Luxation of the metacarpophalangeal and metatarsophalangeal joints in horses

Lateral or medial luxation of the metacarpophalangeal or metatarsophalangeal (fetlock) joint in 10 horses is presented. Closed and open fetlock luxation each occurred in five horses. Horses were treated by cast immobilisation after debridement of soft tissue and joint lavage in cases of open luxations. Suture apposition of a ruptured collateral ligament was attempted in three cases. Antibiotic therapy was used in all cases of open fetlock luxation but non-steroidal anti-inflammatory medication was used inconsistently. Whether closed or open, fetlock luxations had a good prognosis for return to breeding status. After treatment, seven horses were used for breeding, one horse was ridden for nine years, one horse remained lame and was destroyed and one horse was lost to follow up.     

Clinical evaluation of the effects of immobilization followed by remobilization and exercise on the metacarpophalangeal joint in horses

OBJECTIVES: To evaluate clinical effects of immobilization followed by remobilization and exercise on the metacarpophalangeal joint (MPJ) in horses. ANIMALS: 5 healthy horses. PROCEDURE: After lameness, radiographic, and force plate examinations to determine musculoskeletal health, 1 forelimb of each horse was immobilized in a fiberglass cast for 7 weeks, followed by cast removal and increasing amounts of exercise, beginning with hand-walking and ending with treadmill exercise. Lameness examination, arthrocentesis of both MPJ, single-emulsion radiographic examination, nuclear scintigraphic examination, ground-reaction force-plate analysis, and computed tomographic examination were done at various times during the study. RESULTS: All horses were lame in the immobilized MPJ after cast removal; lameness improved slightly with exercise. Force plate analysis revealed a significant difference in peak forces between immobilized and contralateral limbs 2 weeks after cast removal. Range of motion of the immobilized MPJ was significantly decreased, and joint circumference was significantly increased, compared with baseline values, during the exercise period. Osteopenia was subjectively detected in the immobilized limbs. Significant increase in the uptake of radionucleotide within bones of the immobilized MPJ after cast removal and at the end of the study were detected. Loss of mineral opacity, increased vascular channels in the subchondral bone, and thickening within the soft tissues of the immobilized MPJ were detected. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate that 8 weeks of enforced exercise after 7 weeks of joint immobilization did not restore joint function or values for various joint measurements determined prior to immobilization.     

Vacuum phenomenon in equine carpal, metacarpophalangeal and metatarsophalangeal joints

In order to establish the incidence of vacuum phenomenon in horses' carpal, metacarpophalangeal and metatarsophalangeal joints, stress-flexed radiographs were made of normal joints, joints with known pathology and in anaesthetised horses with joints under traction. Focal intra-articular radiolucencies were identified in normal stress-flexed carpal, metacarpophalangeal and metatarsophalangeal joints. These radiolucencies can be confused with those associated with pathological conditions.     

The effect of intra-articular methylprednisolone acetate and exercise on equine carpal subchondral and cancellous bone microhardness

Dorsal carpal osteochondral injury is a major cause of lameness in horses undergoing high intensity training. Intra-articular corticosteroid treatment is used commonly to manage exercise-associated articular pain, but its use remains highly controversial in the equine athlete. This project, therefore, aimed to compare the mechanical properties of intra-articular MPA and diluent-treated middle carpal subchondral and cancellous bone in horses undergoing a short-term treadmill exercise programme. It was hypothesised that subchondral and cancellous bone mechanical properties are influenced by intra-articular administration of methylprednisolone acetate (MPA). Eight 2-year-old female horses had MPA or diluent administered into contralateral middle carpal joints at 14 day intervals, for a total of 4 treatments per horse. Horses underwent a standard treadmill exercise protocol until euthanasia (Day 70). Standard sites were located on the dorsal aspect of third, radial and intermediate carpal bones. Osteochondral samples from each test site were divided into subchondral bone and cancellous bone portions. These were dried, resin-embedded and gold-coated. Microhardness measurements were obtained at each test site. No significant effect of intra-articular treatment was detected. At each site, cancellous bone trabecular struts had an 18-19% higher microhardness value than the overlying subchondral bone. These findings indicate that intra-articular administration of MPA at this dose has no effect on subchondral or cancellous bone adaptation to short-term exercise and, therefore, on the propensity of carpal bones to injury. Further investigation into the calcified cartilage layer, effect of different corticosteroid preparations and diffusion of medication are required.     

