Evaluation of samarium-153 for synovectomy in an osteochondral fragment-induced model of synovitis in horses

OBJECTIVE: To determine the effects of intraarticular administration of Samarium-153 (153Sm) bound to hydroxyapatite microspheres (153SmM) on an osteochondral chip-induced synovitis. STUDY DESIGN: Sixty days after implantation of autogenous osteochondral fragments in the middle carpal and metacarpophalangeal joints, 153SmM was administered into 1 joint of each type. The contralateral joints were used as untreated controls. ANIMALS OR SAMPLE POPULATION: Fifteen horses without preexisting joint disease were randomly divided into 2 groups (7 in the carpal group, 8 in the metacarpophalangeal group). METHODS: Horses had osteochondral fragments that were harvested from the lateral ridge of the trochlea of the talus and implanted bilaterally into a middle carpal joint and a metacarpophalangeal joint; the opposite joint type served as a control. Sixty days later, 10 to 15 mCi of 153SmM (20 to 50 microm diam) was injected into the fragment-implanted joints. Three horses were treated with nonradioactive hydroxyapatite fragments. Horses were examined clinically until they were killed 14 or 30 days later. Control and treated joints were examined grossly and microscopically to determine the effects of 153SmM on synovial membrane and cartilage. RESULTS: Intraarticular 153SmM caused a transient flare with lameness, effusion, and edema for 48 to 72 hours. Implanted osteochondral chips induced a synovitis characterized by variable degrees of joint damage and synovial infiltrate. Use of 153SmM resulted in synovectomy of variable depth and extent. CONCLUSIONS: Intraarticular 153SmM may be a useful method for synovectomy of inflamed synovial membrane. CLINICAL RELEVANCE: With further testing, radioactive pharmaceuticals might become useful clinical treatments for persistent synovitis not responsive to conventional techniques.     

Lameness and poor performance in horses used for team roping: 118 cases (2000-2003)

OBJECTIVE: To determine the types of musculoskeletal problems that result in lameness or poor performance in horses used for team roping and determine whether these problems are different in horses used for heading versus heeling. DESIGN: Retrospective study. ANIMALS: 118 horses. PROCEDURE: Medical records of team roping horses that were evaluated because of lameness or poor performance were reviewed to obtain information regarding signalment, primary use (ie, head horse or heel horse), history, results of physical and lameness examinations, diagnostic tests performed, final diagnosis, and treatment. RESULTS: Among horses evaluated by lameness clinicians, the proportion with lameness or poor performance was significantly greater in horses used for heading (74/118) and lower in horses used for heeling (44/118) than would be expected under the null hypothesis. Most horses examined for poor performance were lame. A significantly greater proportion of horses used for heading had right forelimb lameness (26/74 [35%]), compared with horses used for heeling (7/44 [16%]). Horses used for heading had more bilateral forelimb lameness (18/74 [24%]), compared with horses used for heeling (4/44 [9%]). Horses used for heeling had more bilateral hind limb lameness (3/44 [7%]), compared with horses used for heading (0%). The most common musculoskeletal problems in horses used for heading were signs of pain limited to the distal sesamoid (navicular) area, signs of pain in the navicular area plus osteoarthritis of the distal tarsal joints, and soft tissue injury in the forelimb proximal phalangeal (pastern) region. Heeling horses most commonly had signs of pain in the navicular area, osteoarthritis of the metatarsophalangeal joints, and osteoarthritis of the distal tarsal joints. CONCLUSIONS AND CLINICAL RELEVANCE: Horses used for heading were most commonly affected by lameness in the right forelimb. Horses used for heeling had more bilateral hind limb lameness than horses used for heading.     

