dog

A case of osteochondritis dissecans of the lateral femoral trochlear ridge in a young dog is presented. The localisation is rare and diagnosis and treatment are discussed.     

Rotating dome trochleoplasty: an experimental technique for correction of patellar luxation using a feline model.

The purpose of this study was to compare a trochlear block recession to a rotating dome trochleoplasty, a novel technique for the correction of patellar luxation in small animals. Twenty-eight limbs were used from 14 feline cadavers. With the stifles in flexion and extension, computed tomography was utilized to compare width and depth of the trochlea, medial trochlear ridge height, trochlear articular surface area preserved, patellar contact articular surface area, patellar area covered by the trochlear ridges and patellar tilt angle. The results of this study demonstrated that a rotating dome trochleoplasty is superior to a trochlear block recession with regard to medial trochlear height, trochlear width, trochlear depth and trochlear surface area preservation. The results of this study support further biomechanical evaluation of this technique which eventually may lead to clinical trials.     

Arthroscopic Approach and Intra-Articular Anatomy of the Plantar Pouch of the Equine Tarsocrural Joint

Arthroscopic examination of structures within the plantar pouch of the tarsocrural joint was accomplished via portals in both the plantaromedial and plantarolateral aspects of the joint. Flexion and extension of the tarsus while examining the joint through either portal allowed observation of the proximal and plantar aspects of the lateral and medial trochlear ridges, the trochlear groove, the caudal aspect of the distal tibia, and the deep digital flexor tendon (DDFT) in its sheath. From a plantarolateral portal, the plantar talocalcaneal ligament and the plantar aspect of the lateral malleolus could be observed. The caudal aspect of the medial malleolus could not be observed with flexion or extension of the joint from a plantaromedial portal, but in some horses, the caudal aspect of the lateral malleolus could be observed. The dorsolateral and dorsomedial aspects of the plantar pouch were best examined from a portal on the ipsilateral side of the joint. An instrument portal opposite either arthroscope portal allowed access to most regions of the joint except the abaxial surface of the trochlear ridge opposite the instrument.     

Comparison of radiography and ultrasonography for the diagnosis of osteochondritis dissecans in the equine femoropatellar joint

Reasons for performing study: Osteochondritis dissecans (OCD) lesions of the femoropatellar (FP) joint are diagnosed routinely by radiography, but lesions located in the trochlear groove or without accompanying subchondral bone changes can be difficult to visualise. Ultrasonography allows evaluation of articular cartilage and subchondral bone in the FP joint. Objectives: To document the radiographic and ultrasonographic appearance of OCD lesions in the equine FP joint, grade ultrasonographic lesions and compare their accuracy in the diagnosis of these lesions. Methods: The medical records of all horses diagnosed with FP OCD between 1995 and 2006 were assessed. Inclusion criteria included availability of both radiographic and ultrasonographic images. Lesion characteristics were evaluated in each trochlear ridge and trochlear groove. For assessment of the accuracy (sensitivity and specificity) of both imaging techniques in the diagnosis of OCD, only cases with an arthroscopic or necropsy examination were studied. Results: Twenty‐one horses were included. OCD lesions were diagnosed by radiography (30/32 joints) and ultrasound (32/32 joints). The lateral trochlear ridge (LTR, 91%) and the medial trochlear ridge (MTR, 17%) were involved on radiography. The localisation on ultrasound examination was similar (97% LTR, 25% MTR). All but one lesion seen on radiography were also detected with ultrasound; 2 LTR and 3 MTR lesions, not seen on radiography were diagnosed by ultrasound and confirmed at arthroscopy or necropsy. The specificity was 100% regardless of the site and imaging procedure except for the distal third of the MTR (94% for ultrasound). The sensitivity varied, depending on lesion site. Conclusion: Ultrasonography is a valuable diagnostic tool to diagnose OCD lesions in the FP joint and more sensitive than radiography for lesions affecting the MTR of the distal femur. Clinical relevance: Ultrasound should be considered as a useful adjunct to radiography for diagnosing equine FP OCD, especially in cases of high clinical suspicion but equivocal radiographic findings. Images can be generated immediately when digital radiography is not available, permitting an immediate on‐site diagnosis.     

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.