Evaluation of increased subchondral bone density in areas of contact in the metacarpophalangeal joint during joint loading in horses

OBJECTIVE: To quantitatively evaluate contact area under 2 loads and subjectively compare contact areas with subchondral bone (SCB) density patterns in intact metacarpophalangeal joints of horses. SAMPLE POPULATION: 6 forelimbs from horses without musculoskeletal disease. PROCEDURES: Computed tomographic scans of intact metacarpophalangeal joints were analyzed to obtain SCB density measurements. Each limb was loaded on a materials testing system to 150 degrees and 120 degrees extension in the metacarpophalangeal joint, and the joint was stained via intra-articular injection with safranin-O or toluidine blue, respectively. Each joint was disarticulated, and the surface area was digitized. Total articular surface area, contact area, and percentage contact area at each angle were calculated for the distal third metacarpal condyles, the proximal phalanx, and the proximal sesamoid bones. RESULTS: Contact area on the third metacarpal condyles, proximal sesamoid bones, and the proximal phalanx significantly increased with increased load. Areas of contact subjectively appeared to have a higher density on computed tomographic scans. CONCLUSIONS AND CLINICAL RELEVANCE: Areas consistently in contact under higher load were associated with increased SCB density. This supports the idea that the SCB adapts to the load applied to it. As load increased, contact area also increased, suggesting that areas not normally loaded may have a high degree of stress during impact loading. Quantifying how contact in the joint changes under different loading conditions and the adaptation of the bone to this change in normal and abnormal joints may provide insight into the pathogenesis of osteochondral disease.     

Biochemical analysis of the articular cartilage and subchondral and trabecular bone of the metacarpophalangeal joint of horses with early osteoarthritis

OBJECTIVE: To assess whether site-related changes in biochemical composition are present in the cartilage and subchondral and trabecular bone of the metacarpophalangeal joint of horses with early osteoarthritis. SAMPLE POPULATION: Right metacarpophalangeal joints from 59 mature warmblood horses. PROCEDURE: Biochemical data (cross-link, amino acid, DNA, and ash contents; denatured collagen and glycosaminoglycan [GAG] concentrations; bone mineral density; and mineral composition) were obtained from 2 differently loaded sites of phalanx I cartilage and subchondral and trabecular bone samples; data were compared with previously published values from nonosteoarthritic equine joints. RESULTS: Compared with findings in nonosteoarthritic joints, GAG concentration was lower in cartilage from osteoarthritic joints and there was a loss of site differences in cellularity and lysylpyridinoline (LP) cross-link content. In subchondral bone, LP cross-link content was decreased overall and there was a loss of site differences in osteoarthritic joints; ash content was higher in the osteoarthritic joints. Hydroxyproline content in trabecular bone from osteoarthritic joints was greater than that in nonosteoarthritic trabecular bone. In all 3 layers and at both sites, the linear increase of the pentosidine cross-link content with age had diminished or was not apparent in the horses with osteoarthritic joints. CONCLUSIONS AND CLINICAL RELEVANCE: In equine metacarpophalangeal joints with early osteoarthritis, distinct biochemical changes were detected in the cartilage and subchondral and trabecular bone. The dissimilarity in response of the different tissues and differences between the sites that are affected may be related to differences in biomechanical loading and transmission and dissipation of force.     

Scintigraphic evaluation of metacarpophalangeal and metatarsophalangeal joints in clinically sound horses.