Clinical, biochemical, and histologic effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis

OBJECTIVE: To assess the clinical, biochemical, and histologic effects of intra-articular administration of autologous conditioned serum (ACS) in the treatment of experimentally induced osteoarthritis in horses. ANIMALS: 16 horses. PROCEDURES: Osteoarthritis was induced arthroscopically in 1 middle carpal joint of all horses. In 8 placebo- and 8 ACS-treated horses, 6 mL of PBS solution or 6 mL of ACS was injected into the osteoarthritis-affected joint on days 14, 21, 28, and 35, respectively; PBS solution was administered in the other sham-operated joints. Evaluations included clinical assessment of lameness and synovial fluid analysis (performed biweekly); gross pathologic and histologic examinations of cartilage and synovial membrane samples were performed at necropsy. RESULTS: No adverse treatment-related events were detected. Horses that were treated with ACS had significant clinical improvement in lameness, unlike the placebo-treated horses. Among the osteoarthritis-affected joints, ACS treatment significantly decreased synovial membrane hyperplasia, compared with placebo-treated joints; although not significant, the ACS-treated joints also appeared to have less gross cartilage fibrillation and synovial membrane hemorrhage. The synovial fluid concentration of interleukin-1 receptor antagonist (assessed by use of mouse anti-interleukin-1 receptor antagonist antibody) was increased following treatment with ACS. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this controlled study indicated that there was significant clinical and histologic improvement in osteoarthritis-affected joints of horses following treatment with ACS, compared with placebo treatment. On the basis of these findings, further controlled clinical trials to assess this treatment are warranted, and investigation of the mechanisms of action of ACS should be pursued concurrently.     

Osteitis of the axial border of the proximal sesamoid bones in horses: eight cases (1993-1999).

OBJECTIVE: To determine clinical, radiographic, and scintigraphic abnormalities in and outcome of horses with septic or nonseptic osteitis of the axial border of the proximal sesamoid bones. DESIGN: Retrospective study. ANIMALS: 8 horses. PROCEDURE: Data collected from medical records included signalment; history; horse use; severity and duration of lameness; results of perineural anesthesia, radiography, ultrasonography, and scintigraphy; and outcome following surgery. RESULTS: Five horses did not have any evidence of sepsis; the other 3 had sepsis of the metacarpophalangeal or metatarsophalangeal joint or the digital synovial sheath. All horses had a history of chronic unilateral lameness. Three of 5 horses improved after diagnostic anesthesia of the metacarpophalangeal or metatarsophalangeal joint; the other 2 improved only after diagnostic anesthesia of the digital synovial sheath. Nuclear scintigraphy was beneficial in localizing the source of the lameness to the proximal sesamoid bones in 4 horses. Arthroscopy of the palmar or plantar pouch of the joint or of the digital synovial sheath revealed intersesamoidean ligament damage and osteomalacia of the axial border of the proximal sesamoid bones in all horses. All 5 horses without sepsis and 1 horse with sepsis returned to their previous uses. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that osteitis of the axial border of the proximal sesamoid bones is a distinct entity in horses that typically is associated with inflammation of the associated metacarpointersesamoidean or metatarsointersesamoidean ligament and may be a result of sepsis or nonseptic inflammation. Arthroscopic debridement may allow horses without evidence of sepsis to return to their previous level of performance.     

Evaluation of iatrogenic hemarthrosis of the metacarpophalangeal joint as a method of induction of temporary reversible lameness in horses

OBJECTIVE: To determine whether iatrogenic hemarthrosis of the metacarpophalangeal joint could be used as a model for temporary reversible joint pain in horses. ANIMALS: 8 adult horses. PROCEDURE: Each horse was evaluated on a treadmill before and after injection of 1 metacarpophalangeal joint with 10 mL of autogenous blood. Horses were evaluated subjectively and objectively by use of a computerized force measurement system at intervals until lameness abated. The mean force difference between injected and noninjected limbs at all time periods after injection was compared with the difference between limbs at baseline. From each horse, synovial fluid samples collected before and 24 hours and 30 days after injection were analyzed for total protein concentration and cell type and number. Venous blood samples were collected before and 6 and 24 hours after injection for assessment of plasma cortisol concentration. RESULTS: For 24 hours after injection, the mean force difference between injected and noninjected limbs was significantly increased over baseline. The greatest force difference was detected after 2 and 4 hours. Baseline and 24-hour force data were not significantly different. Compared with baseline values, synovial fluid protein concentration and nucleated cell and RBC counts were increased significantly at 24 hours after injection but were not different at 30 days after injection. No significant changes in plasma cortisol concentration were detected at any time point. CONCLUSIONS AND CLINICAL RELEVANCE: In horses, iatrogenic hemarthrosis of the metacarpophalangeal joint appears to induce temporary reversible lameness with a mild to moderate degree of synovitis.     

