Osteochondral Fragmentation in the Synovial Pad of the Fetlock in Warmblood Horses

Objectives— To determine clinical and arthroscopic characteristics associated with fragments in the synovial pad of the fetlock and to characterize their morphology. Study Design— Retrospective study. Animals— Warmblood horses (n=104) with fragment(s) in the synovial pad. Methods— S ignalment and results of radiographic and clinical examination were collected before surgery. After arthroscopic fragment removal and joint evaluation for synovial and/or cartilage abnormalities, fragments were measured, and evaluated by histopathology. Results— Synovial pad fragments (n=142) were removed from 127 fetlocks. Two older horses had lameness. During arthroscopy, abnormalities were observed in 40 joints (31.5%) and multivariate logistic regression analysis showed a significant correlation between the observed arthroscopic abnormalities and the presence of large fragments (P=.016). Fragments were osteochondral bodies completely surrounded by fibrous tissue. At the edges of the hyaline cartilage cap an underlying fibrous structure was obvious in the extracellular matrix giving it a reactive pattern. Conclusions— Although the impact on lameness was minimal, there was a significant correlation between arthroscopic abnormalities and presence of large synovial pad fragments. On histopathology, these osteochondral fragments are embedded in fibrous tissue and show a reactive pattern. They are not a manifestation of any well‐described joint pathology. Clinical Relevance— Large synovial pad fragments in Warmblood horses can be associated with synovial and cartilage abnormalities, but further studies are warranted to determine their origin and clinical importance.     

Synovial Fluid Cytokines and Eicosanoids as Markers of Joint Disease in Horses

OBJECTIVE: To evaluate the value of various synovial fluid cytokines and eicosanoids to diagnose joint disease or categories of joint disease. STUDY DESIGN: Prospective acquisition of clinicopathologic data. ANIMALS OR SAMPLE POPULATION: Client-owned or donated horses: 50 joints with no evidence of disease; 28 joints with acute disease; 32 joints with chronic disease; 9 joints with cartilage damage and no other signs of joint disease. METHODS: Concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), interleukin-6 (IL-6), prostaglandin E(2) (PGE(2)), thromboxane B(2) (TXB(2)), prostaglandin F1-alpha (PGF(1)-alpha), and leukotriene B(4) (LTB(4)), were measured in equine synovial fluid by immunoassay and categorized according to duration and degree of joint disease. Any test value for a given category that was different from normal was further analyzed for sensitivity (S), specificity (Sp), and operating point (most valid test cutoff value). Likelihood ratios and predictive values were calculated at the operating point. Mediator concentrations were correlated to synovial fluid white blood cell count. Tests were reported as poor, fair, good, or excellent based on predictive values of <.25,.25-.5,.5-.75, or >.75, respectively. RESULTS: TNF synovial fluid concentration as a predictor of joint disease was good, and the value of TNF (maximum S and Sp) indicating joint disease was >36 pg/mL. IL-1beta as a predictor of joint disease was good, and the value of IL-1beta indicating joint disease was >4.5 pg/mL. IL-6 concentration was an excellent predictor of joint disease. Any IL-6 in synovial fluid indicated joint disease and correlated highly with synovial fluid white blood cell count (P <.0001). PGE(2) was a good-excellent predictor of disease (positive predictive value [PPV] = 0.75), and the concentration indicating joint disease was >22.5 pg/mL. The diagnostic PGF(1)-alpha concentration indicating severe chronic joint disease was identified to be >16.5 pg/mL with very high sensitivity (S = 1) and specificity (Sp =.89). PGF(1)-alpha concentrations > 9.5 pg/mL had a good PPV (.69) and NPV (.6) for any joint disease. TBX(2) concentrations below 31.5 pg/mL (S =.57; Sp =.61) were a very good predictor of joint disease (PPV =.72). LTB(4) concentration appeared to be greater in severe acute joint disease than normal joints; this was not significant (P =.15) and correlated highly with synovial fluid white blood cell count (P =.0001). CONCLUSIONS: The ability of a single value from a joint in an adult horse predicting the presence of joint disease was often good (.5-.75), and was excellent (> or =.75) for IL-6 and PGE(2). TNF-alpha and IL-1beta were no more effective than white blood cell count in screening for joint disease. IL-6 was the most sensitive and specific for joint disease and could be an excellent screening test for the presence of joint disease when lameness is difficult to identify or is intermittent. PGE(2) would be a functional screening test for the presence of any joint disease and offers a differentiating feature because values were not influenced by white blood cell count. PGF(1)-alpha values > 16.5 pg/mL identified chronic severe joint disease and may be clinically useful when there are minimal radiographic changes but substantial articular cartilage degradation.     

