A Lateral Surgical Approach to the Equine Femoropatellar Joint

A surgical approach to the lateral trochlear ridge of the distal femur of the horse was developed to facilitate evaluation and curettage of osteochondral defects of the lateral trochlear ridge. Surgical exploration of the lateral trochlear ridge was achieved in 11 patients with osteochondral defects of the lateral trochlear ridge using a craniolateral arthrotomy between the middle and lateral patellar ligaments. The technique described allowed adequate exposure for evaluation, removal of loose osteochondral fragments, and curettage of cartilage abnormalities on the lateral trochlear ridge.     

lleocolostomy A Technique for Surgical Management of Equine Cecal Impaction

Several surgical alternatives have been described for the management of cecal impaction in the horse, but none has met with consistently successful results. This study was done to evaluate a surgical bypass of the cecum by anastomosis of the ileum to the right ventral colon (ileocolostomy). A ventral midline celiotomy was performed on nine adult ponies (155-350 kg) and a mechanically stapled 10 cm side-to-side ileocolostomy was created. In five ponies a complete cecal bypass (CCB) was created by transecting the ileum distal to the anastomosis. In the other four, an incomplete cecal bypass (ICB) was created with no interruption of the ileum. Six horses with clinical cecal impaction also underwent cecal bypass procedures. Five had a CCB and one had an ICB. All the ponies maintained body weight, had no change in consistency of the feces and had no abdominal pain during the 6 month observation period. At necropsy, the lengths of the lateral cecal band, lateral free band of the colon, and the diameter of the anastomotic stoma were compared to measurements made at surgery. The lateral cecal band length decreased significantly more in the CCB ponies than in the ICB ponies (p = 0.008). The anastomotic stoma diameter was significantly larger in the ICB group than in the CCB group (p = 0.032). Five of the six clinical cases recovered and returned to their previous activity. CCB by an ileocolostomy resulted in removal of the cecum from the functional flow of ingesta without complication in the ponies, and was successful in five clinical cases of cecal impaction.     

Diagnostic and Surgical Arthroscopy of the Equine Shoulder Joint

An arthroscopic technique for examination and surgical treatment of conditions of the shoulder joint was evaluated in eight normal horses and two horses with osteochondrosis lesions. A single arthroscope entry point caudal to the infraspinatus tendon allowed inspection of the cranial, lateral, and caudal surfaces of the shoulder joint. With the humeral head and glenoid cavity distracted by a curved forceps, the entire cartilage surface of the shoulder could be examined. The caudomedial portion of the humeral head was seen better with a 70 degree angled arthroscope. Instruments for intra-articular manipulation were introduced through a separate skin incision 2 to 4 cm caudal to the arthroscope entry point. Two horses with osteochondrosis lesions of the shoulder were examined arthroscopically and debrided with instrument triangulation. Five normal horses and both horses with osteochondrosis lesions were euthanized immediately after the procedure and a necropsy was performed. Minor iatrogenic damage to the cartilage surfaces and joint capsule resulted from the technique. Three horses recovered from anesthesia and were killed 3, 30, or 60 days after surgery. Subcutaneous fluid that accumulated during surgery had resorbed by 3 days and lameness was evident for 12 to 24 hours. Gross examination and histopathologic findings of specimens collected at 30 and 60 days showed several small nonhealing partial-thickness cartilage defects attributed to instrument insertion. Arthroscopy is a satisfactory method to examine the joint surfaces and to evaluate and treat osteochondrosis lesions of the shoulder joint in horses.     

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.     

Arthroscopic Surgical Approaches and Intraarticular Anatomy of the Equine Shoulder Joint

Arthroscopic approaches to the scapulohumeral joint were developed in four clinically normal, live horses (5 limbs) to determine their usefulness for evaluation and potential surgical treatment of intraarticular lesions. The articular surface of the entire glenoid, cranial humeral head (medial and lateral) and caudolateral humeral head, as well as the synovial membrane, could be closely examined from an arthroscopic portal cranial to the infraspinatus tendon. The caudomedial humeral head could be examined partially. Cranial and caudal instrument portals allowed good surgical access to the entire glenoid and the majority of the humeral head (except caudomedial in adult, heavily muscled horses). The described arthroscopic and instrument portals allowed access to the areas frequently affected with osteochondritis dissecans (OCD). Potential difficulties with this technique include problems establishing triangulation, extravasation of fluids, and inability to reach potential lesions on the caudomedial humeral head with conventional equipment in heavily muscled horses.     

A Comparison of Two Surgical Approaches to the Equine Femoropatellar Joint for the Treatment of Osteochondritis Dissecans

The femoropatellar joints of four mature, clinically normal horses were surgically entered by a craniolateral or a lateral approach. Visualization of intra-articular structures was documented for each approach. Horses were euthanized 21, 42, and 63 days after surgery. Joint healing was evaluated clinically, and the joints were subjected to gross pathological and histopathological examination. Healing was by first intention following arthrotomy in six limbs. Skin dehiscence occurred in two limbs with healing by second intention. Subcutaneous seromas developed which resulted in peri-incisional swelling in seven limbs. The lateral approach to the femoropatellar joint provided greater exposure of the lateral femoral trochlear ridge and articular surface of the patella.
Surgery was performed on nine joints of seven clinical patients with osteochondritis dissecans. The craniolateral approach was used on four joints, and the lateral approach was used on five joints. Skin dehiscence occurred following four arthrotomies. Location of the lesion was concluded to be the main criterion for selection of the surgical approach.     

