Use of radiographic measurements in the evaluation of dogs with medial patellar luxation

This prospective study used radiographic techniques to evaluate the inclination, Norberg, quadriceps and femoral varus angles, and the patellar position in dogs with developmental medial patellar luxation. The study also compared these measurements pre- and post-operatively to determine how they were affected by surgical procedures. Eighteen dogs with unilateral or bilateral luxation were used, and 4 groups were established according to luxation grade. Except for the quadriceps angle, there was no difference among the groups preoperatively. Significant differences for the quadriceps angle were observed between Grades 1 and 3, and between Grades 2 and 3. The Norberg and femoral varus angles and the patellar position showed no changes between pre- and postoperative groups. However, measurements of the preoperative quadriceps angle and postoperative inclination angle may be useful for evaluating dogs with grade-3 luxation. Further studies using other imaging techniques are required in dogs with severe grade-4 luxation due to the difficulty in obtaining a good radiographic position.     

Pharmacokinetics and effects on thromboxane B2 production following intravenous administration of flunixin meglumine to exercised thoroughbred horses

Flunixin meglumine is commonly used in horses for the treatment of musculoskeletal injuries. The current ARCI threshold recommendation is 20 ng/mL when administered at least 24 h prior to race time. In light of samples exceeding the regulatory threshold at 24 h postadministration, the primary goal of the study reported here was to update the pharmacokinetics of flunixin following intravenous administration, utilizing a highly sensitive liquid chromatography–mass spectrometry (LC‐MS). An additional objective was to characterize the effects of flunixin on COX‐1 and COX‐2 inhibition when drug concentrations reached the recommended regulatory threshold. Sixteen exercised adult horses received a single intravenous dose of 1.1 mg/kg. Blood samples were collected up to 72 h postadministration and analyzed using LC‐MS. Blood samples were collected from 8 horses for determination of TxB₂ and PGE₂ concentrations prior to and up to 96 h postflunixin administration. Mean systemic clearance, steady‐state volume of distribution and terminal elimination half‐life was 0.767 ± 0.098 mL/min/kg, 0.137 ± 0.12 L/kg, and 4.8 ± 1.59 h, respectively. Four of the 16 horses had serum concentrations in excess of the current ARCI recommended regulatory threshold at 24 h postadministration. TxB₂ suppression was significant for up to 24 h postadministration.     

Pre- and postoperative radiographic and computed tomographic evaluation of dogs with medial patellar luxation

OBJECTIVE: To quantify, using radiographic and computed tomographic (CT) techniques, the effects of surgical procedures most commonly combined to treat dogs with medial patellar luxation (MPL). STUDY DESIGN: Prospective study. METHODS: Six dogs with 8 MPL were studied. Radiographs and CT of the pelvic limbs were obtained before and immediately after soft-tissue reconstruction, trochlear wedge recession, and tibial crest transposition. Radiographic measurements included angle of inclination, Norberg angle, quadriceps angle (QA), anteversion angle, ratio of the length of the patellar tendon (PT) to the length of the patella, and change in patella tendon angle. CT measurements included angle of inclination, Norberg angle, QA, anteversion angle, depth of the femoral trochlear groove, ratio of the middle femoral trochlear groove depth to the patella thickness, and tibial crest alignment. RESULTS: Conformation of the coxofemoral joint was not affected by surgery. Surgical treatment corrected the QA by 33-58%. Trochlear wedge recession was most effective in deepening the proximal trochlea by 103.5%. The ratio of the middle femoral trochlear groove depth to the thickness of the patella postoperatively resulted in 50% coverage of the patella. Tibial crest transposition resulted in caudalization of the PT by 8.5+/-3.0 degrees, with lateralization of the tibial tuberosity of 11.3 degrees. CONCLUSION: The effects of surgery for MPL can be quantified with radiographic and CT measurements. Surgical correction restored the alignment of the quadriceps and adequately deepened the femoral trochlear groove. Tibial crest transposition resulted in caudalization of the patella tendon and lateralization of the tibial tuberosity. CLINICAL RELEVANCE: These pilot data quantified the effects of surgical procedures most commonly combined to treat MPL. We hope to use these measurements to correlate surgical treatment with functional outcome and postoperative occurrence of luxation.     

