Intrathecal deep digital flexor tenectomy for treatment of septic tendonitis/tenosynovitis in four horses

Objective: To describe partial removal of the intrathecal component of the deep digital flexor tendon (DDFT) in horses with chronic septic DDF tendonitis and tenosynovitis unresponsive to conventional therapy, and to report long‐term outcome. Study Design: Case series. Animals: Horses (n=4). Methods: Four horses with chronic septic DDF tendonitis and tenosynovitis were treated by surgical tenectomy of the intrathecal component of the DDFT, followed by stabilization in casts and subsequent corrective shoeing. All horses were previously managed unsuccessfully with combinations of conventional therapy consisting of systemic antibiotics, through and through tendon sheath lavage/open drainage, regional limb perfusions, tenoscopy with debridement and transection of the palmar/plantar annular ligament, and intrathecal antibiotics. Results: Time from initial injury/diagnosis to tenectomy ranged from 10 to 210 days. Mean hospitalization time after surgery was 82 days. Long‐term follow‐up (>1.5 years; mean, 3.8 years) was available. All 4 horses were able to walk comfortably at pasture and were used as broodmares. Conclusions: Intrathecal tenectomy is a viable surgical procedure for treatment of chronic septic tenosynovitis of the digital sheath that is complicated by septic tendonitis of the DDFT.     

Heel bulb lacerations in horses: 101 cases (1988-1994)

OBJECTIVE: To determine clinical history, structures involved, treatment, and outcome of lacerations of the heel bulb and proximal phalangeal region (pastern) in horses. DESIGN: Retrospective study. ANIMALS: 101 horses. PROCEDURES: Medical records of horses with lacerations of the heel bulb and pastern were reviewed, and follow-up information was obtained. RESULTS: 75 horses were Quarter Horses. Most horses were not treated with antimicrobial drugs prior to referral. Mean +/- SD time from injury to referral was 24 +/- 45 hours (range, 1 to 168 hours). Lacerations were most frequently caused by contact with wire or metal objects. In 17 horses, lacerations involved synovial structures; the distal interphalangeal joint was most commonly affected. One horse was euthanatized after initial examination. Wound treatment consisted of cleansing, lavage, debridement, lavage of affected synovial structures, suturing of fresh wounds, and application of a foot bandage or cast. Fifty-six horses were treated with systemically administered antimicrobial drugs. Follow-up information was collected for 61 horses. Fifty-one horses returned to their intended use and had no further complications; 10 horses had complications associated with the wound, and of those horses, 5 were euthanatized and 1 horse died from an unrelated cause. Horses with lacerations that involved synovial structures had worse outcomes than horses with lacerations that did not involve synovial structures. CONCLUSIONS AND CLINICAL RELEVANCE: Horses that sustain heel bulb lacerations can successfully return to their intended use. Involvement of the distal interphalangeal joint is associated with poor prognosis.     

Treatment of septic common digital extensor tenosynovitis by complete resection in seven horses

OBJECTIVE: To describe and evaluate a technique for radical resection of the entire intrathecal component of the common digital extensor tendon (CDET) in horses. STUDY DESIGN: Prospective clinical study. ANIMALS OR SAMPLE POPULATION: Seven client-owned horses. METHODS: Seven horses with wounds that resulted in septic tenosynovitis of the CDET sheath were treated by complete surgical resection of the affected tendon and ablation of the tendon sheath; 5 had previous surgery that was unsuccessful. Time from initial injury to complete resection was 1-22 weeks. In 6 horses, the wound was closed primarily using a closed suction (4 horses), penrose (1), or passive open drainage system (1). In 1 horse, the surgical wound healed by second intention. All horses had postoperative bandaging, antibiotic administration, and physiotherapy. RESULTS: Surgical wounds healed primarily in 6 horses and by second intention in 1 horse. Follow-up (mean, 26.4 months; range, 18-38 months) was available for 6 horses; all returned to their athletic performance level without lameness or gait abnormality. CONCLUSIONS: Complete resection of the CDET was an effective surgical technique for management of chronic septic tenosynovitis. CLINICAL RELEVANCE: Horses with infection of the CDET and its sheath may be returned to long-term soundness without gait abnormality after radical resection.     

