Repair and Function of Synovium After Arthroscopic Synovectomy of the Dorsal Compartment of the Equine Antebrachiocarpal Joint

The reparative ability of equine synovium was determined by gross, histological, and ultrastructural examination. The functional potential of the synovium was estimated by examination of synovial cell organelles with transmission electron microscopy. Results from rested and exercised horses were compared to determine the effect of exercise on synovial healing. The response of the synovectomized joint to exercise was evaluated with a standardized lameness examination and by gross, histological, and histochemical observations of the articular cartilage. A 7-mm diameter motorized synovial resector was used to perform a subtotal synovectomy in 1 antebrachiocarpal joint of each of 8 horses; the contralateral joint served as a control. After 2 months rest, four randomly selected horses were rigorously exercised for the remainder of the study; the other four horses continued paddock rest. Lameness examinations and synovial fluid analyses were conducted at 0, 2, 30, 60, and 120 days. Synovium and articular cartilage from all horses were examined at necropsy at 120 days. None of the horses were lame during the study, and a transient synovitis occurred in the synovectomized joints. The hyaluronan concentration of treated joints decreased at 2 days but returned to normal by 60 days. Synovial fluid composition, including hyaluronan concentration, was unchanged by exercise. Significant cartilage damage was not observed in any of the joints. At 120 days, the healing synovium was devoid of villi and its subintima was fibrotic, however transmission electron microscopy confirmed that an intimal layer was present within the repair tissue. The cells within the repair tissue appeared actively engaged in both synthesis and phagocytosis. Exercise did not modify any of these findings. The results of this study suggest that 120 days after subtotal synovectomy, the joint environment was maintained and the resected synovium had evidence of restoration and increased metabolic potential. Synovectomized joints withstood exercise but synovial repair was not accelerated by exercise.     

Arthroscopic Approach and Intra-articular Anatomy of the Palmaroproximal or Plantaroproximal Aspect of Distal Interphalangeal Joints

An arthroscopic approach to the palmaroproximal or plantaroproximal pouch of the distal interphalangeal joint was developed in six cadaver limbs and seven limbs of three clinically normal horses. The dorsal aspect of the proximal border and the proximal articular margin of the distal sesamoid (navicular) bone, the palmar aspect of the distal articular margin of the middle phalanx, the collateral sesamoidean ligaments of the distal sesamoid bone, and the joint capsule attachments were readily accessible. Distending the joints with fluid gave access to portions of the articular surface between the distal sesamoid bone and the middle phalanx in all joints, and to a small portion of the distal phalanx in two hind distal interphalangeal joints. Two horses allowed to recover from anesthesia were not lame on days 30 and 37, respectively. Problems encountered initially were difficulty entering the joint, hemarthrosis, and minimal iatrogenic cartilage damage.     

Changes in Third Carpal Bone Articular Cartilage After Synovectomy in Normal and Inflamed Joints

Objective —To determine if arthroscopic synovectomy in normal and inflamed joints had temporal or site-related effects on articular cartilage.
Study Design —Alterations in equine third carpal bone articular cartilage were studied at two time periods: groups 1 and 2 (6 weeks) and groups 3 and 4 (2 weeks) after synovectomy in normal (groups 2 and 4) and inflamed carpi (groups 1 and 3).
Animal Population —16 carpi from eight horses.
Methods —Biochemical and biomechanical properties of dorsal and palmar articular cartilage were determined by radiolabeling, proteoglycan (PG) extraction, chromatography, electrophoresis, and indentation testing.
Results —Synovectomy in inflamed joints produced the greatest concentration of newly synthesized PG in articular cartilage by 2 weeks. Synovectomy in normal joints produced significantly greater newly synthesized PG in articular cartilage by 6 weeks. Endogenous PG was only significantly greater in inflamed joints after 6 weeks. Dorsal sites had greater newly synthesized and endogenous PG in some groups. Chromatographic profiles of newly synthesized PG demonstrated early and late PG peaks. Electrophoresis of late PG peak showed a toluidine blue-positive band that comigrated with human A1D1 PG monomer in the two groups with the most newly synthesized PG. This band was reactive with monoclonal antibody 1C6 specific for the hyaluronic acid-binding region of aggrecan. For the material properties evaluated, only Poisson's ratio was significantly decreased between groups as a function of time (6 weeks < 2 weeks), and this was most pronounced in the thicker dorsal sites.
Conclusions —Synovectomy in inflamed joints produced site-specific, significantly greater responses in articular cartilage as compared with synovectomy in normal joints.
Clinical Relevance —Synovectomy may not be beneficial to the articular cartilage in inflamed joints.     

