Subchondral cyst-like lesions in the distal portion of the radius of four horses

Four horses with subchondral cyst-like lesions in the medial radial facet of the distal portion of the radius were examined. Joint effusion and signs of pain from flexion of the antebrachiocarpal joint were not observed, but lameness was observed in 3 of the 4 horses. Regional nerve blocks and intra-articular anesthesia were used to localize the lesions, and conservative treatment resulted in soundness for performance.     

Occult subchondral osseous cyst-like lesions of the equine tarsocrural joint

OBJECTIVE: To report the clinical signs, diagnosis, management, and outcome of horses with occult sub-chondral osseous cyst-like lesions of the tarsocrural joint. DESIGN: Retrospective study. ANIMALS: Twelve horses with subchondral osseous cyst-like lesions (SOCLs) in the tarsocrural joint. METHODS: Information about history, examination findings, diagnostic techniques, and surgical procedures as obtained from medical records. Outcome was determined by patient re-evaluation and telephone communication with the referring veterinarian, owner, or trainer. RESULTS: Horses were aged from 3 to 29 years. Lameness (2 weeks to 1 year) varied from moderate to severe. Synovial fluid analyses (9 horses) yielded changes consistent with suppurative inflammation and positive bacterial culture was obtained in 4 horses. Eight of 9 horses that had intra-articular analgesia had a dramatic reduction in lameness. No abnormalities were detected on tarsal radiographs in 10 horses. Scintigraphy identified foci of increased radiopharmaceutical uptake in the distal tibia or talus of all horses, and the lesion was further characterized by computed tomography in 7 horses. SOCLs were identified in the medial malleolus (5), intertrochlear groove of the talus (4), lateral malleolus (2), and distal intermediate ridge of the tibia (1). One horse was euthanatized, 6 horses had surgical debridement, and 5 horses were managed conservatively. Four horses treated surgically (67%) returned to soundness. Conservatively treated horses continued to exhibit lameness but 2 were sufficiently sound for light pleasure riding. CONCLUSIONS: Occult lesions of the tarsus not visible on radiographs can be detected by computed tomography and scintigraphy and may be a source of lameness. CLINICAL RELEVANCE: SOCL, possibly of septic origin, should be a differential diagnosis for persistent lameness localized to the tarsocrural joint without radiographic abnormalities. Surgical debridement of the lesions may offer the best prognosis for a return to athletic soundness.     

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.     

A Muscle Separating Approach to the Equine Shoulder Joint for the Treatment of Osteochondritis Dissecans

A muscle separating approach with tenotomy of the teres minor was used to expose osteochondritis dissecans lesions in the shoulder joints of five horses. Horses selected for surgery were severely lame or had a long history of lameness. Adequate surgical access allowed removal of cartilage flaps, curettage of the subchondral bone, and in one horse, the removal of an osteocartilaginous free body. Surgical wounds healed by primary intention; one horse developed a seroma that was drained. Three of the five horses were clinically sound 3 months following surgery. Two other horses were pasture sound but lame after extensive athletic activity.     

Lameness Associated with Mineralization of the Central Tarsal Bone and a Small Osseous Cyst-Like Lesion in Two Sport Horses

The clinical features, response to local analgesia, and imaging findings of two mature sport horses with lameness associated with abnormal mineralization of the dorsal aspect of the central tarsal bone and a small osseous cyst-like lesion are described. Although the radiological findings and the lesions identified using magnetic resonance imaging were similar, the lameness characteristics and responses to perineural analgesia differed. One horse failed to respond to treatment and was retired. The second horse was humanely destroyed. Postmortem examination confirmed the presence of an osseous cyst-like lesion distal to the subchondral bone plate of the central tarsal bone and extensive dense cancellous bone extending one-half the dorsoplantar depth of the bone.     