Desmotomy of the accessory ligament of the deep digital flexor tendon in the forelimb of 24 horses 2 years and older

Objective: To report outcome after desmotomy of the accessory ligament of the deep digital flexor tendon (ALDDFT) in adult horses (≥2 years) for treatment of desmitis of the ALDDFT or flexural deformity of the distal interphalangeal joint (FDDIJ). Study Design: Case series. Animals: Horses with desmitis of the ALDDFT (n=9) and FDDIJ (n=15). Methods: Records (April 1996–July 2008) of 24 adult horses (mean age, 6.7 years) that had ALDDFT desmotomy were reviewed. Follow‐up data was obtained 12–120 months after desmotomy. Results: Outcome was available for 22 horses; 18 (82%; 6 of 8 horses with desmitis of the ALDDFT and 12 of 14 with FDDIJ) returned to their intended use within 6–24 months (mean, 12 months). Conclusion: In mature horses, ALDDFT desmotomy resulted in successful return to intended use in most horses with ALDDFT desmitis (75%) or FDDIJ (86%).     

Tenoscopic surgery for treatment of lacerations of the digital flexor tendon sheath

REASONS FOR PERFORMING STUDY: Lacerations to the digital flexor tendon sheath (DFTS) are a common injury in the horse, but little information is available in the literature regarding prognostic indicators. OBJECTIVE: To ascertain whether laceration of the DFTS carried a better prognosis if treated by tenoscopic lavage, debridement and repair within 36 h of the original injury. METHODS: A retrospective analysis of 39 horses treated surgically for lacerations to the DFTS was performed over a 3 year period. The injury-to-surgery interval was recorded as <36 or >36 h. The structures damaged by the injury were also recorded, as well as age, sex, use and outcome. RESULTS: Sixteen horses had laceration and contamination of the DFTS alone, of which 15 (94%) returned to their original or intended use. Sixteen horses had lacerations involving the superficial digital flexor tendon, of which 12 (75%) made a full recovery. Six horses had lacerations to both superficial and deep digital flexor tendons, 5 were subjected to euthanasia intraoperatively and one is paddock sound. Treatment within 36 h of initial laceration carried a significantly better prognosis for return to intended athletic use (25 of 28 horses allowed to recover from anaesthesia) than treatment after 36 h (2 of 5 P = 0.03; Fisher's Exact Test). CONCLUSIONS: If sepsis is treated early using tenoscopic visualisation, lavage and repositol antibiotics, the limiting factor in return to athletic function is tendon damage. POTENTIAL RELEVANCE: This study supports anecdotal evidence that early treatment of synovial sepsis improves the prognosis for return to intended use. It also provides information on prognostic indicators including extent of damage to collateral structures.     

Open drainage, intra-articular and systemic antibiotics in the treatment of septic arthritis/tenosynovitis in horses.

Open drainage was used to treat 26 horses with persistent or severe septic arthritis/tenosynovitis. Infected synovial structures were drained through a small (3 cm) arthrotomy incision that was left open and protected by a sterile bandage. Joint lavage was performed in all 26 horses. In addition to systemic antibiotics, 23 of these horses were also treated with intra-articular antibiotics; amikacin (17 horses), gentamycin (2 horses), cefazolin (2 horses), and 2 horses were injected at different times with gentamycin and amikacin. The infection was eliminated from the involved synovial structures in 25 of 26 horses; 24 survived and were released from the hospital. The arthrotomy incisions healed by granulation in 16 horses; in 9 horses the arthrotomy incision was sutured closed once the infection was eliminated. Seventeen horses returned to soundness and resumed athletic function. Open drainage was an effective method of achieving chronic drainage from a joint or tendon sheath. It is indicated in horses that have established intra-synovial infections or in horses that do not respond to joint lavage through needles.     

What is the likelihood that a horse treated for septic digital tenosynovitis will return to its previous level of athletic function?

