Arthroscopic surgery in the management of contamination and infection of joints, tendon sheaths, and bursae

The influence of tenoscopic approaches on radiocarpal joint perforation during carpal sheath tenoscopy in horses

OBJECTIVE

To report the frequency of radiocarpal joint (RCJ) perforation during two proximolateral carpal sheath (CS) approaches and to investigate whether the presence or absence of a natural communication between the RCJ and CS.

STUDY DESIGN

Experimental, randomized, controlled study.

SAMPLE POPULATION

Twelve adult horses and 12 cadaver front limbs.

METHODS

Proximolateral CS tenoscopy was performed on both carpi of 12 horses under general anaesthesia. Limbs were randomly assigned into two groups. In group 1, the instrument portal was centered at the level of the distal radial physeal remnant (PR). In group 2, the instrument portal was centered 2 cm proximal to the PR. Immediately after tenoscopy, dye-coloured fluid was instilled arthroscopically into the dorsolateral RCJ, and the open tenoscopic portals were evaluated for leakage. Twelve cadaver front limbs were examined for naturally occuring RCJ and CS communication by using positive-contrast computed tomography (CT). Frequency of perforations were compared with McNemar's test for two matched proportions.

RESULTS

In group 1, 10 of 12 RCJ were perforated during tenoscopy, and, in group 2, four of 12 RCJ were perforated (P = 0.03). No diffusion of contrast from the RCJ to the CS was detected by CT.

CONCLUSION

Perforation of the RCJ was common when CS instrument portals were placed at the level of the PR. No natural communication was detected between the RCJ and CS.

CLINICAL SIGNIFICANCE

Carpal sheath tenoscopic instrument portals may need to be placed >2 cm proximal to the PR to prevent inadvertent RCJ perforation, especially in horses undergoing tenoscopic treatment of a septic CS.

Comparison of Arthroscopic Lavage and Needle Lavage Techniques, and Lavage Volume on the Recovery of Colored Microspheres From the Tarsocrural Joints of Cadaver Horses

OBJECTIVE

To quantify recovery of colored microspheres from normal cadaver tarsocrural joints using arthroscopic or needle lavage with 1-5 L of fluid.

STUDY DESIGN

Ex vivo experimental study.

ANIMALS

Adult Quarter Horse cadavers (n = 8).

METHODS

After euthanasia, 1.5 × 10(6)  colored microspheres were injected into each tarsocrural joint. Each joint was randomly assigned to receive lavage (5 L 0.9% NaCl) with an arthroscope (dorsomedial arthroscope and dorsolateral egress cannula) or three 14 g needles (dorsomedial ingress, dorsolateral, and plantarolateral egress). Egress fluid from each liter was collected separately over time and the number of microspheres present in each recovered liter determined by spectrophotometry.

RESULTS

A significant interaction was present between treatment group and liter of fluid (P < .01). The number of microspheres recovered in the first liter of lavage fluid was significantly higher in the needle lavage group than in the arthroscopic lavage group (P < .01). For both groups, the number of microspheres recovered in the first liter of lavage fluid represented a majority of the total microspheres collected and was significantly different from each subsequent liter collected (P < .01). The number of microspheres recovered did not differ between liters 2, 3, 4, and 5 within or between treatment groups.

CONCLUSION

In this model, tarsocrural lavage with three 14 g needles was more effective at removing colored microspheres from the joint than arthroscopic lavage, suggesting that the number or placement of portals present may be more important than portal size and flow rate. No difference in microsphere recovery was seen with lavage volumes >1 L.

Analysis of factors influencing prognosis in foals with septic arthritis

The purpose of this paper was to identify factors that would positively or negatively affect the short-term survival rate of foals with septic arthritis. Medical records of 81 foals (≤seven months of age) with a clinical diagnosis of septic arthritis, referred to the equine hospital at Cornell University Hospital for Animals, between 1994 and 2003 were reviewed. Signalment, age at presentation, number of affected joints, joint fluid parameters, bacterial agents, treatment modalities and year of treatment were compared between survivors and nonsurvivors. Sixty-two of 81 foals (77%) were discharged from the hospital and classified as 'survivors'. Multiple joint involvement and detection of intra-articular Gram-negative, mixed bacterial infection and degenerate neutrophils were negatively associated with short-term survival. Initiation of treatment within 24 hrs of onset of clinical signs and combination of treatment modalities were positively correlated with survival. Further investigation is needed to determine if these two factors have a similar influence on athletic performance.

Wounds of the distal limb complicated by involvement of deep structures

The authors describe the clinically relevant structures of the distal limb and the current diagnostic and treatment modalities. Specific problems include tendon laceration, septic tenosynovitis, and sep-tic arthritis of the distal joints. A detailed description of tendon repair, tendon sheath lavage, and postoperative convalescent methodology is provided. This article makes available to the reader information necessary to appropriately diagnose and treat wounds of the distal equine limb involving deep structures. Information on the overall prognosis is also provided.