Ultrasonographic examination of the collateral ligaments of the distal interphalangeal joint in horses. Part B: Abnormal findings and lesions

Ultrasonography is an easy and rewarding technique for the assessment of collateral ligaments of the distal interphalangeal joint (CL‐DIPJ) desmopathies and enthesopathies. Comparison between ligaments of both feet and oblique incidence improve sensitivity and specificity of the ultrasonographic diagnosis. The main limitation of the procedure is imaging the distal part of the CL‐DIPJ and corresponding fossa of the distal phalanx. Alone, or in combination with other imaging procedures, ultrasonography is valuable in the diagnosis of the injured structures, which may help to determine the corrective shoeing and the rehabilitation programme of the horse.     

Ultrasonographic examination of the collateral ligaments of the distal interphalangeal joint in horses: Part A: Technique and normal images

The collateral ligaments (CL) of the distal interphalangeal joint (DIPJ) are important structures for DIPJ stability. Collateral ligament injuries must be considered in the differential diagnosis of foot pain. An accurate examination of the CL‐DIPJ can be performed with an adequate ultrasonographic technique and equipment. This paper describes the technique and normal ultrasonographic images as reference data for the diagnosis and documentation of CL‐DIPJ desmopathies and enthesopathies.     

Proximodistal alignment of the canine patella: radiographic evaluation and association with medial and lateral patellar luxation

Objectives— To evaluate the contribution of proximodistal alignment of the patella to patellar luxation, and to evaluate the structures contributing to proximodistal alignment of the patella relative to the femoral trochlea.
Study Design— Retrospective study using a convenience sample.
Animals— Medium to giant breed dogs (n=106).
Methods— Medical records and stifle radiographs of 106 dogs were reviewed. Radiographic measurements evaluated the proximodistal alignment of the patella with respect to the femoral trochlea, distal aspect of the femur, and proximal aspect of the tibia. Measurements were compared between dogs with clinically normal stifles (controls; n=51 dogs, 66 stifles), and dogs with a clinical diagnosis of medial patellar luxation (MPL, n=46 dogs, 65 stifles) or lateral patellar luxation (LPL, n=9 dogs, 11 stifles) using ANOVA.
Results— In dogs with MPL, the ratio of patellar ligament length (PLL) to patellar length (PL) was increased, as was the ratio of the distance from the proximal aspect of the patella to the femoral condyle (A) to PL ( P <.0001). Dogs with LPL had a decreased A:PL ( P =.003) and an increased ratio of the proximal tibial length (PTL) to distal tibial width (DTW; P =.009).
Conclusions— MPL is associated with a relatively long patellar ligament and patella alta in medium to giant breed dogs. LPL is associated with a relatively long proximal tibia and patella baja. Values for PLL:PL>2.06 and A:PL>2.03 are suggestive of the presence of patella alta, whereas a value for A:PL<1.92 is suggestive of patella baja.
Clinical Relevance— Measurements of both PLL:PL and A:PL are recommended in dogs with patellar luxation, and surgical correction should be considered in those with abnormal values.     

Ultrasonographic characteristics (cross-sectional area and relative echogenicity) of the digital flexor tendons and ligaments of the metacarpal region in Purebred Spanish horses

The objectives of this study were to establish normal values for relative echogenicity (RE) and cross-sectional area (CSA) of the flexor tendons and ligaments of the metacarpal region of Purebred Spanish horses (PBSH), and to determine the effect of body mass index (BMI), age, sex and forelimb on these variables. Transverse ultrasonographic images were obtained using 20 normal PBSH (10 females, 10 males; 2–25 years of age; BMI 132.04–152.25; not in training). The images were digitised and values for CSA and RE were determined for each structure.The suspensory ligament was the most echogenic and the largest structure, and the superficial digital flexor tendon was the least echogenic and smallest of the tissues examined. The tendons and ligaments of the metacarpal region in PBSH showed similar RE but smaller CSAs when compared to other breeds.     

Comparison of intra-articular injection of 2 ml of 0.9% NaCl solution with rest alone for treatment of horses with traumatic arthritis.