Synovial Fluid and Clinical Changes After Arthroscopic Partial Synovectomy of the Equine Middle Carpal Joint

Changes in synovial fluid and clinical variables after arthroscopic partial synovectomy of the middle carpal joint were studied in 12 normal horses. A 7 mm motorized synovial resector was inserted into each middle carpal joint; one middle carpal joint of each horse was randomly selected to have arthroscopic synovectomy (treated) and the opposite joint was lavaged (control). Lameness examinations and synovial fluid analyses were performed before operation and at 8, 14, 21, and 28 days after operation. Lameness variables did not differ between treated and control legs. Middle carpal and carpometacarpal joint circumference measurements were increased for 4 weeks. Synovial fluid specific gravity, pH, total protein, albumin concentration, and alpha-1-, beta- and gamma-globulin concentrations, at 8 and 14 days were significantly higher than before operation in both treated and control middle carpal joints. No significant differences were found between treated and control middle carpal joints at any time for color, clarity, pH, mucin clot formation, total protein, albumin, and globulin fractions. Arthroscopic partial synovectomy and lavage did not cause significant lameness and resulted in a synovitis indistinguishable from synovitis related to arthroscopic lavage alone.     

Intra‐Articular Use of a Platelet‐Rich Product in Normal Horses: Clinical Signs and Cytologic Responses

Objectives

(1) To report the clinical and synovial effects of a platelet‐rich product (PRPr) in normal equine joints, (2) to assess the persistence of platelets within synovial fluid after intra‐articular injection, (3) to compare responses to different preparations of that product, and (4) to evaluate a gravity filtration system for PRPr preparation in horses.

Study Design

Experimental.

Methods

A platelet‐rich saline product (PRPr) was prepared from 7 normal horses using a proprietary preparation device and was divided into 3 treatments: resting, CaCl₂‐activated (23 mM, final), and bovine thrombin‐activated (10 U/mL, final). Each horse had 3 concurrent randomly assigned intra‐articular PRPr treatments administered in their metacarpophalangeal/metatarsophalangeal joints; the fourth limb was injected with saline (0.9% NaCl) solution as a control. Clinical assessments, cytologic analysis of synovial fluid and hemograms were performed at 6, 24, 48, and 96 hours after injection. PRPr composition and growth factor content were analyzed.

Results

The gravity filtration system produced a moderately concentrated PRPr. At 6 and 24 hours, when compared to control values, all PRPr treatments caused a significant increase in synovial WBC concentration (P < .0059) and neutrophil percentage (P < .0005). Bovine thrombin‐activated PRPr injection consistently caused increased effusion scores and periarticular signs. At all time points, the synovial WBC concentration after thrombin‐activated PRPr was significantly greater (P < .001) than for the control, CaCl₂‐activated or resting PRPr. Intact platelets could be observed in synovial fluid for up to 5 days after intra‐articular PRPr injection.

Conclusions

Resting and CaCl₂‐activated PRPr may be safely used to treat equine joints, but bovine thrombin activation is not recommended at 10 U/mL. A PRPr can be prepared using a gravity filtration system, eliminating the need for centrifugation.     

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

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

Expression of Progesterone Receptor in the Utero‐tubal Junction After Intra‐uterine and Deep Intra‐uterine Insemination in Sows

The aim of this study was to investigate the expression of progesterone receptor (PR) in the utero‐tubal junction (UTJ) of sows at 24 h after intra‐uterine insemination (IUI) and deep intra‐uterine insemination (DIUI) compared with conventional artificial insemination (AI) in pigs. Fifteen multiparous sows were used: AI (n = 5), IUI (n = 5) and DIUI (n = 5). The sows were inseminated with a single dose of diluted semen during the second oestrus after weaning at 6–8 h prior to ovulation (AI: 3000 × 10⁶ spermatozoa, IUI: 1000 × 10⁶ spermatozoa and DIUI: 150 × 10⁶ spermatozoa). The UTJ was collected and subject to immunohistochemical staining using avidin‐biotin immunoperoxidase technique with mouse monoclonal antibody to PR. In the oviductal part of the UTJ, the intensity of PR in the tunica muscularis and the proportion of PR‐positive cells in the surface epithelium after DIUI were lower than AI (p < 0.05). The intensity and the proportion of PR‐positive cells between AI and IUI in all compartments of the UTJ did not differ significantly (p > 0.05). When comparing between tissue compartments, prominent staining was observed in the muscular layer of the UTJ. It could be concluded that the expression of PR in the UTJ prior to fertilization after DIUI with a reduced number of spermatozoa was lower than that after AI. This might influence sperm transportation and the fertilization process.     

