Long‐Term Outcome after Arthroscopic Debridement of Distal Phalanx Extensor Process Fragmentation in 13 Horses

Objective— To report long-term outcome after arthroscopic removal of fragmentation of the extensor process of the distal phalanx in horses.
Study Design— Case series.
Animals— Adult horses (n=13).
Methods— Medical records (2003–2004) of horses that had arthroscopic debridement of fragmentation of the extensor process of the distal phalanx were reviewed. Inclusion criteria included: lameness localized to the foot, fragmentation of the extensor process of the distal phalanx debrided arthroscopically, and a follow-up period of ≥4 years.
Results— Of the 13 horses, lameness was resolved in 11 (85%) initially but distal interphalangeal joint pain recurred in 2 (15%) within 1 year of surgery. Three (23%) other horses were retired because of lameness at other sites during the follow-up period resulting in 46% (6/13) being not lame and in full work after 4 years. Substantial changes were identified at surgery in the contralateral joint of 7 horses, even when fragments were only present unilaterally.
Conclusions— Arthroscopic debridement of fragmentation of the extensor process of the forelimb distal phalanx has a good short-term prognosis for resolution of lameness and return to work but a more guarded prognosis for long-term soundness.
Clinical Relevance— These results allow for more accurate prognostication preoperatively and may support early debridement of fragmentation of the extensor process of the distal phalanx.     

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.     

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.     

Prevalence and response to surgical treatment of lateral palmar intercarpal ligament avulsion in horses: 37 cases (1990-2001)

OBJECTIVE: To clarify the diagnosis of avulsion of the lateral palmar intercarpal ligament (LPICL), correlate avulsion of this ligament with lameness, determine the prevalence of avulsion of the LPICL in a hospital population, and evaluate the response to surgical removal of the avulsion fragment in horses. DESIGN: Retrospective study. ANIMALS: 37 horses with avulsion of the LPICL. PROCEDURE: Medical records and radiographs of horses with avulsion of the LPICL were reviewed; follow-up information was obtained from race records and from owners via a telephone survey. RESULTS: Of 6,418 horses evaluated for forelimb lameness from March 1, 1990, to December 31, 2001, 37 (0.5%) had avulsion of the LPICL; each horse had a discrete fragment associated with avulsion of the ligament origin from the ulnar carpal bone. Twenty-six horses underwent arthroscopic fragment removal; 20 of 22 (91%) horses for which follow-up information was available returned to work. Of 9 horses treated conservatively, 5 returned to work. Odds ratio calculations indicated that horses treated surgically were 8 times as likely to return to work than those not treated surgically. Twelve horses had LPICL avulsion without concurrent osteochondral fragmentation in the same or additional joints; follow-up information was available for 9 of those horses, of which 8 returned to athletic work. CONCLUSIONS AND CLINICAL RELEVANCE: In horses, discrete avulsion of the LPICL can be a cause of lameness and arthroscopic debridement may be the treatment of choice. Prognosis for return to work of horses with avulsion of the LPICL is good.     