The purpose of this study was to describe the pattern of radiopharmaceutical uptake in the metacarpophalangeal (MCP) and metatarsophalangeal (MTP) (fetlock) joints in clinically sound horses. Scintigraphic images from 29 clinically normal horses were evaluated. All the images were assessed subjectively. The lateral views were assessed quantitatively using vertical line profiles through the center of the joint, and mean ratios of radiopharmaceutical uptake were calculated from regions of interest around the third metacarpal or metatarsal bones, and the proximal phalanx and proximal sesamoid bones. From the vertical line profiles, in the majority of forelimbs (65%) the peak activity of radiopharmaceutical distribution was at the proximal region of the proximal phalanx, with a significantly lower activity within the condyles of the third metacarpal bone. However, in 84% of hindlimbs there was a broader profile peak incorporating the condyles of the third metatarsal bone and the proximal aspect of the proximal phalanx, indicating a more generalized even uptake of radiopharmaceutical across the MTP joint. When the regions of interest were compared between front and hindlimbs, there was no significant difference between proximal phalanx and proximal sesamoid bones, but the distal condyles of the third metacarpal bone of the forelimb had significantly lower radiopharmaceutical activity than hindlimbs (P < 0.04). In lateral images, the mean forelimb ratios tended to be higher in the left MCP joint compared with the right (P = 0.069). In hindlimbs, the mean ratios tended to be higher in the right MTP joint than the left (P = 0.052). There was no significant effect of age.     

Communications and boundaries of the middle carpal and carpometacarpal joints in horses

To study communications and boundaries of the middle carpal and carpometacarpal joints of the horse, 50 forelimbs were obtained from fresh cadaver specimens. Blue latex solution (20 +/- 2.5 ml) was injected into the middle carpal joint, and the specimens were frozen in extension. Frozen specimens were cut into 1-cm sagittal sections from the middle of the radius to the middle of the metacarpus. The communications between the middle carpal and carpometacarpal joints and the presence, length, and position of the distopalmar outpouchings of the carpometacarpal joint were recorded. The middle carpal and carpometacarpal joints always communicated between os carpale III (C3) and os carpale IV (C4). An additional communication between the joints existed in 17 (34%) of the specimens, 10 on the palmar aspect of C4, and 3 on the palmar aspect of os carpale II (C2). When os carpale I (C1) was present (n = 5), communication between C1 and C2 was observed in 4 of the 5 specimens. In all specimens, medial and lateral distopalmar outpouchings of the carpometacarpal joint were observed and were located between the axial surface of os metacarpale II (MC2) and os metacarpale IV (MC4) and the abaxial surface of the suspensory ligament. There was no significant difference between the lengths of the lateral (2.3 +/- 0.54 cm) or medial (2.6 +/- 0.75 cm) distopalmar outpouchings. Small extensions from the distopalmar outpouchings were seen and extended axially into the fibers of the suspensory ligament or between the suspensory ligament and the distal accessory ligament of the deep digital flexor tendon.(ABSTRACT TRUNCATED AT 250 WORDS)     

Radiographic and scintigraphic evaluation of the third carpal bone of control horses and horses with carpal lameness

We compared the radiographic and scintigraphic findings in the third carpal bone of horses performing different work disciplines and investigated their relationship with lameness. Horses had undergone carpal radiography including acquisition of a dorsoproximal-dorsodistal oblique (DPr-DDiO) image of the distal row of carpal bones and/or scintigraphic examination of the carpi. Cause of lameness, breed, age, and work discipline were recorded. Increased opacity in the third carpal bone was graded, ratio of radiopharmaceutical uptake calculated objectively, and increased radiopharmaceutical uptake graded subjectively. Relationships between radiographic, scintigraphic, and clinical findings were assessed statistically. Increased opacity in the third carpal bone (P = 0.003) and ratio of radiopharmaceutical uptake (P = 0.015) were associated with the work discipline. Increased opacity in the third carpal bone was associated with both increased radiopharmaceutical uptake grade (P = 0.002; rs = 0.59) and ratio of radiopharmaceutical uptake (P = 0.013; rs = 0.46). Increased radiopharmaceutical uptake and increased opacity in the third carpal bone were not always observed concurrently. Lameness related to the middle carpal joint was associated with increased opacity (P < 0.001), ratio of radiopharmaceutical uptake (P = 0.037), and increased radiopharmaceutical uptake grade (P < 0.001). Radiographic and scintigraphic abnormalities were observed in horses performing all disciplines, indicating that high-speed exercise may not be the only factor determining the development of osseous disease in the third carpal bone. Both increased opacity and increased radiopharmaceutical uptake were more likely to be seen in horses with lameness related to the middle carpal joint than in horses with other sources of pain.     