Rupture of collateral ligaments in metacarpophalangeal and metatarsophalangeal joints in horses: 17 cases (1999--2005)

OBJECTIVE: To characterize ruptures of collateral ligaments (CLs) in metacarpophalangeal and metatarsophalangeal joints in horses. DESIGN: Retrospective case series. ANIMALS: 17 horses with ruptured CLs. PROCEDURES: Data were obtained from medical records, including signalment, history, clinical signs, ultrasonographic and radiographic findings, treatment, and outcome. Additional follow-up information was obtained from owners or referring veterinarians. RESULTS: The lateral CL was ruptured in 11 horses; the medial CL was ruptured in 6 horses. Ultrasonography revealed ipsilateral rupture of the short and long components of the CL in 11 horses and rupture of only 1 component in 6 horses. No biaxial ruptures were detected, but 9 horses had desmitis of the CL on the nonruptured side of the affected joint. All horses were lame (lameness score range, 2/5 to 4/5). Joint instability was palpable in 9 horses; only 4 horses had episodes of joint luxation. Avulsion fractures were identified radiographically in 6 horses and ultrasonographically in another 2 horses. Stress radiography revealed joint instability in 10 horses. Horses were managed by stall confinement, limb immobilization, and gradual return to exercise. Eight horses returned to riding, 2 resumed breeding, 2 were retired, 2 were euthanized, and 3 were doing well 86 to 139 days after injury. CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasonographic examination is indicated in horses with acute lameness and swelling at the metacarpophalangeal or metatarsophalangeal joint, particularly when stress radiography cannot be performed or findings are equivocal. Affected horses can be conservatively managed. Prognosis for athletic use may be better than originally believed.     

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.     

Glycosaminoglycans in horses with osteoarthritis

Horse articular cartilage glycosaminoglycans (GAGs) were measured in synovial fluids from 48 joints affected with osteoarthritis (OA), 22 normal joints, four joints with osteochondritis, three joints with traumatic arthritis and seven joints infected with bacteria. Serum and urine from individual horses were also examined for the presence of GAGs. High levels of GAGs were found in synovial fluids (SF) from horses with OA. In each case, the level was higher in the synovial fluid than in the serum or urine from the same horse. Horses with OA showed high GAG levels in SF, serum and urine compared to horses with normal and infected joints. High levels were also found in horses with osteochondritis and traumatic arthritis. Levels of synovial fluid GAG reflect cartilage destruction in arthritis and may be useful for monitoring disease progression in the equine species.     

Effects of intra-articular administration of dimethylsulfoxide on chemically induced synovitis in immature horses