Osteochondral fragmentation of the distal aspect of the patella in horses

A condition characterised by osteochondral fragmentation of the distal aspect of the patella in 15 horses is described. The problem was unilateral in six horses and bilateral in nine. There were eight Quarterhorses, three Thoroughbreds, two American Saddlebreds, one American Paint and one Warmblood-Thoroughbred cross. A previous medial patellar desmotomy had been performed on 12 of the 15 horses. The condition manifested as hindlimb lameness and stiffness ranging from mild to severe. There was fibrous thickening in the stifle area in the 12 cases with a previous medial patellar desmotomy, and synovial effusion in seven of 12 cases. Synovial effusion was present in two of the three cases in which a previous medial patellar desmotomy was not performed. The radiographic changes included bony fragmentation, spurring (with or without an associated subchondral defect), subchondral roughening and subchondral lysis of the distal aspect of the patella. All horses were treated with arthroscopic surgery. The lesions at arthroscopy varied from flaking, fissuring, undermining or fragmentation of the articular cartilage to fragmentation or lysis of the bone at the distal aspect of the patella. The subchondral bone was involved in all cases that had a previous medial patellar desmotomy. Of the 12 horses that had a previous medial patellar desmotomy, eight became sound at their intended use, one was sold in training without problems, one is in early training without problems, one never improved and one is in convalescence. Of the three that did not have a patellar desmotomy, two performed their intended use well but one was unsatisfactory.     

Nonsurgical treatment of cubital subchondral cyst-like lesions in horses: seven cases (1983-1987).

Subchondral cyst-like lesions of the cubital joint were diagnosed in 7 horses at the teaching hospital between 1983 and 1987. Diagnosis of the lesions was made by administration of intra-articular local anesthesia and/or radiographically. Initial treatment for all horses consisted of stall rest for 60 to 90 days. In addition, 2 horses were administered sodium hyaluronate intra-articularly, 1 horse was given injections of polysulfated glycosaminoglycans IM, and 1 horse was given phenylbutazone orally. Follow-up information was compiled 6 weeks to 4 years after initial examination. At the time of follow-up inquiry, 6 horses were sound for intended use and only 1 horse became lame when exercised. A logical approach to choice of surgical or nonsurgical treatment is proposed on the basis of these findings and those reported in the literature.     

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

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

Prevalence and distribution of radiographically evident lesions on repository films in the hock and stifle joints of yearling Thoroughbred horses in New Zealand

AIM: To characterise the prevalence and distribution of radiographic changes in the hocks and stifles of Thoroughbred yearling colts and fillies in New Zealand and compare them with other populations of young horses. METHODS: Repository radiographs taken in New Zealand for the 2003-2006 Thoroughbred national yearling sales were evaluated by two individual readers. The distribution of radiographic changes was classified as left side only, right side only, or bilateral. Lesions were categorised by type, location, and sex of the yearling. Complete sets of hock and stifle radiographs of 1,505 yearlings were evaluated. RESULTS: Osteophytes or enthesophytes were seen radiographically in the distal tarsal joints of 460/1,505 (31%) horses. Osteochondrosis was seen in the tibiotarsal joint of 66/1,505 (4%) horses, and in the femoropatellar joint of 40/1,505 (3%) horses. Radiographic lucency in the distal or axial aspect of the medial femoral condyle was seen in 247/1,505 (16%) horses, and lucencies consistent with subchondral cyst-like lesions were seen in 26/1,505 (2%) horses. No significant difference was seen in the proportion of colts and fillies with radiographic changes in the hock or stifle. The prevalence of osteochondrosis and subchondral cyst-like lesions in the stifles of the yearlings examined were similar to those reported in Thoroughbred yearling sale horses in the United States of America (USA). The prevalence of changes in the distal tarsal joints was similar to those reported in Standardbred and Thoroughbred yearlings from Scandinavia and the USA. CONCLUSIONS: There was no significant difference in the prevalence of osteochondrosis in the hock and stifle, lucencies in the distal medial femoral condyle, or radiographic changes in the distal tarsal joints between colts and fillies. CLINICAL RELEVANCE: Establishment of the normal prevalence and distribution of radiographic changes in the hocks and stifles of Thoroughbred yearlings in New Zealand will allow comparison with populations of young horses in other countries. Knowledge of the normal prevalence will assist veterinarians to identify abnormally high or low prevalences on individual farms, to further investigate the pathogenesis of the lesions.     