REASONS FOR PERFORMING STUDY: Septic digital tenosynovitis is a serious problem in the horse, with a poor prognosis being reported for recovery. HYPOTHESIS: The occurrence of septic digital tenosynovitis would significantly reduce the likelihood of a horse returning to its previous level of athletic function. METHODS: Medical records of 90 horses treated for septic digital tenosynovitis were reviewed. Data retrieved included age, sex, location of inciting cause of sepsis, time from onset of clinical signs to presentation for treatment, and whether the horse survived to be discharged. Long-term outcome was determined through telephone questionnaires. Univariate analyses of categorical variables were conducted for each outcome. RESULTS: Overall, 87.8% of horses (79/90) survived to be discharged from the hospital. Only one factor examined was shown to have a significant effect on outcome. A delay of 1-7 days between onset of clinical signs and presentation for treatment reduced significantly the likelihood of the horse surviving to be discharged from the hospital. Of the horses discharged from the hospital, long-term follow-up was available for 72 horses, with 54.2% (39/72) returning to their previous level of athletic function. CONCLUSIONS: Only approximately 50% of horses treated for septic digital tenosynovitis returned to their previous level of athletic function following resolution of synovial sepsis. POTENTIAL RELEVANCE: Accurate figures allowing a realistic assessment of the athletic future of a horse following treatment for septic digital tenosynovitis are of value to both the owner and treating veterinarian.     

Traumatic Septic Tenosynovitis of the Tarsal Sheath with Fragmentation of the Sustentaculum Tali: Surgical Treatment and Outcome in 3 Horses

This case report describes surgical treatment of 3 cases of septic chronic tenosynovitis of the tarsal sheath with fragmentation of the sustentaculum tali in 3 horses. Diagnosis was based on clinical signs, radiographic and ultrasonographic findings, synovial fluid cytology, and bacteriology. In each case, treatment consisted of tenovaginoscopy of the tarsal sheath performed with the horse under general anesthesia and regional intravenous perfusion of antibiotics. Follow-up data obtained between 12 and 46 months after surgery reported a good outcome, with a good cosmetic appearance in all cases described. Two horses returned to their intended use at 44 and 46 months, and 1 horse reportedly showed a remarkable functional improvement after 12 months. Despite the poor prognosis associated with the chronicity of the lesions, the presence of adhesions and the degree of involvement of the lateral digital flexor tendon, tenovaginoscopy of the tarsal sheath and regional antimicrobial therapy were successful therapeutic options for treating septic tenosynovitis of the tarsal sheath with fragmentation of the sustentaculum tali.     

Tenoscopy in 33 horses with septic and nonseptic digital tenosynovitis (1997–2001)

Tenoscopy is the use of an arthroscope to access tendon sheaths. This article reports clinical findings, treatments, and outcomes of 33 horses with either septic or nonseptic digital tenosynovitis submitted to 36 tenoscopies during 34 occasions at the Marion duPont Scott Equine Medical Center (1997–2001). Two of the 16 horses with septic tenosynovitis were euthanized at the hospital. From the 32 horses discharged from the hospital, outcome was obtained in 31 cases: 12 horses (6 septic) could work at the same level. No difference was detected between the outcome groups regarding clinical and laboratory variables. In nonseptic cases, lameness grade, circulating white blood cells, and plasma fibrinogen before surgery were lower, while the period between the onset of clinical signs and surgery was longer and duration of phenylbutazone treatment and hospitalization was shorter. No difference in the outcome was detected when septic and nonseptic cases were compared. Tenoscopy was useful for diagnosis and treatment of nonseptic and septic digital tenosynovitis. The small number of cases and the lack of accurate information due to the retrospective nature of the study may have prevented detection of a difference between the outcomes of horses with septic versus nonseptic tenosynovitis.     

Tenoscopic examination and proximal annular ligament desmotomy for treatment of equine "complex" digital sheath tenosynovitis