The effects of intra-articular administration of dimethylsulfoxide (DMSO) on chemically induced synovitis in the middle carpal joint of 6 weanling horses were evaluated. Following aseptic collection of synovial fluid, the middle carpal joint of each forelimb was injected with 50 mg of Na-monoiodoacetate to induce synovitis. Eight days after injection, synovial fluid was obtained and the right middle carpal joints were injected with 2 ml of 40% DMSO in lactated Ringer solution. The corresponding joints of the left limb (control) were injected with 2 ml of lactated Ringer solution. Sampling and treatments were repeated on post-injection days 11 and 14, for a total of 3 treatments. Horses were visually evaluated daily for lameness and joint effusion. Synovial fluid was evaluated for color and clarity, differential and total WBC count, total protein content, and hyaluronic acid concentration. The Kaegi gait analysis system provided an objective assessment of lameness prior to inducing synovitis, again on day 7, and on day 17. At necropsy (day 17), synovial fluid, synovial membrane, and articular cartilage specimens were collected. Joint effusion was evident 12 hours after injection of Na-monoiodoacetate in all joints. Mild lameness was evident at 24 hours; however, the lameness resolved by 72 hours. Objective assessment of lameness did not reveal significant differences between treatment or control limbs. Hyaluronic acid concentrations increased significantly (P = 0.023) above baseline values in most joints over the study period. Synovial fluid WBC counts increased significantly (P = 0.002) following Na-monoiodoacetate injection and remained significantly (P = 0.002) above baseline values throughout the study.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Use of magnetic resonance imaging for identifying subchondral bone damage in horses: 11 cases (1999-2003)

OBJECTIVE: To assess the use of magnetic resonance (MR) imaging for identifying subchondral bone damage in the distal limbs of horses. DESIGN: Retrospective study. ANIMALS: 11 horses. PROCEDURE: Medical records of horses with lameness and subsequent evidence of subchondral bone damage as determined by MR imaging were reviewed. Severity and duration of lameness, results of diagnostic local anesthesia and diagnostic testing, surgical and necropsy findings, and treatment were recorded. Outcome was determined by follow-up information obtained from the owner or referring veterinarian. RESULTS: Lameness was localized by physical examination and diagnostic local anesthesia. Lameness was localized to the metacarpophalangeal or metatarsophalangeal joint in 4 horses, distal interphalangeal joint in 5 horses, and tarsocrural joint in 2 horses. The duration of lameness ranged from 2 weeks to 20 months. Magnetic resonance imaging of the affected joints revealed abnormal fluid accumulation within the subchondral bone. None of the abnormalities observed by MR imaging were detected by radiography. Subchondral bone damage was diagnosed in all horses. Arthroscopy of the affected joint was performed in 4 horses. Communication with the articular surface of the affected bone was suspected on the basis of results of MR imaging in 4 horses and was confirmed by arthroscopy in 1 horse and by necropsy in 1 horse. CONCLUSIONS AND CLINICAL RELEVANCE: Magnetic resonance imaging was useful for providing a diagnosis when other imaging techniques did not definitively identify the cause of lameness. Subchondral bone damage was clearly identified by MR imaging and should be considered as a cause of lameness in horses in which radiographic findings are unremarkable.     

Luxation of the metacarpophalangeal and metatarsophalangeal joints in horses

Lateral or medial luxation of the metacarpophalangeal or metatarsophalangeal (fetlock) joint in 10 horses is presented. Closed and open fetlock luxation each occurred in five horses. Horses were treated by cast immobilisation after debridement of soft tissue and joint lavage in cases of open luxations. Suture apposition of a ruptured collateral ligament was attempted in three cases. Antibiotic therapy was used in all cases of open fetlock luxation but non-steroidal anti-inflammatory medication was used inconsistently. Whether closed or open, fetlock luxations had a good prognosis for return to breeding status. After treatment, seven horses were used for breeding, one horse was ridden for nine years, one horse remained lame and was destroyed and one horse was lost to follow up.     

Analgesic and anti-hyperalgesic effects of epidural morphine in an equine LPS-induced acute synovitis model