Osseous cyst‐like lesions in the feet of lame horses: Diagnosis by standing low‐field magnetic resonance imaging

Osseous cyst‐like lesions (OCLLs) were diagnosed by standing low‐field magnetic resonance (MR) imaging in 9 mature horses (age range 6–17 years). All horses had been subjected to a routine lameness evaluation (including standard foot radiographs) with no diagnosis being reached prior to MR imaging. The duration of lameness ranged from one month to one year. OCLLs were diagnosed in 12 feet. The site of the lesions included the distal phalanx in 11 feet (subchondral bone in 4, insertion of collateral ligaments of the distal interphalangeal joint in 4, insertion of the distal sesamoidean impar ligament in 3) and the subchondral bone of the distal aspect of the middle phalanx in one foot. OCLLs were characterised by discrete spherical or elliptical areas of high or intermediate signal in all MR sequences. In most cases the lesion was surrounded by a rim of bone with abnormally low signal.     

Arthroscopic reattachment of osteochondritis dissecans lesions using resorbable polydioxanone pins

REASONS FOR PERFORMING STUDY: Debridement of osteochondritis dissecans (OCD) cartilage lesions results in fibrocartilage and imperfect hyaline repair tissue, and forms a permanent irregularity to the subchondral bone plate. OBJECTIVE: To evaluate the clinical, radiographic and outcome effects of OCD cartilage flap reattachment for select lesions as an alternative to OCD debridement. HYPOTHESIS: Separated cartilage flaps resulting from OCD lesions may be re-incorporated into the hyaline cartilage surface by reattachment rather than debridement and removal. METHODS: Resorbable polydioxanone pins were used to reattach OCD flap lesions in 16 joints of 12 horses. Criteria for attachment, rather than removal, included an unmineralised cartilage flap on preoperative radiographs and a relatively smooth surface with some residual perimeter attachment at surgery. RESULTS: There were 12 subjects, 6 males and 6 females, 7 Thoroughbred or Standardbred weanlings, 3 Warmbloods, 1 Arabian and 1 Quarter Horse, mean age at surgery 6.8 months. All horses had effusion of the affected femoropatellar joint (n = 9), tarsocrural joint (n = 1) or fetlock (n = 2). Radiographic lesions varied in length between 1.8-6.3 cm; reattachment was used in 16 of 18 affected joints and the OCD cartilage was not satisfactory for salvage in 2 stifles. Number of pins required was 2-10. One horse was subjected to euthanasia due to a tendon laceration 8 weeks after surgery; of the remaining 11 horses, mean duration of follow-up was 3.9 years (range 4 months-8 years). Nine of these were sound and had entered work, while 2 were sound but remained unbroken 4 and 6 months post operatively, respectively. Radiographic resolution of the OCD lesion occurred in 14 of 16 pinned joints in the 9 horses with long-term follow-up. The 2 remaining joints had a 3 and a 5 mm mineralised flap in the original defect sites. CONCLUSIONS: This study indicated cartilage flap reattachment was an alternative to removal in selected OCD lesions. POTENTIAL RELEVANCE: Relatively smooth OCD cartilage flaps may be salvaged by reattachment and can result in normal radiographic subchondral contour and a high likelihood of athletic performance. Further case numbers are required to determine which lesions are too irregular or contain too much mineral for effective incorporation after reattachment.     

Pathological changes in the navicular bone and associated structures of the horse.

Navicular bones from 74 horses were examined at necropsy. Animals ranged in age from eight months to 30 years. Eight horses had a clinical history of navicular disease. Degenerative lesions in the fibrocartilaginous surface of the navicular bone and of the surface of the deep flexor tendons were age related changes not necessarily related to lameness. These lesions were more extensive in horses with a history of navicular disease, and were often accompanied by adhesions and subchondral cavitation of the fibrocartilaginous surface of the navicular bone. Osteophytes, present in 12 of the 74 horses, appeared to be age-related and were uncommon in horses with a history of navicular disease. Nutrient foramina on the distal border of the navicular bone were highly variable in size and shape; in horses with a history of navicular disease they often had a small external opening that became larger as it penetrated the bone. Occlusive vascular disease (arteriosclerosis) was found in sound horses and in horses with a history of navicular disease. Thrombosis of arteries or ischemic necrosis of bone was not identified in any case.     