Occult subchondral osseous cyst-like lesions of the equine tarsocrural joint

OBJECTIVE: To report the clinical signs, diagnosis, management, and outcome of horses with occult sub-chondral osseous cyst-like lesions of the tarsocrural joint. DESIGN: Retrospective study. ANIMALS: Twelve horses with subchondral osseous cyst-like lesions (SOCLs) in the tarsocrural joint. METHODS: Information about history, examination findings, diagnostic techniques, and surgical procedures as obtained from medical records. Outcome was determined by patient re-evaluation and telephone communication with the referring veterinarian, owner, or trainer. RESULTS: Horses were aged from 3 to 29 years. Lameness (2 weeks to 1 year) varied from moderate to severe. Synovial fluid analyses (9 horses) yielded changes consistent with suppurative inflammation and positive bacterial culture was obtained in 4 horses. Eight of 9 horses that had intra-articular analgesia had a dramatic reduction in lameness. No abnormalities were detected on tarsal radiographs in 10 horses. Scintigraphy identified foci of increased radiopharmaceutical uptake in the distal tibia or talus of all horses, and the lesion was further characterized by computed tomography in 7 horses. SOCLs were identified in the medial malleolus (5), intertrochlear groove of the talus (4), lateral malleolus (2), and distal intermediate ridge of the tibia (1). One horse was euthanatized, 6 horses had surgical debridement, and 5 horses were managed conservatively. Four horses treated surgically (67%) returned to soundness. Conservatively treated horses continued to exhibit lameness but 2 were sufficiently sound for light pleasure riding. CONCLUSIONS: Occult lesions of the tarsus not visible on radiographs can be detected by computed tomography and scintigraphy and may be a source of lameness. CLINICAL RELEVANCE: SOCL, possibly of septic origin, should be a differential diagnosis for persistent lameness localized to the tarsocrural joint without radiographic abnormalities. Surgical debridement of the lesions may offer the best prognosis for a return to athletic soundness.     

Racing performance after arthroscopic removal of apical sesamoid fracture fragments in Thoroughbred horses age > or = 2 years: 84 cases (1989-2002)

REASONS FOR PERFORMING STUDY: Studies have shown that surgical removal of apical fracture fragments in Standardbred racehorses carries the best prognosis for return to racing performance, but there are no reports involving mature Thoroughbred (TB) racehorses. OBJECTIVES: To describe the incidence of apical proximal sesamoid fractures in TB racehorses and determine probability and quality of racing performance after arthroscopic removal of such fractures in TB racehorses age > or = 2 years. METHODS: Medical records and pre- and post operative race records of TB racehorses age > or = 2 years that underwent arthroscopic surgery for removal of apical proximal sesamoid fracture fragments were reviewed. RESULTS: Sixty-four percent of fractures occurred in the hindlimbs and 36% in the forelimbs. Horses with forelimb fractures had a reduced probability of return to racing (67%) compared to those with hindlimb fractures (83%), but the majority (77%) of treated horses recovered to return to race post operatively. Horses with medial forelimb fractures raced at only a 47% rate; those with suspensory desmitis at 63%. Unlike Standardbreds, there was no difference in probability of racing post operatively between horses that had, and had not, raced preoperatively. CONCLUSIONS: Data show that arthroscopic removal of apical proximal sesamoid fracture fragments is successful at restoring ability to race in skeletally mature TB horses without evidence of severe suspensory ligament damage. Prognosis for return to racing is excellent (83%) in horses with hindlimb fractures and good (67%) in those with forelimb fractures. Medial fractures of the forelimb have the worst prognosis. POTENTIAL RELEVANCE: The determination of prognosis for differing sites in TB racehorses should increase knowledge of apical proximal sesamoid bone fractures and improve communication from veterinarian to owner, and trainer, on the potential for arthroscopic restoration of the ability to race.     

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.     

Complete and partial hoof wall resection for keratoma removal: post operative complications and final outcome in 26 horses (1994-2004)

REASONS FOR PERFORMING STUDY: There are no data on the frequency of post operative complications following keratoma removal, such as recurrence, hoof wall instability and excessive granulation tissue formation, or their relation to the method of surgical removal. OBJECTIVE: To identify important factors in the outcome for horses undergoing surgical removal of a keratoma and compare the post operative complications encountered following keratoma removal by complete hoof wall resection (CR) and partial hoof wall resection (PR). HYPOTHESIS: Horses undergoing PR would have fewer post operative complications and would return to work more quickly than those undergoing CR. METHODS: A retrospective review of medical records from one equine hospital identified 26 horses that underwent removal of a keratoma by CR or PR. Clinical, radiological and surgical findings and outcome were analysed. RESULTS: Common clinical signs included lameness and the presence of a subsolar abscess. Fourteen horses underwent CR and 12 PR. The complication rate following CR (71%) was significantly lower than that following PR (25%) (P<0.01). Complications encountered included excess granulation tissue formation, hoof crack formation and keratoma recurrence at the surgical site. The time taken to return to full work post operatively was significantly shorter in horses undergoing PR compared to CR (P<0.01). All horses, except one, returned to their previous exercise level. CONCLUSIONS: PR resulted in fewer post operative complications and a more rapid return to athletic activity than CR. Potential relevance: Although the overall complication rate for CR was higher than for PR, the overall prognosis for return to soundness and the previous performance level is very good.     