Successful Management of Severe Open Metacarpophalangeal Joint Dorsal Luxation in a Horse

A 3-year-old Darreh-Shuri stallion was presented with left forelimb open dorsal fetlock luxation immediately after being hit by a motorized vehicle. The horse was in a non–weight-bearing position on the affected limb. General physical examination revealed normal vital parameters and no special concurrent abnormality. Radiographic examination in lateromedial and dorsopalmar views of the affected limb showed complete luxation of the metacarpophalangeal joint with no fractures. Ultrasonographic evaluation revealed intact collateral ligaments. Under general anesthesia and following routine preparations, forceful manual pressure was exerted on the distal part of the metacarpus and proximal part of the first phalanx to reduce the luxation. Joint capsule and skin laceration were sutured. Intraarticular amikacin (500 mg) was administered and repeated on the third and fifth days postoperatively. A palmar polyvinyl chloride, synthetic plastic polymer (PVC) splint was placed following adequate padding from the carpus to the toe. The higher and lower third of the splint was casted and the middle part left open to manage the joint and skin lesion. Intraarticular sodium hyaluronate (20 mg) was administered 10 days later. After cast removal following 5 weeks, the stallion revealed no sign of lameness. The owner was instructed to keep the stallion confined to a stall for at least 2 more months with a restricted daily short hand walk. Special casting methods for immobilization of a limb with an open joint luxation can tremendously improve the healing process.     

Septic Arthritis of the Distal Interphalangeal Joint in 12 Horses

The medical records of 12 horses with septic arthritis of a distal interphalangeal joint were reviewed to determine clinical features and response to treatment. Sepsis was caused by trauma or an injection that resulted in an open or contaminated distal interphalangeal joint. All horses were severely lame. Treatment included broad-spectrum parenterally administered antimicrobial drugs (ten horses), percutaneous through-and-through joint lavage (eight horses), indwelling drains (three horses), immobilization of the limb in a cast (three horses), intraarticular injection of sodium hyaluronate (one horse), intraarticular injection of antimicrobial drugs (five horses), curettage of the distal phalanx (one horse), and cancellous bone grafting to promote fusion (one horse). Five horses were euthanatized. Ankylosis of the affected joint developed in five horses, four of which are pasture sound. Two horses treated medically are sound although one underwent subsequent palmar digital neurectomy for treatment of navicular syndrome.     

Diagnostic and Operative Arthroscopy of the Coxofemoral Joint in Horses

Arthroscopic examination of the hip joint was performed in mature and juvenile horses, using a lateral approach and standard or long instruments depending on body weight. Nine hip joints were examined in three cadavers and four anesthetized horses. The lateral, cranial, and caudal regions of the femoral head and acetabulum were accessible, and, after distraction of the limb, the ligament of the head of the femur and the acetabular notch were also visible. In small horses, the medial regions of the hip joint were visible but were inaccessible in larger horses. Iatrogenic injury to the sciatic nerve or periarticular vasculature was not evident at necropsy examination. Six horses with lameness localized to the hip joint were examined arthroscopically. At surgery, two horses had tearing of the ligament of the head of the femur, two horses had osteochondrosis of the femoral head or acetabulum, and two horses had degenerative joint disease, one associated with a rim fracture of the caudal aspect of the acetabulum and the other of indeterminant origin. Improvement after debridement occurred in one of the horses with partial disruption of the ligament of the head of the femur and in both horses with osteochondrosis. Diagnostic and surgical arthroscopy of the hip can be accomplished in foals and weanlings using standard equipment, but, in adults weighing more than 300 kg, longer instruments are required and the ease of access and the visible extent of the hip joint is considerably reduced.     