Effect of subchondral drilling on repair of partial-thickness cartilage defects of third carpal bones in horses

Arthrotomies of middle carpal joints were done on 13 horses, and a 1-cm partial thickness, round defect was made on the radial facet of both third carpal bones. In one joint, 1-mm diameter 1-cm deep holes were drilled within the defect, and one joint was used as a control. horses were assigned to 2 groups--group 1 (n = 6 horses), 5 drill holes; group 2 (n = 7 horses), 11 drill holes. At 1 and 3 weeks after surgery, differences between joints in synovial fluid total protein values, WBC counts, or results of mucin precipitate tests were not significant (P = 0.005). Physically and radiographically, horses were the same during the 12 initial weeks they were housed in stalls and the 9 weeks they were kept in paddocks. Twenty-one weeks after surgery, horses were euthanatized. Joints with drill holes had a significantly greater area (P less than 0.05) of healthy fibrocartilage new tissue: group 1-33 to 68% new tissue, compared with 0 to 23% new tissue in controls; and group 2-22 to 64% new tissue, compared with 0 to 37% new tissue in controls. Differences between healing of defects with drill holes in groups 1 and 2 were not significant. Thickness of new tissue over drill holes was 33 to 61% of thickness of cartilage adjacent to the defect, and thickness of tissue between drill holes was 11 to 43% (group 1) and 8 to 79% (group 2) of the thickness of cartilage adjacent to the defect.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of exercise on chondrocyte viability and subchondral bone sclerosis in the distal third metacarpal and metatarsal bones of young horses

The objective was to determine the effects of early exercise on the articular cartilage and subchondral bone at specific sites of the distal third metacarpal and metatarsal bones of 12 young Thoroughbred horses allowed free choice exercise at pasture. Six of the horses had additional controlled exercise 5 days per week from mean age of 21+/-20 days of age (range: 3-83 days) until 17.1 months of age. Confocal laser scanning microscopy was used to quantify viable and non-viable chondrocytes. Proteoglycan scoring and modified Mankin scoring was performed and subchondral bone mineral density measured by computed tomography. The number of viable chondrocytes was significantly greater in the conditioned group, which also had a higher Safranin O/Fast Green (SOFG) score than did the group which could exercise only at pasture. There was no difference in mean bone mineral density between groups, nor was there relationship between subchondral bone mineral density and chondrocyte viability. The apparent beneficial effects of early conditioning exercise may support the use of exercise to optimise development of articular cartilage in young individuals.     

Moment arms about the carpal and metacarpophalangeal joints for flexor and extensor muscles in equine forelimbs

OBJECTIVE: To determine whether muscle moment arms at the carpal and metacarpophalangeal joints can be modeled as fixed-radius pulleys for the range of motion associated with the stance phase of the gait in equine forelimbs. SAMPLE POPULATION: 4 cadaveric forelimbs from 2 healthy Thoroughbreds. PROCEDURE: Thin wire cables were sutured at the musculotendinous junction of 9 forelimb muscles. The cables passed through eyelets at each muscle's origin, wrapped around single-turn potentiometers, and were loaded. Tendon excursions, measured as the changes in lengths of the cables, were recorded during manual rotation of the carpal (180 degrees to 70 degrees) and metacarpophalangeal (220 degrees to 110 degrees) joints. Extension of the metacarpophalangeal joint (180 degrees and 220 degrees) was forced with an independent loading frame. Joint angle was monitored with a calibrated potentiometer. Moment arms were calculated from the slopes of the muscle length versus joint angle curves. RESULTS: At the metacarpophalangeal joint, digital flexor muscle moment arms changed in magnitude by < or = 38% during metacarpophalangeal joint extension. Extensor muscle moment arms at the carpal and metacarpophalangeal joints also varied (< or = 41% at the carpus) over the range of joint motion associated with the stance phase of the gait. CONCLUSIONS AND CLINICAL RELEVANCE: Our findings suggest that, apart from the carpal flexor muscles, muscle moment arms in equine forelimbs cannot be modeled as fixed-radius pulleys. Assuming that muscle moment arms at the carpal and metacarpophalangeal joints have constant magnitudes may lead to erroneous estimates of muscle forces in equine forelimbs.     