Metacarpophalangeal Joint Synovial Pad Fibrotic Proliferation in 63 Horses

Medical records, radiographs, and sonograms of 63 horses with metacarpophalangeal joint synovial pad proliferation were examined retrospectively. All horses had lameness, joint effusion, or both signs associated with one or both metacarpophalangeal joints. Bony remodeling and concavity of the distodorsal aspect of the third metacarpal bone (Mc3) just proximal to the metacarpal condyles was identified by radiography in 71 joints (93%); 24 joints (32%) had radiographic evidence of a chip fracture located at the proximal dorsal aspect of the proximal phalanx. Fifty-four joints (71%) were examined by ultrasound. The mean ± SD sagittal thickness of the synovial pad was 11.3 ± 2.8 mm. Seventy-nine percent of the horses had single joint involvement with equal distribution between the right and left forelimbs. Sixty-eight joints in 55 horses were treated by arthroscopic surgery. Sixty joints (88%) had debridement of chondral or osteochondral fragmentation from the dorsal surface of Mc3 beneath the synovial pad and 30 joints (44%) had a bone chip fracture removed from the medial or lateral proximal dorsal eminence of the proximal phalanx. Complete or partial excision of both medial and lateral synovial pads was completed in 42 joints. Only the medial synovial pad was excised or trimmed in 21 joints, and 5 joints had only the lateral pad removed. Eight joints in eight horses were treated by stall rest, administration of intra-articular medication and systemic nonsteroidal anti-inflammatory drugs. Follow-up information was obtained for 50 horses treated surgically and for eight horses treated medically. Forty-three (86%) that had surgery returned to racing; 34 (68%) raced at an equivalent or better level than before surgery. Three (38%) of the medically treated horses returned to racing; only one horse raced better than the preinjury level. Horses that returned to racing at a similar or equal level of performance were significantly younger in age than horses returning at a lower level or not racing (P≤.05). Overall, horses with synovial pad proliferation treated by arthroscopic surgery had a good prognosis for return to racing at a level equal or better than before injury.     

Subchondral cystic lesions of the proximal extremity of the tibia in horses: 12 cases (1983-2000)

OBJECTIVE: To determine clinical and radiographic features of subchondral cystic lesions (SCL) of the proximal extremity of the tibia in horses that could be used to classify these lesions as being related to osteochondrosis or osteoarthritis and to evaluate results of surgical debridement. DESIGN: Retrospective study. ANIMALS: 12 horses with 14 SCL. PROCEDURE: Medical records and radiographs obtained before and after treatment were reviewed. RESULTS: In 6 young horses (8 lesions), SCL were considered to be related to osteochondrosis; all involved the lateral tibial condyle. The remaining 6 horses were mature and had radiographic evidence of osteoarthritis in addition to SCL. Arthroscopic debridement was performed in 4 horses in which lesions were considered to be a result of osteochondrosis and in 3 horses with osteoarthritis. Three horses in which SCL were considered to be a result of osteochondrosis performed athletically after debridement. Two horses with moderate osteoarthritis returned to work after arthroscopic debridement but at a lower level of athletic performance. One horse with SCL related to osteochondrosis responded to medical treatment and went on to race. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that arthroscopic debridement of SCL is feasible in horses in which lesions involve the cranial portion of the lateral or medial tibial condyle, and that treated horses may be able to perform athletically.     