Epidural morphine is widely used in veterinary medicine, but there is no information about the anti-hyperalgesic and anti-inflammatory effects in acute inflammatory joint disease in horses. The analgesic, anti-hyperalgesic and anti-inflammatory effects of epidural morphine (100mg/animal or 0.17±0.02mg/kg) were therefore investigated in horses with acute synovitis. In a cross-over study, synovitis was induced in the talocrural joint by intra-articular lipopolysaccharide (LPS). The effect of epidural morphine was evaluated using physiological, kinematic and behavioural variables. Ranges of motion (ROM) of the metatarsophalangeal and talocrural joints were measured, clinical lameness scores and mechanical nociceptive thresholds (MNTs) were assessed and synovial fluid inflammatory markers were measured. The injection of LPS induced transient synovitis, resulting in clinical lameness, decreased ranges of motion in the talocrural and metatarsophalangeal joints, decreased limb loading at rest and increased composite pain scores. Epidural morphine resulted in a significant improvement in clinical lameness, increased ROM and improved loading of the LPS-injected limb at rest, with no effects on synovial fluid inflammatory markers. Morphine prevented a decrease in MNT and, hence, inhibited the development of hyperalgesia close to the dorsal aspect of inflamed talocrural joints. This study showed that epidural morphine provides analgesic and anti-hyperalgesic effects in horses with acute synovitis, without exerting peripheral anti-inflammatory effects.     

Evidence supporting an increased presence of reactive oxygen species in the diseased equine joint

Reactive oxygen species (ROS) are capable of degrading many components of the joint in the presence of insufficient antioxidant defences, and as a result have been implicated in the pathogenesis of joint disease in horses. However, to our knowledge, evidence of ROS occurring in diseased joints of horses has not been reported. The objective of this experiment was to compare differences in synovial fluid protein carbonyl content (as a marker of oxidative modification of synovial fluid proteins by ROS) and the antioxidant status of synovial fluid between clinically normal and diseased equine joints. Synovial fluid was collected from the metacarpophalangeal, metatarsophalangeal, carpal and tarsal joints of 4 horses, age 2-5 years, as controls, and from diseased joints (metacarpophalangeal, metatarsophalangeal, carpal, tarsal and/or femoropatellar) of 61 horses, age 2-5 years. Synovial fluid protein carbonyl content was higher (P<0.01) in diseased joints as compared to controls. Antioxidant status of synovial fluid from diseased joints was higher, but not significantly, than that of controls (P = 0.0595). These findings require further study to determine their contribution to the overall disease process.     

Chemical arthrodesis of the distal tarsal joints using sodium monoiodoacetate in 104 horses

OBJECTIVE: To evaluate chemical arthrodesis using sodium monoiodoacetate for treatment of degenerative joint disease of the tarsometatarsal and distal intertarsal joints. DESIGN: Retrospective clinical study. METHOD: Horses were diagnosed with degenerative joint disease of one or more of the tarsometatarsal or distal intertarsal joints based on history, lameness examination, radiographic findings and, in some cases, response to intra-articular anaesthesia or medication. Intra-articular injections of sodium monoiodoacetate were performed using 23 gauge needles in the sedated, standing horse. Positive contrast arthrography of the distal intertarsal joint was performed in all horses to evaluate needle placement and the presence or absence of communication with other synovial structures. The mean intra-articular dose of sodium monoiodoacetate was 192 mg. Horses were subject to a graded exercise program commencing 7 to 10 days after treatment. Where possible, follow up lameness examination and radiography was performed at 3, 6, 12 and 24 months after treatment. RESULTS: At 3, 6, 12 and 24 months after treatment, respectively, 0/57, 14/55, 41/50, and 29/34 of horses were sound. At 3, 6, 12 and 24 months after treatment, respectively, 5/55, 24/38, 26/30 and 18/18 of horses had radiographic evidence of ankylosis of treated joints. Post injection pain was marked in 6.7% of horses and significant complications requiring further treatment occurred in 3.8% of horses. CONCLUSIONS: Chemical arthrodesis using sodium monoiodoacetate was an effective treatment method for degenerative joint disease of the distal tarsal joints. The technique was performed in the sedated standing horse and required minimal equipment. Results were comparable to those achieved following surgical arthrodesis. The risk of significant complications was minimised through good technique using an appropriate injection volume and concentration.     