A Modified Cloward''s Technique for Arthrodesis of the Normal Metacarpophalangeal Joint in the Horse

A modified Cloward's technique was performed for arthrodesis of one metacarpophalangeal (MCP) joint in eight horses. Dorsal arthrotomies were performed medial and lateral to the common digital extensor tendon and two 16 mm holes were drilled through the joint. A perforated cylindrical stainless steel basket filled with cancellous bone was impacted into each hole. The limbs were supported in casts for 8 weeks. The joints were examined and radiographed at 4 weeks, 8 weeks, 6 months, and 10 months. One horse was euthanatized at week 14 to assess the progress of the arthrodesis. In the other seven horses, there was clinical fusion at month 6. Dynamographic evaluations were performed 11 months after surgery at the walk and trot. The maximum vertical forces exerted during weight bearing by treated and control limbs were compared. No difference was detected at the walk; however, a significant difference was present at the trot (p less than 0.05). It was calculated that at the trot the horses placed 90% as much force on the treated limb as on the control limb. Eleven months after surgery, the baskets contained compact and cancellous bone. Ingrowth of bone occurred through all openings, completely filling the baskets and fusing the joints.     

The Arterial Supply of the Metacarpophalangeal Joint in the Bactrian Camel (Camelus bactrianus)

The arterial supply of the six metacarpophalangeal joints was studied in Bactrian camels. The arterial branches supplying the metacarpophalangeal joints were derived from the metacarpal distal perforating, medial and lateral branches of the palmar metacarpal artery III, medial and lateral branches of the palmar common digital artery III and the abaxial palmar proper digital arteries III and IV. These arterial branches were the proximal dorsoaxial distal metacarpal, distal dorsoaxial distal metacarpal, abaxial distal metacarpal, palmar distal metacarpal, interosseous distal metacarpal, dorsoaxial proximal proximal phalangeal, palmoaxial proximal proximal phalangeal, palmoabaxial proximal proximal phalangeal and dorsoabaxial proximal proximal phalangeal branches. They linked with each other around the metacarpophalangeal joint.     

Comparison of Three Drilling Techniques for Carpometacarpal Joint Arthrodesis in Horses

Objective: To evaluate 3 drilling techniques for arthrodesis of the equine carpometacarpal (CMC) joint. Study Design: Experimental study. Sample Population: Cadaveric equine forelimbs (n=15). Methods: Limbs were divided into 3 groups (5 limbs each) to evaluate 3 drilling techniques: (1) use of a 4.5 mm drill bit inserted into the joint through 4 entry points and moved in a fanning motion; (2) a 5.5 mm drill bit inserted through 2 entry points to create 3 nonfanned drill tracts (3 drill technique); and (3) a 4.5 mm drill bit used in a 3 drill technique. The CMC joint was disarticulated after drilling, and cartilage and subchondral bone damage evaluated visually and by gross and microradiographic examination using planimetry. Results: Technique 1 produced significantly more damage of the proximal surface, but significantly less to the subchondral bone of the distal surface. Technique 1 produced the most damage to both the articular cartilage and subchondral bone of the total CMC joint than either of the 3 drill tract techniques; however, the difference between techniques 1 and 2 was not significant. Damage from technique 3 was significantly less than that with techniques 1 or 2. Conclusions: Techniques 1 and 2 produced the most cartilage and subchondral bone damage with technique 2 changes more equally distributed between proximal and distal joint surfaces. Clinical Relevance: Technique 1 (fanning) and 2 (5.5 mm 3 drill tracts) may be preferable to achieve arthrodesis of the CMC joint. Morbidity and efficacy of these arthrodesis techniques need to be evaluated in vivo.     