OBJECTIVE: To compare effects of intra-articular injection of 2 ml of 0.9% NaCl solution with rest alone for treatment of horses with traumatic arthritis. ANIMALS: 38 Standardbred horses with moderate to severe lameness that resulted from traumatic arthritis. PROCEDURE: Horses were stratified on the basis of number of affected joints. In each stratum, horses were allocated randomly to treatment groups (intraarticular injection of 2 ml of 0.9% NaCl solution vs rest only). Treatment was for a period of 3 weeks. Horses were inspected weekly with a final examination 2 to 4 weeks after completion of treatment. RESULTS: Mean lameness index was significantly lower during the 3-week treatment period and the entire study period for the NaCl-injected group. A significant decrease in the lameness index during the first 3-week treatment period also was detected for the rest-only group; however, the lameness index increased significantly for this group during the follow-up period, and an overall significant decrease was not detected. Comparison of the lameness index curve indicated a difference in favor of NaCl injection, with a significant difference between the 2 groups at final examination. Nine horses became sound during treatment with rest only, but 6 relapsed before final examination. In the NaCl-injected group, 5 of 10 sound horses relapsed. CONCLUSIONS AND CLINICAL RELEVANCE: Intra-articular injection of 2 ml of 0.9% NaCl solution was beneficial in horses with traumatic arthritis. Use of rest alone for a limited period was inadequate for treatment of young Standardbred horses with traumatic arthritis.     

Comparison of medial and lateral ultrasound-guided approaches for periarticular injection of the thoracolumbar intervertebral facet joints in horses

Objective: To compare ultrasound‐guided lateral and medial approaches for periarticular injections of the thoracolumbar intervertebral facet joints (IFJ). Study Design: Experimental cadaveric study. Sample Population: Adult equine cadavers (n=4). Methods: IFJ (T12–T13 to L5–L6) were identified by ultrasound (transducer perpendicular to the spine axis) and insertion of a 13 cm, 18 g spinal needle monitored until bone contact using medial (right side) and lateral (left side) approaches. Number of needle insertions at each site, needle repositioning, and insertion depth were recorded. On bone contact 2 mL latex was injected. Intraarticular deposition, distance of latex from the closest articular margin, and presence of latex in the multifidus muscle were established by dissection. Results: Of 96 attempts, only 1 site require reinsertion of the needle; however, 46% of the injections required needle repositioning. Mean ± SD insertion depth was 8.5 ± 1.1 cm. Most injections (86%) were intraarticular and 96% were at or within 0.5 cm of the closest articular margin. Needle insertion relative to the transducer (lateral, medial) had no effect on the distance from the latex to the closest articular margin and all injections were performed into the multifidus muscle. Conclusions: Ultrasound‐guidance facilitated accurate periarticular injection of thoracolumbar IFJ irrespective of using a medial or lateral approach.     

Disposition of methylprednisolone acetate in plasma,urine, and synovial fluid following intra‐articular administration to exercised thoroughbred horses

Methylprednisolone acetate (MPA) is commonly administered to performance horses, and therefore, establishing appropriate withdrawal times prior to performance is critical. The objectives of this study were to describe the plasma pharmacokinetics of MPA and time‐related urine and synovial fluid concentrations following intra‐articular administration to sixteen racing fit adult Thoroughbred horses. Horses received a single intra‐articular administration of MPA (100 mg). Blood, urine, and synovial fluid samples were collected prior to and at various times up to 77 days postdrug administration and analyzed using tandem liquid chromatography‐mass spectrometry (LC‐MS/MS). Maximum measured plasma MPA concentrations were 6.06 ± 1.57 at 0.271 days (6.5 h; range: 5.0–7.92 h) and 6.27 ± 1.29 ng/mL at 0.276 days (6.6 h; range: 4.03–12.0 h) for horses that had synovial fluid collected (group 1) and those that did not (group 2), respectively. The plasma terminal half‐life was 1.33 ± 0.80 and 0.843 ± 0.414 days for groups 1 and 2, respectively. MPA was undetectable by day 6.25 ± 2.12 (group 1) and 4.81 ± 2.56 (group 2) in plasma and day 17 (group 1) and 14 (group 2) in urine. MPA concentrations in synovial fluid remained above the limit of detection (LOD) for up to 77 days following intra‐articular administration, suggesting that plasma and urine concentrations are not a good indicator of synovial fluid concentrations.     

