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.     

Meniscal Mineralization in Domestic Cats

Objective: To (1) determine prevalence of radiographically detectable meniscal mineralization in domestic cats and (2) to evaluate the association between meniscal mineralization and degenerative joint disease (DJD). Study Design: Prospective study. Animals: Client‐owned cats (n=100) and 30 feline cadavers. Methods: Randomly selected client‐owned cats were used to determine the prevalence of meniscal mineralization. Stifles from feline cadavers were used to evaluate the relationship between meniscal mineralization (using high‐resolution X‐ray), radiographic DJD, and cartilage damage. Menisci were evaluated histologically. Results: Forty‐six percent of the client‐owned cats had meniscal mineralization detected in 1 or both stifles. Pain scores were not significantly different between stifles with meniscal mineralization and those with no radiographic pathology (P=.38). Thirty‐four of 57 cadaver stifles had meniscal mineralization, which was always located in the cranial horn of the medial meniscus. Percentage mineralization of the menisci was significantly correlated with the cartilage damage score of the medial femoral (r²=0.6; P<.0001) and tibial (r²=0.5; P<.0001) condyles as well as with the total joint cartilage damage (r²=0.36; P<.0001) score and DJD score (r²=0.8; P<.0001). Conclusion: Meniscal mineralization is a common condition in domestic cats and seems to indicate medial compartment DJD. Clinical Relevance: Clinical significance of meniscal mineralization is uncertain. Further work is needed to determine if the meniscal mineralization is a cause, or a consequence of joint degeneration.     

Suture Materials and Suture Selection for Use in Exotic Pet Surgical Procedures

Exotic animals are becoming increasingly popular and more exotic pet owners are seeking veterinary care. This has led to a demand for properly trained veterinarians who are capable of providing quality, up-to-date medical and surgical treatments. Many surgeries are now performed on exotic pets, and selection of the appropriate suture material is an important part of the treatment protocol. An understanding of different available suture materials, healing times of different tissues, and knowledge of different anatomic and physiologic characteristics in different species is important in the selection of the most appropriate suture material. This review will summarize important aspects of suture selection in exotic animals.     

Laparoscopic Ovariectomy in Dogs: Comparison Between Single Portal and Two-Portal Access

Objective: To compare surgical times and perioperative complication rates of single portal access and 2-portal laparoscopic ovariectomy (LapOVE) in dogs using a bipolar vessel sealer/divider device, and to evaluate the performance of novice laparoscopists for right ovariectomy.
Study Design: Controlled clinical trial.
Animals: Female dogs (n=42).
Methods: Dogs were divided into groups: 1=single portal and 2=2 portal. LapOVE was performed using a 5 mm vessel sealer/divider device and a 10 mm operating laparoscope (Group 1) or a 5 mm laparoscope (Group 2). Dog characteristics (weight, body condition score, ovarian ligament fat score), operative time, and perioperative complication rate were compared between groups. Right ovariectomy duration was evaluated for 2 novice laparoscopists.
Results: No significant difference was found in mean total surgical time between group 1 (21.07 min/s) and group 2 (19.06 min/s). Factors significantly affecting times included body condition scores, ovarian ligament fat score, ovarian bleeding, and surgeon expertize. Minor complications (bleeding from ovaries or after splenic trauma) occurred and were similar in both groups. Bleeding was correlated to body condition score and ovarian ligament fat score. Interindividual differences were found among surgeons for right ovariectomy time.
Conclusions: Single portal access LapOVE using vessel sealer/divider device is feasible, safe, and does not significantly increase total surgical time in comparison with 2-portal approach. Laparoscopic skills may play a role in ability to perform single portal LapOVE.
Clinical Relevance: LapOVE can be performed using single portal access.     

Effects of Ketamine on the Equine Electroencephalogram During Anesthesia With Halothane in Oxygen

OBJECTIVE: To investigate the effects of ketamine on the electroencephalogram (EEG) of the horse. STUDY DESIGN: Prospective experimental study. ANIMALS: Eight Welsh mountain pony geldings weighing between 280 and 330 kg, 5 to 9 years old. METHODS: During halothane anesthesia at an end-tidal halothane concentration between 0.75 and 0.85%, the EEG frequency power spectrum and the auditory evoked potential were recorded while an infusion of ketamine was given. Ketamine 200 mg was infused over 5 minutes in 8 ponies. The effects of ketamine on the EEG were recorded continuously during the infusion and for a further 55 minutes. RESULTS: The ketamine infusion produced a plasma ketamine concentration that was significantly greater than the baseline until 7 minutes after the start of the infusion. The highest recorded ketamine concentration was 4.2+/-1.1 microg/ml recorded at 5 minutes after the start of the infusion. The spectral edge and median frequency of the EEG and the midlatency of the auditory evoked potential were compared with those recorded before the start of the infusion. The spectral edge, median frequencies and mid-latency of the auditory evoked potential were reduced by 21+/-13%, 31+/-20% and 19+/-36% respectively (mean +/- SD). Only the reduction in spectral edge frequency reached statistical significance. CONCLUSIONS: These results compared with those from other anesthetic and sedative agents suggest that the spectral edge frequency is an indicator of general central nervous system depression whereas the median frequency may be an indicator of antinociception.     

