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.     

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.     

ABERRANT ORIGIN OF THE CRANIAL CRUCIATE LIGAMENT MIMICKING AN OSTEOCHONDRAL LESION RADIOGRAPHICALLY: A CASE HISTORY REPORT

An aberrant cranial cruciate ligament mimicked an osteochondral lesion of the lateral femoral condyle in a young dog. This rare condition was diagnosed at surgery. At a four-year follow-up, no radiographic evidence of the apparent osteochondral defect was seen.     

COMPARISON OF RADIOGRAPHIC SUBCHONDRAL BONE CHANGES WITH ARTHROSCOPIC FINDINGS IN THE EQUINE FEMOROPATELLAR AND FEMOROTIBIAL JOINTS: A RETROSPECTIVE STUDY OF 72 JOINTS (50 HORSES)

Radiographs of 72 femoropatellar and femorotibial joints from 50 horses were evaluated. Ninety four arthroscopically evaluated areas were graded according to a predetermined system. The radiographic grade was then compared to arthroscopic findings in the same location. Statistical analysis was performed to determine the association between the radiographic subchondral bone changes and arthroscopic findings. Radiographically normal areas in the femoropatellar joint were arthroscopically positive for cartilaginous changes in 40% of the femoropatellar joints. Areas of mild subchondral bone flattening (grade I) in the lateral trochlear ridge were arthroscopically positive for cartilage changes 78% of the time. Ninety six percent of moderate to severe subchondral bone changes (grades II-V) were arthroscopically positive for cartilage damage. This research demonstrates that (1) a significant number of radiographically normal joints will have cartilage changes, (2) areas of mild subchondral bone flattening have cartilage changes present in the majority of cases and (3) areas of moderate to severe subchondral bone changes have arthroscopically detectable cartilage changes present.     

Comparison of radiography and ultrasonography to detect osteochondrosis lesions in the tarsocrural joint: A prospective study

Reasons for performing study: Lesions located on the medial malleolus of the tarsocrural joint can be difficult to image radiographically. Ultrasonography allows evaluation of articular cartilage and subchondral bone. Objectives: To compare dorso30° lateral‐plantaromedial‐oblique (DL‐PlMO) and dorso45° views to detect lesions on the medial malleolus, to validate the use of ultrasonography to show lesions in the tarsocrural joint and to compare its sensitivity to radiography. Methods: Tarsocrural joints (n = 111) with osteochondrosis were evaluated ultrasonographically and radiographically prior to arthroscopic lesion debridement. A complete radiographic examination was made and the best view to detect each lesion recorded. Longitudinal and transverse ultrasonography of the dorsal aspect of the joint was performed and the best scan plane to image each lesion recorded. Results: There were 94 joints with lesions on the distal intermediate ridge of tibia, 24 with lesions on the medial malleolus, and 4 with lesions on the lateral trochlear ridge. The sensitivity of radiography to detect lesions on the medial malleolus and distal intermediate ridge of tibia was 71 and 96%, respectively. Eighty‐two percent of lesions on the medial malleolus were better imaged on dorso30° view. The sensitivity of ultrasonography to detect lesions on the medial malleolus and distal intermediate ridge of tibia was 83 and 98%, respectively. Ultrasonography was significantly more sensitive than radiography to detect lesions on the medial malleolus and distal intermediate ridge of tibia. Conclusion: Dorso30° lateral‐plantaromedial‐oblique view was the best to image lesions on the medial malleolus. Ultrasonography was a valuable diagnostic tool to diagnose lesions in the tarsocrural joint and was more sensitive than radiography for lesions located on the medial malleolus and distal intermediate ridge of tibia. Clinical relevance: Radiographic examination should include a dorso30° view for detection of lesions on the medial malleolus and ultrasonography should be considered to diagnose osteochondrosis in the tarsocrural joints.     

Articular/epiphyseal osteochondrosis in Thoroughbred foals at 5 months of age: Influences of growth of the foal and prenatal copper supplementation of the dam

AIMS: To determine the influence of copper (Cu) supplementation by injection of mares in late gestation on the frequency and severity of osteochondrosis (OC) lesions in their foals at around 160 days of age. To determine if there was any influence of the concentration of Cu in the liver, growth rate, birthweight, weight at 160 days of age, fatness, sex, or year of birth of the foal on the frequency and severity of OC lesions. To determine the influence of dam's age, and sex and birthweight of the foal on the growth rate from birth to 160 days of age, and weight at 160 days of age.