OBJECTIVE: To determine the outcome of horses with "complex" digital tenosynovitis treated by tenoscopic proximal annular ligament desmotomy and resection of synovial masses or adhesions, or both, within the digital sheath. STUDY DESIGN: Retrospective evaluation. ANIMALS OR SAMPLE POPULATION: Twenty-five horses with a clinical and ultrasonographic diagnosis of palmar or plantar proximal annular ligament constriction and ultrasonographic evidence of synovial masses or adhesions within the digital tendon sheath. METHODS: Each horse had tenoscopic surgery for annular ligament desmotomy combined with adhesiolysis and/or synovial mass resection. Mean follow-up time was 3.4 years. Spearman's rank correlation was used to assess the relationship between functional outcome or cosmetic results and preoperative variables including duration of clinical signs, digital sheath synovial fluid total protein concentration and nucleated cell count, thickness of the palmar or plantar proximal annular ligament (PAL), severity of adhesions, severity of synovial masses, degree of synovial distention, or limb affected. RESULTS: A total of 18 (72%) horses returned to athletic soundness, 4 were improved but not sound, and 3 were not improved. Cosmetic outcome was normal in 10 horses, improved but not normal in 12, and not improved in 3 horses. Cosmetic and functional outcome were significantly adversely affected by the duration of clinical signs and the severity of synovial masses. CONCLUSIONS: With appropriate tenoscopic surgical attention, horses with complex tenosynovitis syndrome characterized by synovial masses, adhesions, or both adhesions and masses, and PAL constriction, have a good prognosis for return to athletic soundness. CLINICAL RELEVANCE: Horses with PAL constriction and additional digital tendon sheath pathology such as adhesions and synovial masses have a 72% chance of returning to sound athletic performance, however 60% of horses retain some degree of cosmetic blemish in the affected limb. There is an inverse relationship between the duration of clinical signs and outcome, and therefore, prompt surgical attention is advised.     

Digital extensor tendon lacerations in horses: A retrospective evaluation of 22 cases

Hospital records of 22 horses referred to the Royal Veterinary and Agricultural University (RVAU) of Copenhagen between January 1, 1990 and December 31, 1993 for treatment of digital extensor tendon laations were reviewed, and follow-up information on final outcome was collected to determine whether any injury or treatment factors could be associated with the outcome.

Mean age of the horses was 5.2 years (range, 1 to 20 years), and follow-up time ranged from 1 to 5 years after injury. In 21 (95%) of the horses, injury involved the hind limbs. Eleven (50%) horses returned to their original or intended level of use. Eighteen (82%) horses had no signs of lameness. There was no statistically significant correlation between outcome and elapsed time from injury to treatment, type of injury, treatment variables, or wound healing in the present study, and these findings support previous reports.

It was concluded that horses with digital extensor tendon lacerations had a favorable prognosis for return to riding soundness and a fair prognosis for return to their original or intended level of use. Tendon suturing and primary wound healing did not improve the prognosis.     

Surgical Approach for Removal of Nonarticular Base Sesamoid Fragments of the Proximal Sesamoid Bones in Horses

Objectives— To describe a surgical approach for the removal of nonarticular base sesamoid fragments in performance horses and to report the outcome. Study Design— Retrospective study. Animals— Horses (n=11), 7 months to 10 years of age, with lameness because of nonarticular base sesamoid fragments. Methods— Lameness was localized to the metacarpophalangeal/metatarsophalangeal region by clinical examination or response to diagnostic local anesthesia. Radiographs confirmed the diagnosis of a nonarticular base sesamoid fragment. Surgical removal was performed with an incision over the base of the affected sesamoid through the digital flexor tendon sheath. After identifying the fragment with the aid of needles, a small vertical incision was made in the straight distal sesamoidean ligament (SDSL) and the fragment was freed from its attachments and removed. Six months convalescence and rehabilitation was prescribed for all horses. Results— Eleven horses had 16 nonarticular fragments of the base of the proximal sesamoid bones. Eleven (69%) fragments occurred in the forelimbs with the right front (82%) and medial sesamoid (73%) more commonly affected. Horses were treated by surgical fragment removal. In horses with follow‐up, 9 of 10 returned to their intended use. Conclusions— Surgical removal of nonarticular base sesamoid fragments can be accomplished through a palmar/plantar approach through the digital flexor tendon sheath and SDSL. This “keyhole” approach minimizes damage to the distal sesamoidean ligament attachments to the sesamoid base and allows some horses to return to their intended use. Clinical Relevance— Surgical removal of nonarticular base sesamoid fragments should be considered in horses with performance‐limiting lameness as a result of the fragment.     