Galloping exercise induces regional changes in bone density within the third and radial carpal bones of Thoroughbred horses

This study was performed to test the hypothesis that a localised bone hypertrophy could occur within the subchondral cancellous architecture of the third and radial carpal bones. Using 2 levels of controlled and defined exercise, it was observed that a high intensity treadmill exercise protocol resulted in functional adaptation of the carpal bones. The increase in trabecular thickening and density was seen to be localised to those regions underlying common sites of cartilage degradation, the interface of the thickened trabeculae with the normal architecture in the third carpal bone was coincident with a common site of clinical fractures. The bone changes were determined both qualitatively on examination of slab radiographs and quantified by dual energy x-ray absorptiometry. The findings from this study are relevant to mechanical factors involved in the pathophysiology of joint degeneration. The potential clinical implications of this study are in relation to changes in the type and duration of exercise regimens used in training of equine athletes. The rapid response of bone to mechanical stimulation has implications in the longer term for localised cartilage degradation. Imaging techniques could be developed to monitor these early bone changes in the specific areas identified in this study and thus allow appropriate changes in training intensity to minimise subsequent damage to the articular surface.     

Effect of beta-tricalcium phosphate in surgically created subchondral bone defects in male horses

beta-Tricalcium phosphate (TCP) was evaluated as a synthetic bone grafting material in horses. Sixteen horses were randomly assigned to 4 groups of 4 horses. In each horse, an 11-mm by 10-mm circular defect with a smooth margin was created surgically in the weight-bearing surface of both third metacarpal bones (McIII) and the left third metatarsal bone. The defect in the left McIII was filled with TCP, the defect in the right McIII was filled with a mixture of 50% autogenous cancellous bone (ACB) and 50% TCP, and the defect in the left third metatarsal bone was not filled to serve as a control. Nuclear imaging and radiographic evaluation of surgical sites were performed at postsurgical week (PSW) 4 and 13 in group-I horses and at PSW 26, 39, and 52 in groups-II, -III, and -IV horses, respectively. Horses in groups I, II, III, and IV were euthanatized at PSW 13, 26, 39, and 52, respectively, and specimens were harvested for histologic evaluation. Results were compared among treatment methods, as well as among time intervals. The greatest activity at defect sites was seen in group-I horses at PSW 4. Activity counts in limbs of group-I horses at PSW 13 and counts in limbs of group-II horses at PSW 26 were not significantly (P less than or equal to 0.05) different. Activity counts in groups-III and -IV horses at PSW 39 and 52, respectively, were less than those in groups I and II. However, there was no significant difference in activity counts between limbs implanted with TCP or ACB:TCP.(ABSTRACT TRUNCATED AT 250 WORDS)     

Retrospective study of subchondral sclerosis and lucency in the third carpal bone of Standardbred trotters

The aim was to investigate radiographic findings of subchondral sclerosis and subchondral lucency in the dorsoproximal-dorsodistal (DPr-DDi) projection of the third carpal bone (C3) in relation to clinical appearance and to prognosis for racing. In a retrospective study, case records of 89 Standardbred trotters diagnosed with traumatic carpitis confirmed with intra-articular anaesthesia were examined. Records included data on degree of lameness at presentation and after flexion tests and a radiographic examination of the carpus, including a DPr-DDi projection of the C3. Subchondral lucency was found significantly to influence the degree of lameness at presentation and the time to start but did not significantly affect the chance of racing within 30 months post examination. In the present material no significant relationship between degree of sclerosis and lameness or prognosis for racing within 30 months was found, but the low number of C3 with severe sclerosis limited conclusions about that group.