Electrosurgical Arthrotomy and Excision of Soft Tissue Masses in the Metacarpophalangeal Joint of the Horse

Electrosurgical arthrotomy and excision of infra-articular soft tissue masses from the metacarpophalangeal joint was performed in 12 horses. In six of the 12 horses, osteochondral fragments from the dorsoproximal aspects of the first phalanx were also removed. The electrosurgical scalpel afforded excellent intraoperative efficacy for arthrotomy and relatively bloodless excision of soft tissue masses without the need for a tourniquet. There were no complications associated with healing in 11 of the 12 horses. A retraction technique that used careful positioning of a Langenbeck periosteal elevator relative to the collateral ligaments provided access to both medial and lateral margins of intra-articular masses. With this technique, all masses could be removed through one central arthrotomy incision.     

Histologic Appearance and Distribution of Synovial Membrane Types in the Equine Stifle Joint

A study of the histologic organization of normal synovial membranes of the stifle joint of the horse is described. Three types of synovial membrane, which appear to be randomly distributed within the stifle joint, are described.     

Effect of Four Antimicrobial Lavage Solutions on the Tarsocrural Joint of Horses

Three concentrations of povidone-iodine (0.1% w/v, 0.2% w/v, 0.5% w/v) and one concentration of chlorhexidine (0.5% w/v) were selected as antimicrobial joint lavage solutions. Through-and-through joint lavage was performed with one of these antimicrobial solutions on a tarsocrural joint of 12 horses. The contralateral tarsocrural joints (control limbs) were lavaged with a balanced electrolyte solution (BES). The effect of the lavage solution on the joints was evaluated with respect to lameness, foot flight pattern, soreness to joint palpation, articular and periarticular enlargement, and synovial fluid composition on Day 1,4, and 8 postlavage. On Day 8 postlavage, all horses were euthanized and the tarsocrural joints were examined.
All solutions induced a synovitis. Based on clinical assessment, synovial fluid protein levels, color, clarity, mucin clot forming ability, gross appearance of the joint at necropsy, and synovial membrane histologic evaluation, a similar, mild, transient, synovitis was induced by the BES and 0.1% povidone-iodine (PI) solution. The 0.2% PI solution induced a more prolonged neutrophilic response and poorer mucin clot forming ability in the synovial fluid as compared to the BES.
The 0.5% PI and 0.5% chlorhexidine solutions produced severe lameness, soreness to joint palpation, and limb enlargement. The elevated synovial fluid total protein content persisted significantly longer (p < 0.05) than the corresponding control (BES) solution. Histologic evaluation of the synovial membrane confirmed the presence of a moderate to severe neutrophilic synovitis in these treatment groups.     

The Intercarpal Ligaments of the Equine Midcarpal Joint, Part 3: Clinical Observations in 32 Racing Horses With Midcarpal Joint Disease

Objective— To characterize the clinical features of intercarpal ligament pathology and to determine the relationship among palmar intercarpal ligament tearing, dorsomedial intercarpal ligament (DMICL) hypertrophy, and other intraarticular lesions.
Study Design— Prospective clinical observations.
Animals or Sample Population— Twenty-eight thoroughbred and four standardbred race horses.
Methods— Clinical, radiographic, and arthroscopic examination of 53 midcarpal joints of 32 horses.
Results— Palmar intercarpal ligament tearing was observed in 30 joints of 22 horses. Some tearing of the medial palmar intercarpal ligament (MPICL) was present in 27 joints of 20 horses, and tearing of the lateral palmar intercarpal ligament in 9 joints of 7 horses. There was no correlation between the severity of clinical signs recorded and the degree of MPICL tearing. Joints with grade 2–4 MPICL tearing had significantly less cartilage and bone damage than joints with grade 1 or no ligament damage ( P <.05). There was a significant inverse relationship between the number and size of intra-articular fractures, as assessed radiographically, and ligament damage ( R = -.31). The DMICL was identified in all joints, and in 18 joints the ligament was enlarged. There was a significant correlation between MPICL damage and hypertrophy of the DMICL ( R =.35). There was no correlation between DMICL hypertrophy and articular cartilage damage or subchondral bone damage.
Conclusions— Severe subchondral bone and MPICL damage rarely occur in the same joint and DMICL hypertrophy may be associated with, rather than a cause of, joint disease.
Clinical Relevance— There are no clinical or radiographic findings that will differentiate intercarpal ligament injury from other carpal injuries. Diagnosis is only possible by arthroscopic examination of the midcarpal joint.