Diagnostic findings and prognosis following arthroscopic treatment of subtle osteochondral lesions in the shoulder joint of horses: 15 cases (1996-1999)

OBJECTIVE: To determine clinical, scintigraphic, radiographic, and arthroscopic findings and results of treatment in horses with lameness attributable to subtle osteochondral lesions of the shoulder joint. DESIGN: Retrospective study. ANIMALS: 15 horses. PROCEDURE: Medical records were reviewed, and results of physical examination, scintigraphy, radiography, arthroscopy, and treatment were recorded. RESULTS: Severity of lameness ranged from grade 1 to 4. Response to shoulder flexion or extension was variable. Twelve horses had a narrow upright foot. Intra-articular anesthesia of the shoulder joint localized the cause of the lameness to the shoulder joint in 9 of 10 horses. Scintigraphic abnormalities were detected in 4 of 6 horses. Radiographic lesions were subtle and included glenoid sclerosis, focal glenoid lysis, small glenoid cysts, and alterations in the humeral head contour. Arthroscopic evaluation confirmed clefts in the glenoid cartilage, glenoid cysts, a humeral head cyst, fibrillation of the humeral head cartilage, cartilage fragmentation, or a nondisplaced fracture of the humeral head. After treatment, 12 horses returned to their previous level of performance, 1 was sound for light riding, 1 remained lame, and 1 was euthanatized because of chronic lameness. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that a combination of physical examination, scintigraphy, and radiography is necessary to diagnose subtle osteochondral lesions of the shoulder joint in horses. Arthroscopy can be used to confirm the diagnosis and treat cartilage and subchondral bone lesions. Young and middle-aged horses with subtle osteochondral lesions of the shoulder joints have a good prognosis for return to performance following arthroscopic treatment.     

OSSEOUS LESIONS IN THE METACARPO(TARSO)PHALANGEAL JOINT DIAGNOSED USING LOW-FIELD MAGNETIC RESONANCE IMAGING IN STANDING HORSES

We report the use of low-field standing magnetic resonance imaging in the standing horse for the diagnosis of osseous lesions in the metacarpophalangeal (MCP) or metatarsophalangeal (MTP) joint that were not apparent using standard radiography. Thirteen horses were studied and all had thickening of the subchondral bone plate and abnormal signal intensity in the adjacent spongiosa in either the condyles of metacarpal/metatarsal III or the proximal phalanx or both. Abnormalities were characterized by diffuse decreased signal intensity on T1-weighting adjacent to the subchondral bone and within the spongiosa in at least two imaging planes; in the absence of increases in signal intensity in fat-suppressed images, this change was interpreted as bone sclerosis. Nine horses also had a diffuse decreased signal intensity on T2^*-weighting in the same areas and five had a diffuse increase in signal intensity in fat-suppressed images in conjunction with a decrease in signal intensity on T1- and T2^*-weighted images; the increase in signal intensity in fat-suppressed images was interpreted as fluid accumulation. Five horses had a focal area of change in signal intensity within the subchondral bone with apparent loss of definition between the subchondral bone and the articular cartilage. Eleven horses were available for follow up, of which eight were sound and three remained lame. We conclude that lameness originating from the MCP or MTP joint may be associated with osseous damage in horses of any signalment in the absence of radiographic changes.     

Magnetic resonance imaging findings of bone marrow lesions in the equine distal tarsus

Three horses with sudden onset severe lameness were admitted for further diagnostic investigation. All horses had variable changes on radiographs in the distal tarsal region. Because of the sudden onset and severe degree of lameness, a magnetic resonance imaging (MRI) examination was performed. All horses showed areas of increased signal intensity in short tau inversion recovery (STIR) images involving the central and/or third tarsal bones. These lesions involved both the subchondral bone and bone marrow and are currently defined as bone marrow lesions (BML). Two horses were treated with shockwave therapy, one received intra‐articular medication. Two of the horses returned to previous athletic level and one is still in rehabilitation.     