The intravenous pharmacokinetics of butorphanol and detomidine dosed in combination compared with individual dose administrations to exercised horses

In equine and racing practice, detomidine and butorphanol are commonly used in combination for their sedative properties. The aim of the study was to produce detection times to better inform European veterinary surgeons, so that both drugs can be used appropriately under regulatory rules. Three independent groups of 7, 8 and 6 horses, respectively, were given either a single intravenous administration of butorphanol (100 µg/kg), a single intravenous administration of detomidine (10 µg/kg) or a combination of both at 25 (butorphanol) and 10 (detomidine) µg/kg. Plasma and urine concentrations of butorphanol, detomidine and 3-hydroxydetomidine at predetermined time points were measured by liquid chromatography–tandem mass spectrometry (LC-MS/MS). The intravenous pharmacokinetics of butorphanol dosed individually compared with co-administration with detomidine had approximately a twofold larger clearance (646 ± 137 vs. 380 ± 86 ml hr⁻¹ kg⁻¹) but similar terminal half-life (5.21 ± 1.56 vs. 5.43 ± 0.44 hr). Pseudo-steady-state urine to plasma butorphanol concentration ratios were 730 and 560, respectively. The intravenous pharmacokinetics of detomidine dosed as a single administration compared with co-administration with butorphanol had similar clearance (3,278 ± 1,412 vs. 2,519 ± 630 ml hr⁻¹ kg⁻¹) but a slightly shorter terminal half-life (0.57 ± 0.06 vs. 0.70 ± 0.11 hr). Pseudo-steady-state urine to plasma detomidine concentration ratios are 4 and 8, respectively. The 3-hydroxy metabolite of detomidine was detected for at least 35 hr in urine from both the single and co-administrations. Detection times of 72 and 48 hr are recommended for the control of butorphanol and detomidine, respectively, in horseracing and equestrian competitions.     

Evaluation of corneal anaesthesia after the application of topical 0.5% bupivacaine, 2% lidocaine and 0.4% oxybuprocaine in normal horses

ObjectiveTo compare the corneal anaesthetic effect of 0.5% bupivacaine, 2% lidocaine and 0.4% oxybuprocaine on normal equine eyes.Study designProspective, blinded crossover study.AnimalsA group of 10 clinically healthy horses.MethodsCorneal sensitivity was determined in each eye by measuring corneal touch threshold (CTT). The study had three phases. Each subject was randomly given one of the three treatments followed by a 72 hour washout period. Every horse received all treatments. Baseline CTT was recorded prior to anaesthetic instillation (T0) then CTT was measured 5 and 10 minutes after (T1 and T2, respectively), then 20 to 90 minutes (T3 to T10) at 10 minute intervals. CTT data were compared among treatments at each time point using the Friedman test p < 0.05.ResultsMedian (range) baseline CTT was 51.3 (25.0–60.0) mm for bupivacaine, 50.0 (40.0–55.0) mm for oxybuprocaine and 55.0 (30.0–60.0) mm for lidocaine. All treatments caused a significant decrease in CTT at T1. The lowest CTT was observed at T3 with bupivacaine and oxybuprocaine treatments. Median CTTs at this time point were 18.7 (5.0–25.0) mm and 28.7 (25.0–40.0) mm, respectively. The lowest CTT with lidocaine treatment was 28.7 (20.0–50.0) mm at T6 (50 minutes). At T3, CTT was significantly lower with the bupivacaine treatment compared with oxybuprocaine and lidocaine treatments (p < 0.0074). There was no significant difference in CTT values between T1 and T6 for bupivacaine, between T1 and T7 for lidocaine, and between T1 and T8 for oxybuprocaine. Duration of the maximum effect was 45 minutes for the bupivacaine, 55 minutes for the lidocaine and 65 minutes for the oxybuprocaine treatment.Conclusions and clinical relevanceAdministration of a 0.5% injectable solution of bupivacaine or a 2% lidocaine had similar anaesthetic effect to the commonly used oxybuprocaine. Therefore, they might be used as alternatives for corneal anaesthesia.     

Exercising videoendoscopic evaluation of 7 horses with abnormal respiratory noise and poor performance following partial arytenoidectomy

Exercising upper airway endoscopic evaluation was performed in 7 horses with a history of poor performance after partial arytenoidectomy. Treadmill endoscopy revealed axial deviation of the ipsilateral aryepiglottic fold in all horses. Dynamic collapse of one or more additional upper airway structures was also observed. In 4 horses, laser resection of soft tissue structures that obstructed the upper airway was performed. After laser surgery, 3 horses raced and one performed adequately as a riding horse. Of the remaining 3 horses, 2 raced at a lower class and one performed adequately as a riding horse. In this population of horses, dynamic endoscopy of the upper airway was critical for case management. Based on our observations, horses post arytenoidectomy can have dynamic collapse of the ipsilateral aryepiglottic fold and laser resection of the fold may help resolve the performance problem.