Medial Epicondyle Osteotomy as an Approach to Repair of Medial Femoral Condyle Fractures in the Dog

Fracture of the medial femoral condyle in three dogs is described. This injury resulted in lateral (varus) instability, which was difficult to differentiate from a lateral collateral ligament tear. Radiographs and surgical exploration were necessary to differentiate the two conditions. A medial femoral epicondyle osteotomy was used in two cases to expose the fracture. This exposure technique is advantageous because it allows early return to functional use of the injured limb by eliminating postoperative splintage.     

Multiple Osteochondral Autografts for Treatment of a Medial Trochlear Ridge Subchondral Cystic Lesion in the Equine Tarsus

Objective— To adapt the multiple osteochondral autograft technique for treatment of a subchondral cystic lesion (SCL) of the proximal medial trochlear ridge (MTR) of the equine talus and assess long term outcome.
Study Design— Case report.
Animals— Quarter horse stallion with SCL of the proximal MTR of the talus.
Methods— Osteochondral autograft techniques used in dogs and humans were adapted and optimized in equine cadavers. A horse with a SCL of the MTR of the talus was treated by osteochondral autografting. Three osteochondral autografts were harvested from the distal lateral trochlear ridge of the talus in the affected tarsus. No curettage or debridement of the osteochondral lesion was performed. Three recipient beds were predrilled and osteochondral autografts were press-fit into the proximal MTR of the talus. Outcome was assessed by radiography, telephone interview of the owner, and direct observation during training.
Results— Postoperative radiographs indicated excellent filling of the osteochondral defect and graft-articular surface congruency. No complications were encountered after surgery. At 10 months after surgery, the horse successfully re-entered reining training, and continued to be sound and performing athletically 2 years after surgery.
Conclusion— Osteochondral autografting deserves consideration and further evaluation as a primary treatment option for SCL of the proximal MTR of the talus in horses.
Clinical Relevance— Based on the outcome of this case, osteochondral autografting appears to be a safe, valuable and realistic option for treating SCL of the proximal MTR of the talus in equine athletes.     

Treatment of Bilateral Medial Femoral Condyle Articular Cartilage Fissures in a Horse Using Bone Marrow-Derived Multipotent Mesenchymal Stromal Cells

The objective of this study was to describe the use, and outcome, of multipotent mesenchymal stromal cells (MSCs) in the treatment of equine articular cartilage defects of the medial femoral condyle. A 4-year-old Thoroughbred gelding (n = 1) with bilateral stifle athroscopy was found to have bilateral articular cartilage fissure defects of the medial femoral condyles with concurrent cranial cruciate ligament injury. Bone marrow derived MSCs were isolated, expanded, and suspended in a partially autologous fibrin glue. The initial cell/fibrin glue mixture was delivered arthroscopically into the articular cartilage defects 90 days after the initial arthroscopic examination. Follow-up treatments included two additional injections of MSCs suspended in lactated Ringers solution, 5 and 13 months after the initial examination, directly into the joint. Post-treatment outcome was assessed by arthroscopic examination and by comparison of preinjury and post-treatment performance records. Arthroscopic evaluation 4 months after the initial MSC treatment revealed marked smoothing, reduction in the depth of cartilage defects and observation of moderate improvement in the cranial cruciate ligament. Approximately 15 months after the initial MSC treatment the horse returned to racing. Analysis of race records demonstrated that the post-treatment (including all three MSC treatments) average race earnings (earnings per start) were comparable with those predating the initial injury. The favorable clinical response in the face of an unknown, but likely, guarded prognosis suggest that MSC therapy is not deleterious and may augment healing of articular cartilage fissures of the medial femoral condyle. MSCs represent a viable and promising alternative therapy in the treatment of articular cartilage injuries in performance horses.     

Arthroscopic Subchondral Bone Plate Microfracture Technique Augments Healing of Large Chondral Defects in the Radial Carpal Bone and Medial Femoral Condyle of Horses

OBJECTIVE: To evaluate the effect of arthroscopic subchondral bone microfracture on healing of large chondral defects in horses. STUDY DESIGN: Short- (4 months) and long-term (12 months) in vivo experimental chondral defect model. ANIMALS: 10 horses, aged 2 to 5 years. METHODS: Each horse had a 1 cm2 full-thickness chondral defect created in both radial carpal bones and both medial femoral condyles. One carpus and one femoral condyle of each horse had the subchondral bone plate under the defect perforated using an orthopedic awl. All horses were exercised, five horses were evaluated after 4 months and five horses after 12 months. Gross, histologic, and histomorphometric examination of defect sites and repair tissues was performed, as was collagen typing of the repair tissue. RESULTS: On gross observation a greater volume of repair tissue filled treated defects (74%) compared with control defects (45%). Histomorphometry confirmed more repair tissue filling treated defects, but no difference in the relative amounts of different tissue types was observed. There was an increased percentage of type II collagen in treated defects compared with control defects and evidence of earlier bone remodeling as documented by changes in porosity. CONCLUSIONS: In full-thickness chondral defects in exercised horses, treatment with subchondral bone microfracture increased the tissue volume in the defects and the percentage of type II collagen in the tissue filling the defects when compared to nontreated defects. CLINICAL RELEVANCE: No negative effects of the microfracture technique were observed and some of the beneficial effects are the basis for recommending its use in patients cases with exposed subchondral bone.     