METHODS: Thirty-three Thoroughbred foals, born in two consecutive years, were weighed every 2 weeks from birth. The dams had been supplemented with parenteral Cu or saline during late gestation, and the supplementation regimens were different in each year. Foals had liver biopsies harvested at birth for determination of Cu concentration. Pasture samples were collected every 4–8 weeks for analysis of concentration of Cu and zinc (Zn). At 160 days of age, articular cartilage of long bones was examined. Gross lesions were counted and scored, then sawn and radiographed, and processed for histopathology. Lesions were given radiographic scores and histopathological scores. Maximum scores for each lesion were combined to give a total OC score for each joint and each foal. The fatness of 20 foals (10 each from Years 1 and 2) at 160 days of age was determined chemically.

RESULTS: Supplementation of dams with Cu had no significant effect on the concentration of Cu in the liver of foals at birth, or on the frequency or severity of lesions in articular cartilage at 160 days of age. The Cu and Zn concentrations of pasture were similar in Years 1 and 2, and were lower than current recommendations. All foals in Year 2, and 9/10 foals in Year 1 had irregularities in cartilage that was confirmed histologically to be indicative of OC. The average number of lesions per foal was 4.7 (SD 1.1) and 5.7 (SD 1.1) in Years 1 and 2, respectively. However, the severity of the lesions was considered mild, and no foals showed any clinical evidence of OC while alive. The number of lesions in the tarsocrural (TC) joint and the TC OC score at 160 days were positively associated with average daily weight gain (ADG) in the previous 4 weeks (p=0.005 and p=0.001, respectively). There was no significant effect of sex, fatness, birth-weight, weight at 160 days of age, or year of birth of the foal on the frequency and severity of OC lesions.

CONCLUSIONS: Many of the lesions classified as OC, using classification systems described by other authors, were likely to be normal variations of the process of endochondral ossification. Despite the high frequency of such lesions, they were considered to be of minor significance and none were clinically evident. The distribution of lesions was not typical, and most probably reflected the subtlety of the lesions. These results support the hypothesis that Cu is an over-emphasised factor in the aetiopathogenesis of OC. The relationship between subtle macroscopic lesions and lesions resulting in clinical signs of disease requires further investigation.     

Equine hospital data as a source for study of prevalence and heritability of osteochondrosis and palmar/plantar osseous fragments of Swedish Warmblood horses

Reasons for performing study: Disturbances in skeletal development, primarily osteochondrosis (OC) and palmar/plantar osseous fragments (POF), have been commonly reported as problems in young horses. However, there are few reports of such findings for epidemiological analyses or breeding purposes. Objectives: To evaluate equine hospital data as a possible source of information for genetic evaluations by estimating prevalence and heritability of OC in the stifle, hock and fetlock joints and of POF in the fetlock. Methods: Data on Swedish Warmblood (SWB) horses were obtained from a large equine hospital in south Sweden. Prevalences were based on radiographic examinations of 879 screened horses, mainly evaluated as part of a prepurchase examination and 3639 horses with a reported history of orthopaedic problems. For the heritability study the 2 data sources were pooled and 3199 examined horses with pedigree information were considered for the linear animal model analyses. Results: The overall prevalence of OC was 13% (stifle 9%, hock 6% and dorsal osseous fragments in fetlock [DOF] 10%) and POF 10%. The overall heritability of OC was 0.05 on the visible binomial scale. The corresponding heritabilities for OC in the stifle were 0.03, hock 0.08, DOF 0.10 and POF 0.13. These values correspond to heritabilities of 0.09–0.38 on the underlying quantitative scale. Conclusions and potential relevance: Obtained prevalences and heritabilities were in accordance with other studies, supporting the hypothesis that data regularly obtained from equine hospitals may be a valuable source in studies of inherited disorders such as OC and POF. There is a need for more standardised documentation of diagnoses and consistent recording of identity of examined horses using passports or breed databases. Compilation of results from major clinics is desired in order to cover most progenies of stallions used in a region or nation.     