Arthroscopic Anatomy of the Equine Temporomandibular Joint

OBJECTIVE: To develop an arthroscopic approach to, and describe the arthroscopic anatomy of, the equine temporomandibular joint (TMJ). STUDY DESIGN: Cadaveric study, after which the technique was tested in horses. ANIMALS OR SAMPLE POPULATION: Ten cadaveric equine heads and 5 normal horses (age, 5-13 years; weight, 425-545 kg). METHODS: Specimens or horses were positioned in right lateral recumbency. After fluid distention of the TMJ, arthroscopic portals were made in the dorsal compartment over the most prominent portion of the joint outpouching (caudodorsal approach) and in rostral and intermediate locations. The joint was explored and photographed. Positional changes in the mandible were made to determine if observation of the joint could be improved. Instrument portals were created to assess the feasibility of surgical arthroscopy. Cadaveric heads were dissected to assess iatrogenic damage, whereas experimental horses were observed for postoperative complications for 30 days. RESULTS: A caudodorsal arthroscopic approach provided the best evaluation of the dorsal compartment of the TMJ. The approach allowed observation of the rostral and caudal synovial pouches and the lateral aspect of the joint including the articular disc. Examination of the medial aspect of the joint was limited to the most rostral and caudal aspects. Access to the lateral aspect of the ventral compartment of the TMJ was precluded by the position of the transverse facial artery and vein. In specimens, iatrogenic damage was minimal and limited to the articular fibrocartilage, articular disc, and penetration of the parotid salivary gland. If the latter also occurred in horses, no adverse effects were noted. In horses, mild fluid extravasation occurred and resolved within 1 day. All horses ate normally after surgery but had periarticular swelling and mild pain upon palpation of the TMJ for 2 days. CONCLUSIONS: A caudodorsal arthroscopic approach to the TMJ allowed adequate observation of the lateral aspect of the dorsal compartment of the joint. Access to the ventral compartment was precluded by the location of the transverse facial artery and vein. CLINICAL RELEVANCE: Conditions affecting the lateral and caudal aspects of the dorsal compartment of the TMJ should be visible by arthroscopy.     

Arthroscopic Examination of the Femorotibial Joints of Horses

A technique for satisfactory arthroscopic examination of the lateral and medial femorotibial joints of the horse is described. The entry portal is made between the middle and medial patellar ligaments with the horse on its back and the stifle flexed. This position allows easy access to view the intercondylar eminence of the tibia. From this reference point, examination of all but the most caudal and medial structures of the joints are possible by manipulating the sleeve and telescope and maintaining joint distention. In a series of 20 examinations, iatrogenic trauma was recognized only once.     

Tenoscopic Anatomy of the Equine Carpal Flexor Synovial Sheath

Objective —To describe the tenoscopic anatomy of the carpal sheath of the flexor tendons (carpal sheath) viewed from a lateral approach.
Study Design —Tenoscopic observation of structures within the carpal sheath subsequently confirmed by dissection.
Animals or Sample Population—12 equine cadaveric forelimbs.
Methods —The limbs were positioned lateral side up with the carpus slightly flexed. After distention of the carpal sheath, a portal for the arthroscope was made approximately 3 cm proximal to the distal radial physis and 2.5 cm caudal to the radius between the tendons of the ulnaris lateralis and lateral digital extensor muscles.
Results —A lateral tenoscopic approach was adequate to identify all structures within the carpal sheath. From proximal to distal, structures identified using this approach were the radial head of the deep digital flexor muscle, accessory ligament of the tendon of the superficial digital flexor muscle, distal radial physis, tendons of the superficial and deep digital flexor muscles, accessory carpal bone, antebrachiocarpal and middle carpal joints, and vincula of the tendon of the deep digital flexor muscle.
Conclusions —A lateral tenoscopic approach offered an easy, repeatable entry into the carpal sheath and allowed good observation of all structures within the sheath except for the medial borders of the tendons of the deep and superficial digital flexor muscles.
Clinical Relevance —Applications of a lateral tenoscopic approach to the carpal sheath include diagnostic procedures, lavage and synovial resection for septic tenosynovitis, desmotomy of the accessory ligament of the tendon of the superficial digital flexor muscle for flexural deformity or tendinitis, and removal of osteochondromas from the distal radial metaphysis.     

Arthroscopic Approaches and Intraarticular Anatomy of the Equine Elbow

Periarticular anatomy and techniques for arthroscopic access to the equine elbow were studied in six joints from cadavers. Caudomedial and craniolateral approaches were evaluated subsequently in 11 anesthetized horses. The caudomedial approach was made between the flexor carpi radialis and flexor carpi ulnaris muscle bellies. Most of the caudal articular surfaces of the humeral condyles, the caudal perimeter of the radius, and the trochlear notch and portions of the anconeal process of the ulna could be identified. The voluminous caudal joint capsule cul-de-sac proximal to the anconeal process was readily entered. A 70 degree arthroscope allowed examination of more of the joint recesses and articular surfaces of the olecranon fossa than a 25 degree arthroscope. A second portal for intraarticular instrument manipulation was made caudal and slightly proximal to the arthroscope entry. Entry more proximal than the level of the radiohumeral articulation carried significant risk of damage to the ulnar nerve and collateral ulnar artery and vein. For examination of the cranial regions of the elbow, a craniolateral portal was established cranial to the lateral collateral ligament. An instrument portal was made through the muscle bellies of the extensor carpi radialis or common digital extensor muscles. The cranial articular surfaces of the humeral condyles were readily exposed by extension of the elbow. The weight-bearing articular surface of the radius could not be seen. Eight horses were euthanatized without recovery from anesthesia and the elbows were dissected for examination. Three horses were allowed to recover from anesthesia and were euthanatized on days 3, 30, and 60.(ABSTRACT TRUNCATED AT 250 WORDS)