猫股骨髁粉碎性骨折的手术内固定

为诊断1只高处坠落导致跛行的患猫,采取了临床基本检查、实验室检查及DR影像学检查,确诊为左后肢股骨髁粉碎性骨折。根据检查结果制定手术治疗方案,采用交叉克氏针配合拉力螺钉进行手术内固定。后期回访患猫骨折断端愈合良好,运动功能逐步恢复,表明上述骨折固定方法有效。     

Evaluation of an Interfragmentary Compression System for the Repair of Equine Femoral Capital Physeal Fractures

Femoral neck and proximal epiphyseal lengths were measured in 37 femurs from 19 cadaver foals that were 1 day to 12 months old to determine the applicability of a human interfragmentary compression system to equine femoral capital physeal fractures. Because components of the implant system are available only in fixed sizes, its use was possible in foals older than 5 weeks of age, but not in younger foals. The 135 degree angle plate conformed best to the equine femur. Femoral capital physeal fractures were created surgically and repaired with the implant system in three foals. Fracture stability was evident clinically and radiographically in all three foals until euthanasia at month 3. At necropsy, the treated femurs were 4, 8, and 27 mm shorter than their mates. Epiphyseal viability was verified in all three foals by tetracycline deposition and new appositional bone growth comparable with that in the contralateral control epiphyses. The treated capital physis was open but reduced in thickness in one foal, disorganized in one foal, and closed in one foal. Fixation by compression with the implant system resulted in stability sufficient for fracture healing and maintenance of epiphyseal viability, although it was associated with reduced longitudinal femoral growth.     

The Effects of Implant Orientation, Canal Fill, and Implant Fit on Femoral Strain Patterns and Implant Stability During Catastrophic Testing of a Canine Cementless Femoral Prosthesis

Cementless femoral stems were placed into 12 normal greyhound femora. The implanted femora were divided into three groups by stem orientation and implant size and loaded in axial compression at a rate of 25 newtons (N) per second until failure. Rosette strain gauges were used to measure femoral principal strains at 500 N, 1,000 N, 1,500 N, and at maximum load. During maximum load, varus orientation of the femoral stem had significantly higher tensile hoop strains in the proximomedial cortex, whereas neutral orientation had higher tensile hoop strains along the cranial cortex. Femoral fractures occurred in these areas of peak tensile strain. There was no difference in maximum load between groups, therefore varus orientation did not predispose to fracture. Maximizing canal fill and implant fit increased implant stability.     

Effect of Betamethasone and Exercise on Equine Carpal Joints With Osteochondral Fragments

Osteochondral fragments were created arthroscopically on the distal aspect of both radial carpal bones in 12 horses. On day 14 after surgery, one middle carpal joint of each horse was injected with 2.5 mL Betavet Soluspan (3.9 mg betamethasone sodium phosphate and 12 mg betamethasone acetate per milliliter) and the contralateral joint was injected with 2.5 mL saline as a control. Intra-articular treatments were repeated on day 35. On day 17, six horses began exercising 5 days per week on a high-speed treadmill. The other six horses were kept in box stalls throughout the study as nonexercised controls. On day 56, all horses were examined clinically and radiographically and then were euthanatized. Samples were obtained for histological, his-tochemical, and biochemical evaluation. Mild lameness was observed in five of the six exercised horses at day 56; four horses were lame in the control limb and one horse was lame in the treated limb. Of the five nonexercised horses evaluated for lameness, two were lame in the control limb, two were lame in the treated limb, and one was lame in both the control and the treated limb. No differences were noted on radiographs or palpation of steroid treated limbs versus control limbs. Firm reattachment of the osteochondral fragment to the radial carpal bone occurred in all but three joints. Gross cartilage damage was not different between steroid-treated joints and joints injected with saline. Histologically, there were no significant detrimental effects of betamethasone with or without exercise, but there was a tendency for more pathological change in treated joints. There was a trend toward decreased glycosaminoglycan staining in steroid treated joints of rested horses, whereas exercised horses had similar glycosaminoglycan staining in treated and control joints. No significant difference in the water content or uronic acid concentration was detected between treated and control joints. Intra-articular betamethasone administration in this carpal chip model was not associated with any significant detrimental effects in either rested or exercised horses.     