Arthroscopic injection of corticosteroids into the fibrous tissue of subchondral cystic lesions of the medial femoral condyle in horses: a retrospective study of 52 cases (2001-2006)

REASONS FOR PERFORMING STUDY: There are no published results of subchondral cystic lesions (SCLs) in the medial femoral condyle (MFC) treated with arthroscopic injection of corticosteroids into the lining of the cyst. OBJECTIVES: 1) To determine the success rate for treatment of SCLs in the MFC with arthroscopic injection of the fibrous tissue of the cyst with corticosteroids. 2) To identify any factors that may predict outcome. HYPOTHESES: Injection of the fibrous tissue of SCLs of the MFC with corticosteroids utilising arthroscopic guidance yields a similar or higher chance for intended performance than does arthroscopic debridement as previously reported; this technique will be effective for treating SCLs in older horses. METHODS: Horses with clinical and radiographic evidence of a SCL in the MFC were injected with corticosteroids under arthroscopic guidance, and case records and radiographs were reviewed retrospectively. A telephone survey of referring veterinarians, owners and trainers was conducted. RESULTS: Thirty-five of 52 (67%) cases were classified as successful involving 73 SCLs of which 56 (77%) were classified as successful. There was no significant association between age group (age3 years) and outcome, or cyst configuration and outcome. Significantly more unilateral SCLs (28/31 [90%] SCLs) were classified as successful than bilateral (28/42: 67%). There were significant differences in outcome based on the surgeon operating the case and an association between pre-existing radiographic findings of osteophytes and negative outcome. CONCLUSIONS: Injection of SCLs utilising arthroscopic guidance is an effective alternative method of surgical treatment of SCL. POTENTIAL RELEVANCE: This technique offers a similar chance of success as has been reported with debridement and may allow for a shorter period of convalescence. If unsuccessful, the option remains to debride the cyst in a second surgery.     

Racing performance after arthroscopic removal of apical sesamoid fracture fragments in Thoroughbred horses age < 2 years: 151 cases (1989--2002)

REASONS FOR PERFORMING STUDY: Studies on arthroscopic removal of apical proximal sesamoid fracture fragments in Thoroughbred (TB) horses age > or = 2 years have reported a high success rate. However, there are no reports documenting the racing prognosis of TB horses that undergo such surgery as weanlings or yearlings. OBJECTIVES: To describe the incidence of apical proximal sesamoid fractures in immature TB horses, age < 2 years and determine probability and quality of racing performance after arthroscopic removal of such fractures in 151 TB weanlings and yearlings. METHODS: The medical records of TB horses age < 2 years that underwent arthroscopic surgery for removal of apical proximal sesamoid fracture fragments were reviewed. Follow-up information was obtained from race records. Student's t tests were used to compare performance variables of operated racehorses to that of their maternal siblings. RESULTS: Ninety-two percent (139/151) of fractures occurred in the hindlimbs and 8% (11/151) in the forelimbs (fracture of both fore- and hindlimb, n = 1). Horses with forelimb fractures had a greatly reduced probability of racing (55%) compared to those with hindlimb fractures (86%). Overall, 84% of the horses raced post operatively and had performance records similar to that of their maternal siblings, 78% (787/1006) of which raced. CONCLUSIONS: Arthroscopic removal of apical proximal sesamoid fracture fragments in TB weanlings and yearlings carries an excellent prognosis for racing in horses with hindlimb fractures and a reduced prognosis in those with forelimb fractures. Medial fractures of the forelimb carry the worst prognosis. POTENTIAL RELEVANCE: The determination of prognosis increases knowledge on apical sesamoid bone fractures and potential for arthroscopic restoration of the ability to race; and enables the value of yearlings for subsequent sale to be established.     