Arthroscopic laser extirpation of metacarpophalangeal synovial pad proliferation in eleven horses

A new surgical technique for treatment of chronic metacarpophalangeal synovial pad proliferation in the horse and the findings and long-term follow-up from 11 clinical cases are described. The medical records of all equine lameness cases attributed to metacarpophalangeal synovial pad proliferation admitted to the College of Veterinary Medicine at Cornell University (1991-1996) were reviewed and all those treated surgically by laser extirpation were included in this study. Retrieved data included subject details, preoperative lameness, ultrasonography, radiography and synovial fluid evaluations and lesion histopathology. Lesions were ablated using a CO2 or a Nd:YAG laser intra-articularly with arthroscopic guidance. Long-term follow-up was provided by telephone conversation with owners or trainers. All horses had fetlock joint effusion and were lame at presentation. Mean synovial pad thickness measured ultrasonographically was 9.0 mm (range 6-15 mm). Seven horses (64%) had radiographic evidence of remodelling of the dorsal cortex of distal McIII and 3 horses (27%) had concurrent dorsal proximal P1 fractures. No postoperative complications were noted. All 11 horses returned to training within 90 days of surgery without recurrence of the lesion(s). Laser extirpation of metacarpophalangeal synovial pad proliferation using arthroscopic guidance provided a rapid, safe and efficient method for surgical removal of such lesions without complications or recurrence. This surgical technique provides a suitable alternative to more conventional treatments for chronic metacarpophalangeal synovial pad proliferation in horses, particularly for removal of very large, fibrotic masses.     

Effects of continuous intra-articular infusion of gentamicin on synovial membrane and articular cartilage in the tarsocrural joint of horses

OBJECTIVE: To determine the effects of a continuous intra-articular infusion of gentamicin on the synovial membrane and articular cartilage in the tarsocrural joint of horses. ANIMALS: 6 healthy adult horses. PROCEDURE: A balloon infusion system attached to a catheter placed in the plantarolateral pouch of both tarsocrural joints in each horse was used for continuous gentamicin solution (GM) or balanced electrolyte solution (BES) delivery for 5 days. Cartilage and synovial membrane specimens were collected on day 5 from 3 horses and on day 14 from the remaining 3 horses. Both infused joints from each horse were assessed, using gross evaluation and histologic scoring systems. RESULTS: Significant differences in the histologic scores of synovial membrane specimens between the GM- and BES-treated joints at either 5 or 14 days were not observed. Safranin-O-fast green staining scores were similar between cartilage specimens from GM- and BES-treated joints. Although the synovial membrane histologic scores and safranin-O-fast green staining scores improved from day 5 to 14, the changes in scores were not significant. Loss of synovial intimal cells from villi was found more commonly in sections of synovial membrane from GM-treated joints, compared with BES-treated joints. CONCLUSIONS AND CLINICAL RELEVANCE: Continuous infusion of GM into the tarsocrural joint of horses does not have significant effects on histologic scores of articular cartilage or synovial membrane, compared with those infused with BES. Continuous infusion of GM into the tarsocrural joint of horses for 5 days is an acceptable method for the treatment of septic arthritis.     

Ex vivo investigation of the use of hydrothermal energy to induce chondrocyte necrosis in articular cartilage of the metacarpophalangeal and metatarsophalangeal joints of horses

OBJECTIVE: To evaluate the use of hydrothermal ablation of articular cartilage for arthrodesis in horses through investigation of the effects of joint lavage with physiologic saline (0.9% NaCI) solution (80 degrees C) for various treatment times on chondrocyte viability in the articular cartilage of the metacarpophalangeal and metatarsophalangeal joints of cadaveric horse limbs. Sample Population-7 pairs of metacarpophalangeal and 8 pairs of metatarsophalangeal joints from 8 Thoroughbreds. PROCEDURE: The horses were euthanatized for reasons unrelated to musculoskeletal disease. On a random basis, 1 joint of each pair underwent intra-articular lavage for 5, 10, or 15 minutes with heated saline solution (80 degrees C); the other joint underwent sham treatment of similar duration with saline solution at 22 degrees C (control). Cartilage samples from the distal articular surface of metacarpus III (or metatarsus III), the proximal surface of the proximal phalanx, and the lateral and medial proximal sesamoid bones were assessed for chondrocyte viability via confocal microscopy and viability staining following enzymatic digestion. RESULTS: Compared with the control joints, findings of both viability assays indicated that the percentage of sites containing viable chondrocytes in heat-treated joints was decreased.Treatment hazard ratios of 0.048 (confocal microscopy) and 0.2 (digestion assay) were estimated. Histologically, periarticular soft tissues had minimal detrimental effects after heat treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Ex vivo intra-articular lavage with saline solution at 80 degrees C resulted in the death of almost all articular chondrocytes in the joint. This technique may be a satisfactory method for extensive cartilage ablation when performing arthrodesis by minimally invasive techniques.     