Racing performance following the laryngeal tie-forward procedure: a case-controlled study

REASONS FOR PERFORMING STUDY: The laryngeal tie-forward procedure (LTFP) is becoming widely used for correction of dorsal displacement of the soft palate (DDSP) despite the absence of an evidence-based assessment of its efficacy. HYPOTHESES: The LTFP returns racing performance to preoperative baseline levels and to that of matched controls; and post operative laryngohyoid position is associated with post operative performance. DESIGN AND POPULATION: Case-controlled study of racehorses undergoing a LTFP for dorsal displacement of the soft palate at Cornell University between October 2002 and June 2007. METHODS: The presence of at least one post operative start and race earnings ($) were used as outcome variables. Controls were matched by age, breed and sex from the third race prior to surgery. A novel radiographic reference system was used to determine laryngohyoid position pre- and post operatively. Data for definitively and presumptively diagnosed cases were analysed separately. RESULTS: During the study interval, 263 racehorses presented, of which 106 were included in the study; 36 had a definitive diagnosis of DDSP and 70 a presumptive diagnosis. Treated horses were equally likely to race post operatively as controls in the equivalent race. Treated horses had significantly lower earnings in the race before surgery than matched controls. The procedure moved the basihyoid bone dorsally and caudally and the larynx dorsally and rostrally. A more dorsal post operative basihyoid position and more dorsal and less rostral laryngeal position were associated with an increased probability of racing post operatively. CONCLUSIONS: Horses undergoing a LTFP are as likely to race post operatively as matched controls. The procedure restores race earnings to preoperative baseline levels and to those of matched controls. POTENTIAL RELEVANCE: This study provides strong evidence supporting the use of the LTFP in racehorses. Further work is needed to determine the relationship between laryngohyoid conformation and nasopharyngeal stability in horses.     

Pemphigus foliaceus in the horse: a retrospective study of 20 cases

Twenty horses with pemphigus foliaceus were seen over a period of 15 years in a veterinary medical teaching hospital. Breeds seen were seven quarterhorses, five thoroughbreds, three cross-bred horses, two Arabians and one of each of the following: standardbred, Tennessee walker and warmblood. There was no breed, age or sex predisposition. Nine were mares, ten were geldings and one was a stallion. Ages ranged from 2.5 months to 25 years, with a mean of 8.6 years. Sixteen (80%) of the pemphigus foliaceus horses first exhibited signs between September and February. There was a statistically significant more common occurrence of pemphigus foliaceus during those months. Signs in the four other horses were first noted in March, May or June. Three of those horses were < 13 months of age. Oedema (14/20) and crusts (13/20) were the most common lesions. Pain was present in 9/20 horses, pruritus in 7/20 and pyrexia in 7/20. Follow-up was available for 13 horses. Five of these horses were euthanased. In three horses the reason for euthanasia was laminitis secondary to treatment. Four horses remained lesion-free after medication was discontinued. Two horses required maintenance medication and are doing well at the time of writing.     

Treatment of equine glaucoma by transscleral neodymium:yttrium aluminum garnet laser cyclophotocoagulation: a retrospective study of 23 eyes of 16 horses

Contact neodymium:yttrium aluminum garnet (Nd:YAG) laser transscleral cyclophotocoagulation (TSCP) was performed on 23 eyes of 16 horses for treatment of glaucoma. The mean highest preoperative IOP was 51 ± 17 mmHg. Follow-up evaluation was available for 19 eyes 1 day after surgery, 14 eyes from 1 to 2 weeks, 16 eyes from 4 to 6 weeks, 9 eyes from 12 to 16 weeks, and 10 eyes greater than 20 weeks after laser treatment. The mean intraocular pressure (IOP) the day following surgery was 34 ± 13 mmHg. The mean IOP for each follow-up period was: one to two weeks postoperative, 23 ± 9 mmHg; four to six weeks, 24 ± 7 mmHg; 12–16 weeks, 28 ± 10 mmHg; and  20 weeks, 22 ± 9 mmHg. IOP measurements were significantly different from pretreatment values for all follow-up intervals except for weeks 12–16 ( P < 0.05). Treatment success was defined as maintenance of IOP < 30 mmHg. Treatment success was achieved in 93%, 88%, 78%, and 70% of the treated eyes at the 1–2 weeks, 4–6 weeks, 12–16 weeks, and the  20 weeks re-evaluation, respectively. No significant difference was found between the number of eyes visual at presentation (52.2%) and visual at 20 weeks (60%). The most common laser complications were conjunctival hyperemia (21.7%) and corneal ulcers (13.0%). Results of this study indicate that Nd:YAG TSCP is an effective method of controlling IOP and preserving vision in horses with glaucoma. An effective Nd:YAG laser protocol for TSCP in the equine glaucomatous eye is a power setting of 11 W, duration of 0.4 s, applied 5 mm posterior to the limbus at 60 sites, resulting in a total energy dose of 264 J.     