Mechanoreceptors in the Anterior Horn of the Equine Medial Meniscus: an Immunohistochemical Approach

Lameness due to stifle and especially meniscal lesions is frequent in equine species. In humans, mechanoreceptors involved in proprioceptive function are well studied. Given the high incidence of meniscal injuries in horses, and the lack of information concerning them in equine menisci, our objective was to study these corpuscles in six healthy anterior horns of the equine medial meniscus, which is the most common localisation reported for equine meniscal injuries. Immunohistochemical stainings were performed using antibodies against high molecular weight neurofilaments and glial fibrillary acidic proteins. From a purely fundamental point of view, our work highlights for the first time the presence of Ruffini, Pacini and Golgi corpuscles in equine meniscus. They were found, isolated or in clusters and always located at the vicinity of blood vessels, at the level of the anterior horn of the equine medial meniscus. This morphological approach could serve as a basis for clinical studies, to evaluate the impact of these corpuscles on the poor sportive prognosis in equine meniscal tears.     

Management of Subchondral Lucencies of the Medial Aspect of the Equine Antebrachiocarpal Joint

The objective of this study is to describe the management and outcomes of eight horses with subchondral lucencies (SCLs) of the medial aspect of the antebrachiocarpal (ABC) joint. The medical records and radiographs of the carpi of 8 horses with SCLs of the medial aspect of the ABC joint were reviewed. Follow-up clinical information was obtained for 6–60 months (the median duration of 14 months). Treatment was successful if radiographic healing was apparent or lameness was reduced or eliminated. Four horses had SCLs in the distomedial radius (DMR) and four in the proximal aspect of the radiocarpal bone (RCB). Lameness was present in all horses with DMR SCLs and in one horse with an RCB SCL. Treatments included restriction of exercise (n = 3), intra-articular administration of corticosteroids (n = 2), or placement of a screw across the SCL (n = 3). Exercise restriction alone was successful in three nonlame horses younger than one year with proximal RCB SCL and intra-articular corticosteroid administration in the ABC joint in two horses aged 2 years or younger with DMR SCLs. A yearling with a large proximal RCB SCL and two horses aged 5 years or older with DMR SCLs were successfully treated with screw placement across the SCL. Exercise restrictions and intra-articular administration of corticosteroids were successful in management of DMR SCLs in five horses. Placing a screw across the SCL of three horses resulted in resolution of lameness and substantial improvement of the radiographic appearance of the lesion in the RCB or DMR.     

Femoral Strain Distribution and Subsidence After Physiological Loading of a Cementless Canine Femoral Prosthesis: The Effects of Implant Orientation, Canal Fill, and Implant Fit

Twelve normal greyhound femora were divided into three groups. In group one, femoral stems were placed in neutral position with maximal fill. Group two had undersized femoral stems placed in neutral position. Group three had undersized femoral stems placed in varus position. Intact and implanted femora were loaded from 10 newtons (N) to 300 N in axial compression at a rate of 25 N/s for 10 replications. A strain gauge analysis showed that the strain distribution of all implanted femora were substantially different from intact femora, but femora with large implants placed in neutral position had the least amount of deviation from normal. An undersized stem in neutral position had significantly less compressive longitudinal strains along the proximomedial and proximocranial cortices. An undersized stem in varus position improved implant fit along the proximomedial and distolateral cortices, which resulted in increased tensile hoop strains. There were multiple significant correlations between the strain data and implantation variables (implant alignment, canal fill, and implant fit). Subsidence was significantly greater for the undersized implant in neutral position. There was not a difference in subsidence between the large neutral and varus groups. The most important variable that decreased subsidence was increased lateral implant fit ( r = -0.86, P = .0003).     

犬股骨远端髁间T型骨折内固定实验模型的建立

为创建犬股骨远端髁间T型骨折并同期行内固定术的实验动物模型,观察这种内固定术后的愈合情况。对8条成年犬通过截骨的方法制作动物模型,并分别于术后1d、1周、2周、4周、8周、12周对实验犬进行X线检查。除一条实验犬创口感染形成假关节外,其余的犬对手术耐受良好,X线检查显示,随着固定时间延长,骨折间隙逐渐变窄,骨痂从无到有,骨折线从开始模糊到消失。本实验模型中采用的内固定方法能很好的治愈犬股骨远端髁间T型骨折。     