Arthroscopic reattachment of osteochondritis dissecans cartilage flaps of the femoropatellar joint: long-term results

Reasons for performing study: Long‐term efficacy of arthroscopic cartilage reattachment for the treatment of osteochondritis dissecans (OCD) lesions in the equine femoropatellar joint is unknown. Objective: To evaluate radiographic outcome and long‐term performance of horses undergoing OCD reattachment. Hypothesis: Separated OCD cartilage flaps may be reincorporated into the joint surface by reattachment rather than flap removal. Methods: Polydioxanone pins were utilised arthroscopically to reattach OCD lesions in 40 of 44 joints from 27 horses. Cartilage was reattached when it had persisting perimeter continuity, the surface was not deeply fissured or irregular, and the cartilage was not protuberant or extensively mineralised. Bone marrow aspirate concentrate was grafted to additional areas denuded of cartilage or alongside reattached cartilage. Results: Breeds included Thoroughbred (n = 18), Quarter Horse (n = 4), Warmblood (n = 3), Standardbred (n = 1) and Arabian (n = 1). Mean age was 9.7 months. Radiographic lesion length was 1.5–6.3 cm. Reattachment alone was used in 32 of 44 affected joints, a combination of debridement and reattachment in 8 joints and debridement alone in 4 joints. One horse was destroyed due to tendon laceration. Of the remaining 26 horses, mean duration of follow‐up was 15.6 months (range 2 months–12 years). Radiographic resolution of OCD lesions treated with reattachment was significantly improved at 6 months. Twenty horses had long‐term performance data, of which 19 were sound and had reached intended athletic potential. One horse remained lame, and an additional 6 were sound but remained unbroken or were convalescing. Thus, an overall success rate based upon continued soundness in performing horses was 95% (19/20). Conclusion: Cartilage flap reattachment can salvage OCD cartilage by integration with the underlying bone. Potential relevance: Extensive OCD cartilage flaps may be salvaged by reattachment which can result in normal radiographic subchondral bone contour and long‐term athletic performance.     

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.     

Arthroscopic removal of fractures of the lateral malleolus of the tibia in the tarsocrural joint: A retrospective study of 13 cases

There is limited information on the treatment of lateral malleolus (LM) fractures in the horse, with no previously published case series for the outcome following arthroscopic removal of such fractures. This report reviews and evaluates findings of a retrospective study of 13 horses admitted to a private equine referral hospital over a 10 year period (1999–2009) that underwent arthroscopic removal of fractures of the LM. Hospital records were reviewed and details including patient history, aetiology of the fracture and limb affected, results of all diagnostic tests and surgical reports were documented. Performance information concerning Thoroughbred horses that went onto race post operatively was collected using an online database. Owners and trainers were contacted regarding the return to performance for non‐Thoroughbred cases or those that did not go onto race post operatively. Of the 13 horses presented, 12 were Thoroughbreds, 9 of which were National Hunt racehorses and 3 were Flat racehorses. The other horse in the study was used for general purpose riding. All cases presented with an acute unilateral fracture. Eleven of the 13 had >6 months post operative follow‐up and all were nonlame. Of the 12 Thoroughbreds, 10 have raced again, a total of 104 times (median 5 times). The median time from surgery to return to racing was 241 days (180–366 days). It is concluded that horses with fractures of the LM have an excellent prognosis for return to full athletic performance following arthroscopic debridement; and that arthroscopic fragment removal is an appropriate treatment method for fractures of the LM.     