Outcome of conservative and surgical treatment for luxations of the equine superficial digital flexor tendon from the calcaneal tuber

The objective of this study was to report the outcome of horses treated either conservatively or surgically for luxation of the superficial digital flexor tendon (SDFT) from the calcaneal tuber. Medical records of horses with diagnosed SDFT luxations from the calcaneal tuber were reviewed (1993–2015) and long-term follow-up examinations and owner questionnaires performed. Survival to hospital discharge, complications, final SDFT position, soundness and return to intended use were compared between conservatively or surgically treated horses. Following conservative treatment all horses (n = 8) survived to hospital discharge. At long-term follow-up 71.4% (5/7) had returned to intended use. The SDFT was unstable in all of them resulting in a mild mechanical lameness. Nine horses underwent surgical treatment. The SDFT was reduced and maintained in position with a synthetic mesh and sutures (n = 2), with a synthetic mesh, sutures and suture screws (n = 6) or with sutures and suture screws (n = 1). Only 66.7% (6/9) of the horses survived to hospital discharge. Fatal complications including support limb laminitis (1/9), implant infection (1/9), and support limb laminitis plus infection (1/9) occurred. All horses available for long-term follow-up (n = 5) were clinically sound and 80% (4/5) had returned to intended use. Following conservative treatment, a mild mechanical lameness will persist but will not prevent the horses from returning to their intended use. Surgical repair can result in a stable fixation of the SDFT with long-term soundness and return to intended use; however, fatal complications (support limb laminitis, infection) can occur leading to the euthanasia of the horse in the immediate post-operative period.     

Return to use and performance following exploratory celiotomy for colic in horses: 195 cases (2003–2010)

Reasons for performing study: There are few objective data on return to use and performance in horses following colic surgery. Objective: To investigate return to functional use of horses following colic surgery and factors associated with a negative outcome. Methods: The North Carolina State University Equine Colic Database was reviewed for horses that underwent exploratory celiotomy for colic (2003–2010). Horses were excluded from the study if they survived <6 months, had no intended use preoperatively, or if further data were not available at attempted follow‐up. Information retrieved included history, background, use, and selected pre‐, intra‐, and post operative factors. Telephone interviews were used to obtain follow‐up data. Logistic regression was used to investigate associations between clinical data and outcome, reported as odds ratios with a 95% confidence interval and corresponding P value. Results: Of patients surviving to 6 months, 133/195 (68%) were performing their intended use and 85/156 (54%) were at or above preoperative performance. At one year, 145/190 (76%) horses were performing their intended use and 101/153 (66%) were at or above preoperative performance. Animals were significantly less likely to return to use/performance if they had a previous celiotomy, stall rest for an orthopaedic condition, a nonstrangulating lesion type, incisional hernia, diarrhoea or laminitis. Conclusions: The overall prognosis for return to use and performance following colic surgery is fair to good. Multiple pre‐ and post operative factors may affect the likelihood of return to use and performance. Potential relevance: Targeted owner education regarding preoperative lameness, post operative rehabilitation and treatment for complications, such as incisional hernioplasty, may help inform owners about their horse's potential for return to use and performance following colic surgery.     

Osteomyelitis of the sustentaculum tali in horses: 10 cases (1992-1998)

OBJECTIVE: To determine outcome of horses with osteomyelitis of the sustentaculum tali (ST), with or without associated tarsal sheath tenosynovitis, following surgical debridement and lavage. DESIGN: Retrospective study. ANIMALS: 10 horses in which a diagnosis of osteomyelitis of the ST had been made on the basis of history, physical examination findings, and results of radiography. PROCEDURE: Information on results of diagnostic testing, surgical findings, postoperative treatment, and short-term outcome was obtained from the medical records. Long-term follow-up information was obtained through reevaluation of horses at the teaching hospital and telephone conversations with referring veterinarians, owners, and trainers. RESULTS: Treatment consisted of surgical debridement, intra- and postoperative lavage, and long-term antimicrobial and anti-inflammatory treatment. Eight horses had evidence of involvement of the tarsal sheath. One horse was euthanatized after surgery because of a lack of response to treatment; the other 9 were discharged from the hospital. Severity of lameness had improved, but all still had grade-1 or -2 lameness at the time of discharge. One horse was euthanatized after discharge because of contralateral hind limb laminitis, and another horse was lost to follow-up. Of the remaining 7 horses, 6 returned to their previous use, and 1 was sound but retired for breeding for unrelated reasons. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that horses with osteomyelitis of the ST, with or without concomitant tarsal sheath tenosynovitis, can have an excellent to good outcome and may return to their previous use after surgical debridement of affected tissues and lavage of the tarsal sheath.     

Septic tenosynovitis in horses: 25 cases (1983-1989).