Cylindrical press-fit osteochondral allografts for resurfacing the equine metatarsophalangeal joint

OBJECTIVE: To investigate the feasibility of resurfacing the equine fetlock joint using cylindrical, orthotopic, press-fit, osteochondral allografts. STUDY DESIGN: Experimental study. ANIMALS: Ten mature, mixed-breed horses. METHODS: Cylindrical, osteochondral grafts (6.5-mm diameter) were harvested aseptically from cadaveric equine metatarsophalangeal joints. Allografts were transplanted into 6 horses; 4 horses were sham operated. The surgical approach involved creation of a bone block at the origin of the medial collateral ligament and luxation of the metatarsophalangeal joint. Grafts were placed into the medial and lateral metatarsal condyles. Radiographs were taken at 8 and 25 weeks, and lameness was evaluated at 25 weeks. Horses were killed at 25 weeks. Analyses included gross evaluation, microradiography, paravital staining, light microscopy, and cartilage biochemistry. RESULTS: No complications occurred that could be attributed to the surgical procedure. Graft congruency with the surrounding articular cartilage was fair to excellent. Two horses were sound at 25 weeks. Most grafts had more than 90% articular cartilage coverage, and histologic and microradiographic analysis revealed good graft incorporation and articular cartilage survival. Sulphated glycosaminoglycan concentration was decreased in grafted tissue. CONCLUSIONS: We attribute the viability of osteochondral allografts in the equine fetlock to adequate congruency, stable graft fixation, and the use of orthotopic tissue. Host response to the allograft bone tissue did not affect cartilage viability. CLINICAL RELEVANCE: Before clinical use, improvements to instrumentation are required that would decrease damage to grafts and minimize technique-associated incongruencies of the articular surface at the time of grafting. Larger grafts would also likely be required to resurface a greater surface area.     

Evaluation of ethyl alcohol for use in a minimally invasive technique for equine proximal interphalangeal joint arthrodesis

Objective: To determine whether intra‐articular 70% ethyl alcohol alone (IAEA) or in combination with 2 percutaneously placed transarticular lag screws (EA‐TLS) would result in arthrodesis of the equine proximal interphalangeal (PIP) joint. Study Design: Experimental. Animals: Healthy horses (n=6), aged 1.5–3 years, free of lameness, diagonally paired front and hind PIP joints. Methods: Six milliliters 70% ethyl alcohol was injected into randomly selected diagonally paired front and hind PIP joints. Thirty days later, 2 parallel 5.5 mm cortical screws were inserted in lag fashion across the hind PIP joints and the limbs were cast. Horses were confined for 60 days after surgery before free exercise was permitted. Serial lameness examinations were performed at 1, 6, and 10 months. Radiographs of the PIP joints were obtained before injection with alcohol (front, hind PIP joints), at 6 and 10 months (front PIP joints) and 1, 3, 6, and 10 months (hind PIP joints). At 10 months, horses were euthanatized and gross and histopathologic examination of the treated joints was performed. Results: Horses had variable cartilage thinning (more severe in hind PIP joints) and dorsal bone proliferation. One front and 1 hind PIP joint were fused 10 months after alcohol injection. Conclusions: Ethyl alcohol injected alone or in combination with percutaneously placed transarticular lag screws failed to reliably produce fusion of the PIP joint.