Meniscal tears in horses: an evaluation of clinical signs and arthroscopic treatment of 80 cases

REASONS FOR PERFORMING STUDY: There is little published information available describing clinical signs, arthroscopic findings and prognosis of meniscal injuries in horses. OBJECTIVES: To evaluate the effect on the outcome not only of the arthroscopic findings and treatment, but also of the clinical and radiographic signs in these horses. METHODS: The following were recorded for each case: the meniscal injury, graded according to severity; clinical and radiographic findings prior to surgery; any concurrent injury in the joint seen at arthroscopy. The effect of these factors and the grade of injury on the outcome were analysed using Fisher's exact test or Chi-square analysis. Only horses whose meniscal injury was judged to be the primary cause of lameness were included in the series. RESULTS: A series of 80 meniscal injuries were diagnosed and treated arthroscopically by the authors at the Liphook Equine Hospital and 47% of horses returned to full use. Statistically, poor prognosis was associated with increasing severity of the meniscal injury, the presence of concurrent articular cartilage lesions and radiographic abnormalities in the joint. Arthroscopic treatment of many lesions was limited by the inaccessibility of parts of the femorotibial joint. POTENTIAL RELEVANCE: Further work is required to improve and evaluate arthroscopic techniques for the treatment of these injuries.     

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%).     

Fractures of the palmar aspect of the carpal bones in horses: 10 cases (1984-2000)

OBJECTIVE: To determine clinical and radiographic findings, treatment, and outcome of horses with fractures of the palmar aspect of the radial carpal bone, with or without concurrent fractures of the palmar surfaces of the other carpal bones. DESIGN: Retrospective study. ANIMALS: 10 horses. PROCEDURE: Medical records were reviewed to obtain information on history, signalment, clinical and radiographic findings, treatment, and outcome. Follow-up information was gathered from owners and referring veterinarians. RESULTS: 7 horses became lame after recovery from general anesthesia for treatment of an unrelated problem. The remaining 3 horses developed a fore-limb lameness after falling (1 horse) or being turned out in a pasture (2 horses). Fractures involved the palmar surface of the radial carpal bone in all 10 horses; in addition, the ulnar carpal bone was affected in 2 horses, the intermediate carpal bone in 2 horses, and the distal aspect of the radius in 4 horses. None of the 4 horses treated nonsurgically returned to work, and 3 were euthanatized because of recalcitrant lameness. In the other 6 horses, fragments were removed surgically. Two were euthanatized because of continued lameness, 1 was euthanatized for other reasons, 2 were sound enough for light work, and 1 returned to athletic work. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that fractures of the palmar aspect of the carpal bones are uncommon in horses. The prognosis appears to be poor for affected horses but may be better for horses that undergo arthroscopic removal of intra-articular fragments.     

Evaluation of a cranial arthroscopic approach to the stifle joint for the treatment of femorotibial joint disease in horses: 23 cases (1998-1999)

OBJECTIVE: To describe a single-portal cranial arthroscopic approach to the stifle joint in horses and to determine the clinical outcome in horses with femorotibial joint disease in which this approach was used. DESIGN: Retrospective study. ANIMALS: 23 adult horses. PROCEDURE: Medical records were reviewed to obtain information on clinical outcome in horses in which the single-portal cranial arthroscopic approach was used. RESULTS: Twenty-nine stifle joints of 23 horses were examined arthroscopically, using the described approach. Subchondral bone cysts were treated in 19 medial femoral condyles of 12 horses. Unilateral cruciate ligament desmitis (4 horses), meniscal tearing (3), or both (2) were identified in 9 horses. Evidence of degenerative joint disease without cystic lesions or soft tissue trauma was found in 2 horses. Information on clinical outcome was obtained for 21 of 23 horses. A successful outcome was obtained in 15 of 21 horses and was defined as return to sound performance at a degree equal to or better than that prior to injury and lameness. Eight of 12 horses treated for medial femoral condylar cysts had a successful outcome. Four show horses treated for cruciate ligament lesions alone successfully returned to showing activity. None of the 3 horses with meniscal tearing were able to perform successfully. CONCLUSIONS AND CLINICAL RELEVANCE: The femorotibial joint was evaluated through a single-portal cranial arthroscopic approach, using the femoropatellar joint as the point of access. This approach was easy to perform, allowed controlled access to the femorotibial joint, avoided accidental damage to articular structures, and required fewer access portals.