RADIOGRAPHIC AND PATHOLOGIC CHARACTERIZATION OF LATERAL PALMAR INTERCARPAL LIGAMENT AVULSION FRACTURES IN THE HORSE

In this study, the radiographic and histologic appearance of lateral palmar intercarpal ligament (LPICL) avulsion in the horse was characterized. Thirty-seven horses with radiographic evidence of avulsion fragments originating from the medial palmar aspect of the ulnar carpal bone were examined. The dorsolateral to palmaromedial projection was useful for evaluating the size and shape of the avulsed bone fragment, and the dorsopalmar projection added information on the relative proximity of the fragment to its fracture bed. Radiographic features that differentiated LPICL avulsion from subchondral cystic lesions of the ulnar carpal bone included a variable-sized osseous opacity adjacent to the lucent concavity of the fracture bed and the consistent location within the palmar transition zone at the confluence of LPICL insertion and hyaline cartilage on the palmar surface of the ulnar carpal bone. All 26 horses having surgical removal of the fragments had arthroscopic confirmation that the fragment was within the LPICL. Histologic examination confirmed the fragments were fracture related rather than developmental or the result of dystrophic mineralization. Many of the fragments had attached remnants of a ligament. This study describes the radiographic, surgical, and histologic features in 37 horses which better characterize LPICL avulsion fracture in the carpus and provide differentiating features to assist in separating this syndrome from true osseous cyst-like lesions within the ulnar carpal bone.     

Osteochondrosis and juvenile spavin in equids

Thirty-six of 50 young equids examined at necropsy for gross pathologic and histopathologic evidence of osteochondrosis were determined to have lesions characteristic of this disorder in the distal joints of the tarsus. Abnormalities ranged from retained endochondral cores underlying undisturbed articular cartilage surfaces to clefts, subchondral osseous cyst-like lesions, and cartilage ulceration. Our findings supported the conclusion that osteochondrosis may cause spavin in the juvenile equid.     

Arthroscopic reattachment of osteochondritis dissecans cartilage flaps of the femoropatellar joint: long-term results

Reasons for performing study: Long‐term efficacy of arthroscopic cartilage reattachment for the treatment of osteochondritis dissecans (OCD) lesions in the equine femoropatellar joint is unknown. Objective: To evaluate radiographic outcome and long‐term performance of horses undergoing OCD reattachment. Hypothesis: Separated OCD cartilage flaps may be reincorporated into the joint surface by reattachment rather than flap removal. Methods: Polydioxanone pins were utilised arthroscopically to reattach OCD lesions in 40 of 44 joints from 27 horses. Cartilage was reattached when it had persisting perimeter continuity, the surface was not deeply fissured or irregular, and the cartilage was not protuberant or extensively mineralised. Bone marrow aspirate concentrate was grafted to additional areas denuded of cartilage or alongside reattached cartilage. Results: Breeds included Thoroughbred (n = 18), Quarter Horse (n = 4), Warmblood (n = 3), Standardbred (n = 1) and Arabian (n = 1). Mean age was 9.7 months. Radiographic lesion length was 1.5–6.3 cm. Reattachment alone was used in 32 of 44 affected joints, a combination of debridement and reattachment in 8 joints and debridement alone in 4 joints. One horse was destroyed due to tendon laceration. Of the remaining 26 horses, mean duration of follow‐up was 15.6 months (range 2 months–12 years). Radiographic resolution of OCD lesions treated with reattachment was significantly improved at 6 months. Twenty horses had long‐term performance data, of which 19 were sound and had reached intended athletic potential. One horse remained lame, and an additional 6 were sound but remained unbroken or were convalescing. Thus, an overall success rate based upon continued soundness in performing horses was 95% (19/20). Conclusion: Cartilage flap reattachment can salvage OCD cartilage by integration with the underlying bone. Potential relevance: Extensive OCD cartilage flaps may be salvaged by reattachment which can result in normal radiographic subchondral bone contour and long‐term athletic performance.