Quantitative Evaluation of Equine Deep Digital Flexor Tendon Morphology using Magnetic Resonance Imaging

Injury of the distal aspect of the deep digital flexor tendon (DDFT) is a recognized cause of lameness, but diagnosis is difficult. This study aimed to improve understanding of DDFT morphology and pathology using retrospective evaluation of magnetic resonance (MR) images. We hypothesized that: (1) The distal aspect of the DDFT in normal horses would have a repeatable proximal/distal pattern and symmetry between limbs and between lobes; (2) DDFT dimensions would be related to bodyweight, navicular bone dimensions and hoof size; (3) this symmetry and pattern would be lost in DDFT injury; and (4) DDFT size would increase with injury. MR images of 64 live horse limbs, 26 with no identified DDFT lesion and 38 with identified DDFT abnormalities, and 19 normal cadaver limbs were analyzed. Using standardized transverse images, measurements of DDFT cross-sectional area, medial-lateral (ML) width and dorsal-palmar depth were obtained at six preselected sites. A uniform distal to proximal shape pattern was identified in all horses. The flattened crescent shape at the insertion changed to a deeper bilobed shape more proximally, with the mid-navicular area having the greatest cross-sectional area. Strong ML (P < 0.0006) and left/right symmetry (P < 0.02) were observed. In addition, there was a strong association between DDFT cross-sectional area and horse weight (P = 0.005) and between DDFT and navicular bone ML width (P = 0.004). Symmetry between sides or between lobes was lost at sites with a unilateral lesion and correlation between horse weight and DDFT cross-sectional area was lost in the presence of lesions. DDFTs with core lesions had a consistent increase in cross-sectional area overall, but other lesion types had no significant increase in size. The shape and symmetry seen in normal tendons could be related to the mechanical demands placed upon individual lobes. The limited increase in cross-sectional area with injury may be explained by the restrictive structures of the hoof, possibly explaining the ongoing pain seen in such lesions.     

Effect of Ischemia and Reperfusion on Neutrophil Accumulation in Equine Microvascular Tissue Flaps

Objective— To investigate neutrophil accumulation after ischemia and reperfusion (IR) in microvascular tissue flaps in horses.
Study Design— Randomized controlled experiment.
Sample Population— A total of 8 horses between 1 and 10 years of age, 4 of each sex.
Methods— Control and experimental myocutaneous island flaps based on the superficial branch of the deep circumflex iliac vessels were dissected on each horse. Atraumatic vascular clamps were applied to the pedicle of the experimental flap for 90 minutes and then removed to allow reperfusion. Based on the assumption that rapid infiltration of neutrophils into affected tissues is a hallmark of IR injury, radiolabeled autogenous leukocytes were used to indirectly quantify neutrophil accumulation in flap tissues. Labeled leukocytes were administered through a jugular catheter 30 minutes before flap reperfusion. Biopsies were collected from each flap over a 6 hour postischemia time period; in group 1 (  n = 4  ) from 0 to 6 hours postischemia, and in group 2 (  n = 4  ) from 24 to 30 hours postischemia. Biopsies were examined scintigraphically and histologically for evidence of neutrophil infiltration.
Results— All control flaps survived and 6 of 8 experimental flaps survived. There was no significant evidence of acute neutrophil infiltration into flap tissues after reperfusion in either group.
Conclusions— The results of this study suggest that equine myocutaneous flap tissues can survive a 90-minute ischemic period and reperfusion. No significant evidence of the occurrence of IR injury in flap tissues was found.
Clinical Relevance— The reasons for the previously reported failures of equine free tissue transfer remain uncertain, but they do not appear to be caused by neutrophil mediated injury associated with ischemia and reperfusion.     

Arthroscopic Removal of Palmar/Plantar Osteochondral Fragments from the Proximal Interphalangeal Joint in Four Horses

Objective— To describe anatomic considerations and arthroscopic technique in horses for arthroscopic removal of palmar/plantar osteochondral fragments from the proximal interphalangeal (PIP) joint. Study Design— Retrospective study. Animals— Adult horses (n=4) with osteochondral fragments of the palmar/plantar PIP joint. Methods— Arthroscopic removal of palmar/plantar osteochondral fragments within the PIP joint was performed with horses in dorsal recumbency under general anesthesia. Medical records of affected horses were reviewed to determine history; physical, lameness, and radiological findings; surgical technique; complications and outcome. Results— Two horses had lameness localized to the PIP joint. Two other horses had lameness suspected, but not confirmed to the pastern region. One of these horses had a history of intermittent lameness, but was not lame on admission. All horses had radiographic evidence of palmar/plantar osteochondral fragmentation within the PIP joint. Fragmentation was located abaxially in 2 horses in the hind limb and axially in 2 horses in the left forelimb. Osteochondral fragments were successfully removed via a palmar/plantar arthroscopic approach in all horses. Three horses returned to previous levels of athletic performance; 1 horse was used for trail riding instead of reining. Conclusions— Arthroscopy of the palmar/plantar pouch of the PIP joint allowed limited assessment of the joint and removal of osteochondral fragments. Clinical Relevance— Arthroscopy of the palmar/plantar PIP joint pouch for assessment and removal of osteochondral fragments is possible and should be considered when lameness is localized to this joint.     

Mid-metacarpal Deep Digital Flexor Tenotomy in the Management of Refractory Laminitis in Horses

Deep digital flexor tendon transection at the mid-metacarpus was performed in 20 horses with severe acute or chronic laminitis that was not responsive to conventional treatment. Sixteen horses improved within 72 hours, one horse worsened, and two horses were unaffected by the surgery. Eleven horses survived less than 1 month after surgery and six horses survived longer than 6 months. Three horses surviving longer than 6 months have remained lame and no horse has returned to athletic performance. Transection of the deep digital flexor tendon at the mid-metacarpus may decrease the pain associated with the acute refractory stage of laminitis and may be useful as an immediate salvage procedure; however, despite the early clinical improvement observed after tenotomy, the survival rate of affected horses may not be altered.     

IMAGING OF A SPINAL NEPHROBLASTOMA IN A DOG

An 8-month-old German Shepherd dog was presented for investigation of pelvic limb gait abnormality. Neurolocalization indicated a T3-L3 spinal cord lesion. The myelographic appearance was of an intramedullary lesion at T9/10, but upon subsequent magnetic resonance imaging it was determined that the mass was extramedullary. A diagnosis of nephroblastoma was made on histological examination. The imaging features of this rare tumor and the differentiation of intradural-extramedullary and intramedullary masses are discussed.