The medical records of 25 horses with septic tenosynovitis treated over 7 years (1983 to 1989) were reviewed to determine clinical features of the disease and response to treatment. The median age of horses with septic tenosynovitis was 5 years (range, 1 month to 21 years). Fourteen fore limbs and 11 hind limbs were affected. Sepsis was located in the sheath of the digital flexor tendons of 22 horses. Sepsis was located in the sheath of the extensor carpi radialis tendon (1 horse), sheath of the long digital extensor tendon (1 horse), or sheath of the common digital extensor tendon (1 horse) in the remaining horses. Nine horses received only medical treatment, using a combination of broad-spectrum parenterally administered antimicrobial drugs (8 of 9 horses), nonsteroidal anti-inflammatory drugs (8 of 9 horses), or irrigation of the wound (4 of 9 horses). Fourteen horses were treated surgically with either transection of the palmar/plantar annular ligament of the metacarpo/metatarsophalangeal joint (5 of 14 horses), lavage of the sheath after insertion of drains into the sheath (7 of 14 horses), or both (2 of 14 horses). All horses treated surgically were concurrently treated parenterally with broad-spectrum antimicrobial drugs and nonsteroidal anti-inflammatory drugs. Two horses with septic tenosynovitis were not treated and were euthanatized at the owners' request. Five horses were euthanatized before discharge from the hospital. Two horses (both treated medically) were lost to follow-up. Follow-up information was obtained for 18 horses, 6 to 55 months after discharge from the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)     

Lameness associated with foot pain: results of magnetic resonance imaging in 199 horses (January 2001--December 2003) and response to treatment

REASONS FOR PERFORMING STUDY: The diagnosis of foot-related lameness often remains elusive and it can be difficult to offer rational treatment, or to predict outcome. OBJECTIVES: To describe the spectrum of injuries of the foot identified using magnetic resonance imaging (MRI), to determine their relative prevalence among MRI diagnoses and to establish the long-term results of treatment. METHODS: The MR images of horses examined from January 2001--December 2003 were reviewed. Horses were selected for MRI if the pain causing lameness was localised to the foot using perineural analgesia but any clinical, radiological or ultrasonographic abnormalities were insufficient to explain the degree of lameness. The clinical significance of lesions identified using MRI was determined with reference to the results of local analgesia, radiography, ultrasonography and nuclear scintigraphy. Follow-up information was obtained in January 2004 for horses which had been examined 6-36 months previously and the outcome classified as excellent (horse returned to full athletic function without recurrent lameness), moderate (sound, but only in light work), or poor (persistent or recurrent lameness). RESULTS: One hundred and ninety-nine horses underwent MRI examinations. Deep digital flexor (DDF) tendonitis was the most common injury (59%) with primary injury in 65 horses (33%) and a further 27 horses (14%) having lesions of the DDF tendon and navicular bone. Seventeen percent of horses had injuries to multiple structures, including 24 with DDF tendonitis. Desmitis of a collateral ligament (CL) of the distal interphalangeal (DIP) joint was the second most common injury (62 horses, 31%), with primary injuries in 30 horses (15%) and a further 32 horses (16%) that had CL desmitis in conjunction with other injuries. Prognosis was best for horses with traumatic injuries of the middle or distal phalanges, with 5 of 7 horses (71%) having an excellent outcome. Horses with primary lesions of the DDF tendon or CL of the DIP joint had excellent results in only 13 of 47 (28%) and 5 of 17 horses (29%), respectively. Horses with combined injuries of the DDF tendon and navicular bone, or primary navicular bone abnormalities, had a poor outcome, with the majority of horses suffering persistent lameness. CONCLUSIONS: A wide variety of lesions associated with foot pain were identified using MRI, a high proportion of which were primary soft tissue injuries with a guarded prognosis for return to full athletic function. POTENTIAL RELEVANCE: It is now possible to propose more rational treatment strategies for the variety of foot injuries identified using MRI than had previously been possible; however, further information concerning aetiopathogenesis of these injuries is needed to improve their management.     