Effects of Exercise and Polysulfated Glycosaminoglycan on the Development of Osteoarthritis in Equine Carpal Joints With Osteochondral Defects

This study assessed the effects of postoperative exercise and intra-articular polysulfated glycosaminoglycan (PSGAG) on the repair of osteochondral defects in the carpal joints of ponies. Eighteen ponies with normal carpi had osteochondral defects (mean dimensions 2.4 cm × 0.9 cm) created arthroscopically on the dorsal aspect of the distal articular surface of the radial carpal bone. The ponies were randomized (while balancing for age [range, 2 to 15 years; median, 5.0 years]) to two groups—nine ponies were exercised and nine were stall confined. Beginning at surgery, six ponies in each group received five weekly intra-articular injections of PSGAG (250 mg) in one joint and lactated Ringer's solution in the contralateral joint; the remaining three ponies in each group received lactated Ringer's solution in both joints. The incremental exercise schedule on a circular, rotating walker was begun six days after surgery and occurred twice daily, reaching a maximum of 0.7 miles of walking and 2.7 miles of trotting by the third postoperative month. The effects of treatment on the joint tissues were determined by weekly lameness examinations and measurement of the range of carpal joint motion, carpal radiographs at six and 17 weeks after surgery, synovial fluid analysis, and cytologic evaluation of alcohol-fixed synovial fluid specimens at weeks 1 through 4 and week 17, and histology of the synovial membrane. Ultrasound images of the carpi were acquired before operation and at weeks 1, 2, 4, 8, 10, 13, and 17. Ponies were euthanatized 17 weeks after surgery. Exercise, without medication, caused more lameness throughout the study compared with no exercise. Exercised, nonmedicated ponies had the greatest limitation to carpal flexion (more painful joints), and nonexercised, nonmedicated (control) ponies had the least limitation to flexion. Radiographic scores indicated that the exercised, nonmedicated ponies had significantly (p < .05) more signs of osteoarthritis than exercised, medicated and control ponies. Ultrasonographic measurements indicated that exercise, without medication, caused the greatest increase in combined measurement of the joint capsule thickness and synovial fluid accumulation at all postoperative times. Synovial lining cell numbers in the synovial fluid from exercised ponies were significantly (p < .05) higher than in nonexercised ponies at week 1, and this trend continued at weeks 4 and 17 (p < .1). There were significantly (p < .05) more morphologic abnormalities in the synovial lining cells from exercised than from nonexercised ponies at week 17. Medication with PSGAG enabled exercised carpal joints to be flexed significantly further from weeks 2 through 6 compared with nonmedicated joints. Medication significantly (p < .05) reduced the combined joint capsule and synovial fluid thickness at weeks 4, 8, and 13 compared with nonmedicated joints. On histologic examination, the synovial membrane matrix of exercised, medicated joints had significantly less chronic inflammatory changes than joints receiving other treatments. The authors concluded that this level of exercise was too intense when superimposed on large osteochondral defects in the carpus because it induced osteoarthritis. Polysutfated gtycosaminoglycan ameliorated the clinical signs of osteoarthritis in the exercised ponies. However, PSGAG was also associated with the formation of cartilage repair tissue that contained less type II relative to type I collagen compared with repair tissue from nonmedicated joints.     

Regional Perfusion of the Equine Carpus for Antibiotic Delivery

Regional perfusion of carpal tissues by forced intramedullary administration of fluids was evaluated in 10 horses. Results of subtraction radiography after perfusion with a contrast medium demonstrated that perfusate was delivered to the carpal tissues by the venous system. Perfused India ink was distributed uniformly in the antebrachiocarpal and middle carpal synovial membranes. Histologically, the ink was within the venules of the synovial villi. Immediately after perfusion with gentamicin sulfate (1 g), the gentamicin concentrations in the synovial fluid and synovial membrane of the antebrachiocarpal joint were 349 +/- 240 micrograms/mL and 358 +/- 264 micrograms/g, respectively. When gentamicin concentrations in the synovial fluid of the antebrachiocarpal joint and serum were measured 0, 0.5, 1, 4, 8, 12, and 24 hours after carpal perfusion, the mean peak gentamicin concentration in the synovial fluid was 589 +/- 429 micrograms/mL. At hour 24, the mean gentamicin concentration in the synovial fluid was 4.8 +/- 2.0 micrograms/mL. The resulting peak gentamicin concentration in the serum was 23.7 +/- 14.5 micrograms/mL immediately after the perfusion; it decreased below the desired trough level of 1 micrograms/mL between hours 4 and 8.