Mechanical Evaluation of the Equine Laryngoplasty

Objectives: Mechanical evaluation of the equine laryngoplasty. Study Design: Experimental. Animal Population: Cadaveric cricoid (n=36) and arytenoid (46) cartilages. Methods: Arytenoid and cricoid cartilage specimens were embedded for testing. Suture material (2 Ethilon^®, 5 Ethibond^®, or 5 Fiberwire^®) was inserted simulating laryngoplasty procedures. Constructs were evaluated in single or cyclic loading. Single cycle tests recorded load at failure and stiffness. Cyclical tests recorded displacement after 10,000 cycles. ANOVA and t‐tests were used (significance P<.05). Results: The arytenoid Ethibond^® (241.10±47.67 N) constructs were stronger in single cycle than Ethilon^® (133.85±27.89 N) and Fiberwire^® (142.67±32.40 N). The cricoid Ethibond^® (220.39±49.11 N) constructs were stronger than Ethilon^® (171.93±21.19). The stiffness of Ethilon^® constructs was lower in both the arytenoid and cricoid compared with Ethibond^® and Fiberwire^®. The arytenoids failed at a lower load than the cricoids for Ethilon^® and Fiberwire^® but not Ethibond^® constructs. In cyclic testing complete failure of either cartilage did not occur. Arytenoid Ethibond^® constructs (0.43±0.21 mm) had less distraction than Ethilon^® (0.92±0.41 mm) and a trend for less compared with Fiberwire^® (0.83±0.43 mm; P=.0513). Cricoid Ethibond^® constructs (0.45±0.18 mm) had less distraction compared with Ethilon^® (1.04±0.30 mm) and Fiberwire^® (0.97±0.45 mm). Conclusions: Ethibond^® was superior to Ethilon^® and Fiberwire^® constructs in vitro. Clinical Relevance: Abduction loss after laryngoplasty is a common complication. The results of this study suggest that the use of Ethibond^® should minimize abduction loss after surgery relative to the other materials tested.     

Effects of Exercise and Polysulfated Glycosaminoglycan on the Development of Osteoarthritis in Equine Carpal Joints With Osteochondral Defects

This study assessed the effects of postoperative exercise and intra-articular polysulfated glycosaminoglycan (PSGAG) on the repair of osteochondral defects in the carpal joints of ponies. Eighteen ponies with normal carpi had osteochondral defects (mean dimensions 2.4 cm × 0.9 cm) created arthroscopically on the dorsal aspect of the distal articular surface of the radial carpal bone. The ponies were randomized (while balancing for age [range, 2 to 15 years; median, 5.0 years]) to two groups—nine ponies were exercised and nine were stall confined. Beginning at surgery, six ponies in each group received five weekly intra-articular injections of PSGAG (250 mg) in one joint and lactated Ringer's solution in the contralateral joint; the remaining three ponies in each group received lactated Ringer's solution in both joints. The incremental exercise schedule on a circular, rotating walker was begun six days after surgery and occurred twice daily, reaching a maximum of 0.7 miles of walking and 2.7 miles of trotting by the third postoperative month. The effects of treatment on the joint tissues were determined by weekly lameness examinations and measurement of the range of carpal joint motion, carpal radiographs at six and 17 weeks after surgery, synovial fluid analysis, and cytologic evaluation of alcohol-fixed synovial fluid specimens at weeks 1 through 4 and week 17, and histology of the synovial membrane. Ultrasound images of the carpi were acquired before operation and at weeks 1, 2, 4, 8, 10, 13, and 17. Ponies were euthanatized 17 weeks after surgery. Exercise, without medication, caused more lameness throughout the study compared with no exercise. Exercised, nonmedicated ponies had the greatest limitation to carpal flexion (more painful joints), and nonexercised, nonmedicated (control) ponies had the least limitation to flexion. Radiographic scores indicated that the exercised, nonmedicated ponies had significantly (p < .05) more signs of osteoarthritis than exercised, medicated and control ponies. Ultrasonographic measurements indicated that exercise, without medication, caused the greatest increase in combined measurement of the joint capsule thickness and synovial fluid accumulation at all postoperative times. Synovial lining cell numbers in the synovial fluid from exercised ponies were significantly (p < .05) higher than in nonexercised ponies at week 1, and this trend continued at weeks 4 and 17 (p < .1). There were significantly (p < .05) more morphologic abnormalities in the synovial lining cells from exercised than from nonexercised ponies at week 17. Medication with PSGAG enabled exercised carpal joints to be flexed significantly further from weeks 2 through 6 compared with nonmedicated joints. Medication significantly (p < .05) reduced the combined joint capsule and synovial fluid thickness at weeks 4, 8, and 13 compared with nonmedicated joints. On histologic examination, the synovial membrane matrix of exercised, medicated joints had significantly less chronic inflammatory changes than joints receiving other treatments. The authors concluded that this level of exercise was too intense when superimposed on large osteochondral defects in the carpus because it induced osteoarthritis. Polysutfated gtycosaminoglycan ameliorated the clinical signs of osteoarthritis in the exercised ponies. However, PSGAG was also associated with the formation of cartilage repair tissue that contained less type II relative to type I collagen compared with repair tissue from nonmedicated joints.