Long-Term Outcome in 44 Horses with Stifle Lameness After Arthroscopic Exploration and Debridement

Objective— To (1) examine the outcome in horses with osteoarthritis or intra‐articular soft tissue injuries of the stifle after arthroscopic exploration and debridement and (2) to determine any imaging or surgical findings that may influence prognosis. Design— Case series. Animals— Horses (n=44) with lameness referable to the stifle, diagnosed with osteoarthritis, meniscal tears, or other intra‐articular soft tissue injuries based on arthroscopic examination. Methods— Medical records of horses with stifle lameness that had arthroscopic exploration were reviewed. Horses with osteochondrosis lesions, intra‐articular fractures, or osseous cyst‐like lesions were excluded. Pertinent case information was analyzed and short‐ and long‐term outcome was assessed. Results— There was no association between radiographic score and surgery score. Diagnostic ultrasound had a sensitivity of 79% and a specificity of 56% for identifying meniscal injuries. Follow‐up information was available for 35 horses; 23 horses (60%) improved after surgery, 16 (46%) became sound, and 13 (37%) returned to their previous level of function. A negative association was observed between age and degree of preoperative lameness and outcome. More severe changes observed on preoperative radiographs were also negatively associated with prognosis. No horses with grade 3 meniscal tears improved postoperatively and increasing meniscal pathology was negatively associated with return to previous function. A weak association between surgery grade and outcome was also observed. Degree of chondral damage, location of primary pathology, and microfracture techniques had no effect on outcome. Conclusions— Advanced horse age, severe lameness and preoperative radiographic changes, and presence of large meniscal tears are associated with a negative postoperative outcome for horses with stifle lameness. Appearance of the articular surface at surgery appears to be an inconsistent prognostic indicator. Clinical Relevance— Some horses with extensive cartilage damage may return to athletic function after arthroscopic debridement and lavage. A more pessimistic prognosis may be given to older horses, those with more severe preoperative lameness, and those with severe radiographic changes or large meniscal tears.     

A retrospective study of 192 horses affected with septic arthritis/tenosynovitis.

The medical records of 192 horses with septic arthritis/tenosynovitis 1979-1989 were reviewed. Forty-three horses developed infection after an intra-articular injection, 46 following a penetrating wound, 25 following surgery, 66 were foals less than 6 months old, and 12 were adult horses without a known aetiology. Haematogenous infection of a joint occurs in adult horses and should be considered as a differential diagnosis in horses with an acute onset of severe lameness. The aetiology of the infection had a significant effect on the type of bacteria identified by culture. Staphylococcus was cultured from most of the horses that developed infection following a joint injection or surgery, 69% of the horses from which an organism was identified. Horses that developed infection secondary to a penetrating wound frequently provided cultures of more than one organism; Enterobacteriaceae and anaerobes were more frequently isolated in this group. The most common organisms isolated from foals were Enterobacteriaceae; E. coli was identified in more than 27% of the foals. The hock was the most frequently involved joint. Multiple treatments were used over the 10-year period of study. Survival rates were lowest in foals; only 45% survived to be released from the hospital. Survival was greater in adult horses; 85% of the horses that were treated were released from the hospital. Survival was significantly greater in horses with septic tenosynovitis; all 14 of the horses that were treated survived. Survival was not significantly affected by the joint involved or by the type of bacteria cultured from the synovial fluid.(ABSTRACT TRUNCATED AT 250 WORDS)     

Outcome after lacerations of the superficial and deep digital flexor tendons, suspensory ligament and/or distal sesamoidean ligaments in 106 horses

Objective: To report outcome after the surgical treatment of lacerations of the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), suspensory ligament (SL), and/or distal sesamoidean ligaments (DSL) in horses. Study Design: Case series. Animals: Horses (n=106) with lacerations of the SDFT, DDFT, SL, and/or DSL. Methods: Medical records (1988–2002) were reviewed for signalment, limb and tendon/ligament involvement (location and extent of injury, tendon sheath involvement), method of repair, and outcome. Results: The median age of horses was 7 years and the follow‐up time ranged from 1 to 10 years. Fifty‐five percent of horses returned to their previous level of performance, 27% to a lower level, and 18% were euthanatized. Multivariate statistical analysis demonstrated that the number of structures transected had the most significant influence on outcome. No significant association was detected between outcome and tendon sheath involvement, tendon suturing, casting, or limb affected. Fetlock hyperextension was the most significant complication. Conclusions: A high survival rate can be expected after SDFT, DDFT, SL, and/or DSL lacerations in horses, but only 55% of affected horses returned to their previous activity level. The number of structures affected was the major factor determining whether horses returned to an equal level of performance.