The use of race winnings, ratings and a performance index to assess the effect of thermocautery of the soft palate for treatment of horses with suspected intermittent dorsal displacement. A case-control study in 110 racing Thoroughbreds

REASONS FOR PERFORMING THE STUDY: There have been no reports of the efficacy of thermocautery of the soft palate (TSP) assessed objectively as a treatment of intermittent dorsal displacement of the soft palate (DDSP). OBJECTIVE: To compare: racing performance of horses that underwent thermocautery of the soft palate with matched controls; and 'Racing Post ratings' (RPR) with prize money won (RE) and a performance index (PI) for each of the horses in the study. HYPOTHESIS: Thermocautery of the soft palate has no beneficial effect on racing performance and the 3 measures of performance are significantly related. METHODS: The inclusion criteria were fulfilled by 110 horses and each was matched with 2 controls. Changes in performance were compared statistically. RPR, RE and PI were analysed using a regression model. RESULTS: The percentage of horses that improved in performance following the procedure was 28-51% for the 3 measures of performance, compared to 21-53% for the matched controls. There was no significant effect of the procedure on the changes in RPR or RE. There was a significant effect of the procedure on the change in PI (P=0.015) with more treated horses achieving an improved PI and fewer acquiring a worse PI than matched control horses. The measures of performance showed significant correlation. CONCLUSIONS: Thermocautery of the soft palate alone may not be the most efficacious treatment of DDSP. POTENTIAL RELEVANCE: Production of a reliable measure of racehorse performance may be possible.     

Risk of anesthesia-related complications in draft horses: a retrospective,single-center analysis

ObjectiveTo report anesthetic-related complications and determine risks associated with anesthesia in draft horses.Study designRetrospective study.AnimalsA total of 401 anesthetic records for draft horse breeds that underwent general anesthesia from January 2010 through December 2020 were reviewed; horses euthanized during general anesthesia were excluded.MethodsDemographics, perioperative drugs used, procedure type and duration, time to extubation, number of attempts to stand, use of sling in recovery and perioperative morbidity and mortality were investigated. Morbidity and mortality statistical evaluation included univariable logistic regression analysis and ordinal regression analysis.ResultsAmerican Society of Anesthesiologists (ASA) status I–II, ASA III–V and total mortality rate for all cases was 0.69% (2/288), 6.19% (7/113) and 2.24% (9/401), respectively, with Belgian horses being overrepresented (6/9). Cardiac arrest occurred in six out of nine horses that died without euthanasia, and five out of six of these horses underwent colic surgery. Factors associated with increased mortality risk included ASA status of III–V, increased body weight, emergency status and horses presenting for colic. Hypotension, hypercarbia and hypoxemia occurred in 56% (224/401), 46% (186/401) and 14% (58/401) of horses, respectively. During recovery from anesthesia, lighter horses and horses undergoing shorter anesthetic procedures were more likely to be successful on the first or second attempt to stand and were less likely to require a sling in recovery.Conclusions and clinical relevanceDraft horses undergoing general anesthesia had a higher mortality rate than previously reported for all types and breeds of horses.     

Endodontic treatment of a mandibular premolar abscess in a horse: A case study

A pulpar abscess of cheek tooth 307 (according to the Triadan numerical system) was diagnosed in a 7‐year‐old female Quarter Horse. History included a painful response to palpation in the mandibular region for approximately 4 weeks. Symptoms included swelling of the mandibular bone with subsequent fistulisation. A complete intraoral examination was performed and no lesions or abnormalities were found. Digital radiographs of the mandibular arcade demonstrated a periapical lesion of cheek tooth 307. Various therapeutic options were considered, including standing oral extraction, retrograde repulsion and endodontic therapy. Together with the client, a decision was made to perform endodontic therapy, with the double aim of preserving the tooth and maintaining normal molar occlusion. This was done under general anaesthesia without apicectomy, and using materials commonly used in the field of human endodontics. Following surgery, radiographs were taken and confirmed the complete sealing of the pulp canals. Recovery was uneventful and no post operative complications were observed. A complete intraoral follow‐up examination was performed one year after surgery, and revealed normal eruption and occlusion of the tooth involved. Radiographic examination confirmed the correct position and integrity of the sealant material, as well as normal perialveolar bone structure. This case report indicates that endodontic therapy, following the above protocol, involving pulpectomy and sealing of the pulp cavity, represents a valid alternative to the more commonly used technique of tooth extraction.