Surgical Approach to the Equine Scapulohumeral Joint Through a Longitudinal Infraspinatus Tenotomy

Surgical curettage of an osteochondrosis lesion in an equine scapulohumeral joint was performed. A modified approach to the scapulohumeral joint through a longitudinal infraspinatus tenotomy is described. This technique was performed on a second horse that was free of osteochondrosis lesions to further assess the clinical course of healing following this technique. Both operative sites healed well with no evidence of dehiscence. Previously, four similar clinical cases of osteochondrosis were operated on at the same institution through a transverse infraspinatus tenotomy. All four cases exhibited dehiscence with attendant septic arthritis during the postoperative period. The use of a longitudinal infraspinatus tenotomy to approach the equine scapulohumeral joint for surgical curettage does not appear to clinically compromise the lateral collateral support of the shoulder. When compared retrospectively to other cases of transverse infraspinatus tenotomy performed at this clinic, the described technique appears to have a less complicated postoperative period.     

Prosthetic Coxofemoral Joint Repiacement in the Goose (Anser Sp.): I. Preliminary Results

In order to study failure modes of fixation of artificial hip joints in man, an animal model was needed that had similar loading conditions concerning the hip joint and a life expectancy long enough to allow for fixation failures to occur. Femoral components of a hip joint were implanted into domestic geese ( Anser sp.) to evaluate their suitability for long-term in vivo studies of femoral implants. A prosthesis was developed. It was implanted into mature geese under general anesthesia using a lateral surgical approach. The animals were sacrificed 5 to 11 months after implantation. The results indicate that prosthetic hip joints could be implanted and that joint function was restored in all cases. There was no postoperative morbidity or mortality. Prosthetic loosening was observed in three out of the nine implants.     

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.     

Equine Cryptorchidism: Pre-surgical Considerations and Surgical Management

Horses with undescended testes are frequently presented to the veterinary surgeon for castration. The pertinent pre-operative evaluations and diagnostic procedures that should be made prior to either surgical intervention or referral of such cases are outlined. Several accepted anesthetic and surgical techniques are similarly reviewed. Case histories of 58 horses referred during a two year period are reviewed and correlated with the findings of a recent study of equine testicular development and descent.     

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.     

A Muscle Separating Approach to the Equine Shoulder Joint for the Treatment of Osteochondritis Dissecans

A muscle separating approach with tenotomy of the teres minor was used to expose osteochondritis dissecans lesions in the shoulder joints of five horses. Horses selected for surgery were severely lame or had a long history of lameness. Adequate surgical access allowed removal of cartilage flaps, curettage of the subchondral bone, and in one horse, the removal of an osteocartilaginous free body. Surgical wounds healed by primary intention; one horse developed a seroma that was drained. Three of the five horses were clinically sound 3 months following surgery. Two other horses were pasture sound but lame after extensive athletic activity.     

A Novel Equine Hoof Lamellar Tissue Biopsy Technique

This study aims to validate the efficacy of a new device specifically developed for equine lamellar biopsy. Nine adult horses were used. Under sedation and digital nerve perineural anesthesia and after keratinized tissue thinning, a sample from the dorsal lamellar stratum was obtained using an instrument called Falcão-Faleiros' lamellotome. Hoof pain sensitivity was evaluated for 60 days, and horses were monitored for 6 months. Lateromedial radiographic images to analyze the spatial relationship between the distal phalanx and the hoof capsule were obtained before and 30 days after the biopsy. The effect of time on the variables was statistically analyzed (P < .05). On average (±SD), the biopsies produced samples that were 2.32 (±0.64) cm in length, 0.48 (±0.09) in width, and 0.51 (±0.11) cm in depth. A mean of 69 of intact primary epidermal lamellae was obtained per biopsy sample. Lameness and sensitivity to hoof testers were evident during the first 4 days postbiopsy but returned to basal levels after the fifth day. Minimal radiographic changes were observed, and the horses completely returned to their regular activities after 60 days. All biopsied hoofs grew normally during the 6-month period, making the dorsal wall defects reach the ground level. The use of the lamellotome for equine hoof lamellar biopsy produced an adequate quality and quantity of tissue for histology and allowed for full clinical recovery of the horses.     

Surgical Treatment of Pheochromocytoma: Technique, Complications, and Results in Six Dogs

Six dogs were diagnosed with phcochromocyloma and staged according to the World Health Organization's system for tumor classification. Two dogs had benign tumors (Tl, NO, M0) and four dogs had malignant tumors (T2, NO. M 1 or T3, N0, M0). All dogs had adrenalectomy, two dogs had concurrent nephrectomy, and three dogs had concurrent resection of a tumor thrombus from the vena cava. Anesthetic complications occurred in five dogs, including wide variations in heart rate (four dogs), blood pressure (five dogs), and cardiac arrythmias (one dog). One dog died 12 hours after surgery from partial dehiscence of the suture line and hemorrhage from the vena cava, and one dog died 6 days after surgery during general anesthesia for treatment of laryngeal paralysis. Four dogs survived from 3 to 23 months (median, 15 months). One dog remained hypertensive after surgery. Benign and malignant pheochromocytomas seem to be amenable to surgical resection. © Copyright 1994 by The American College of Veterinary Surgeons