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Frietman SK, van Proosdij R, Rijkenhuizen ABM, van Veggel E. A novel transcoronal surgical technique for the treatment of cystic lesions of the distal phalanx: A cadaveric study. Vet Surg 2024; 53:1062-1072. [PMID: 38819517 DOI: 10.1111/vsu.14105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/16/2024] [Accepted: 04/26/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To assess the feasibility of a novel transcoronal approach for the treatment of axial type 3 cysts of the palmar/plantar aspect of the distal phalanx (P3). STUDY DESIGN Ex vivo, experimental study. SAMPLE POPULATION Ten cadaveric specimens, four forelimbs and six hindlimbs. METHODS All cadaveric specimens underwent radiographically guided drilling, followed by cortical screw placement. The cartilage was macroscopically assessed after disarticulation of the distal interphalangeal joint. The entry point and trajectory were evaluated with computed tomography. Results were categorized as: axial, near-axial and abaxial. The minimal distance from the outer margin of the drill hole and the proximal border of the subchondral bone plate was measured using frontal computed tomographic slices. RESULTS Eight of the 10 screws were in an axial to near-axial position and nine followed the desired axial to near-axial trajectory. One screw was inserted axially but continued in an abaxial trajectory. Iatrogenic damage to the joint cartilage, flexor cortex and solar canal of P3 was not observed. All cortical screws were placed close to the proximal subchondral bone-plate of P3. CONCLUSION The desired axial/near-axial drilling and screw placement, under radiographic guidance, was achieved in nine out of 10 specimens. CLINICAL SIGNIFICANCE This novel technique seems promising for the treatment of inaccessible P3 cysts. Additional studies are required to investigate its feasibility in clinical cases, and the long-term outcome following transcystic screw placement of type 3 P3 cysts.
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Affiliation(s)
- Sjoerd K Frietman
- Equine Department, Veterinary Clinic Den Ham, Den Ham, The Netherlands
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Santschi EM. Equine subchondral lucencies: Knowledge from the medial femoral condyle. Vet Surg 2024; 53:426-436. [PMID: 38229531 DOI: 10.1111/vsu.14062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/25/2023] [Accepted: 12/02/2023] [Indexed: 01/18/2024]
Abstract
Equine subchondral lucencies (SCL) have been described since the first availability of suitable radiographic equipment. The initial clinical sign can be lameness, but SCLs are often first found on surveys of juvenile horses and are primarily a radiographic concern for public auctions. When lameness is present, it varies from subtle to obvious and can be intermittent. Some SCLs heal spontaneously, and some remain blemishes, but when the SCL and lameness are persistent, further damage to the joint and limitations to an athletic career are likely. SCLs were initially described in the distal limb followed by the stifle, and the medial femoral condyle (MFC) is now considered the most common location. The aim of this review is to highlight the initial pathology and discuss the clinical and experimental information available on equine SCLs. SCL treatment has evolved from rest alone and has progressed to debridement, grafting, intralesional injection, and most recently, transcondylar screw and absorbable implant placement. Comparison of success rates between techniques is difficult due to variations in follow-up and outcome measures, and no single technique is best for all SCLs. Treatment appears to increase success by 15%-20% over rest alone, but the method chosen depends on many factors. This review emphasizes the need for further work to fully understand SCL formation and all aspects of trabecular bone healing to optimize surgical therapy and improve treatment success.
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Yuan H, Dong L, Zhang O, Wang X, Chen Z, Li Y, He H, Lü G, Li J, Kuang L. A comparison of interferential current efficacy in elderly intervertebral disc degeneration patients with or without sarcopenia: a retrospective study. BMC Musculoskelet Disord 2024; 25:214. [PMID: 38481194 PMCID: PMC10935844 DOI: 10.1186/s12891-024-07337-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Intervertebral disc degeneration and sarcopenia are both age-related diseases without effective treatments. Their comorbidities may worsen the prognosis, and further studies on interaction and therapy are needed. The purpose of the study was to investigate the prevalence of sarcopenia in intervertebral disc degeneration, and to compare the characteristics of intervertebral disc degeneration with and without sarcopenia and effects of interferential current. METHODS One hundred twenty disc degeneration patients were included from 2021 to 2022 in a single institute. Medical records, examination results and radiological reports were reviewed. Patients with sarcopenia were screened and grouped according to Asian Working Group for Sarcopenia 2019. VAS, ODI, SARC-F, SMI, gait speed (GS), grip strength, disc Pfirrmann grading, standard cross-sectional area (SCSA), degree of fatty infiltration (DFF), and nerve conduction velocity (NCV) were assessed before and after treatment. RESULTS The prevalence of sarcopenia in intervertebral disc degeneration was 28.3%. The difference of VAS, ODI, disc Pfirrmann grading, SCSA, DFF and NCV between two groups were significant before intervention (P < 0.05), SCSA and DFF were related to the degree of disc degeneration. The improvement of SMI, GS, grip strength, VAS, SARC-F and ODI in intervertebral disc degeneration with sarcopenia group was significant after intervention, as well as SMI, GS, grip strength, VAS and ODI in those without sarcopenia (P < 0.05). The improvement of grip strength, GS, ODI and SARC-F in intervertebral disc degeneration with sarcopenia group were greater than the one without sarcopenia (P < 0.05), whereas there was no significance in improvement degree of other indicators between the two groups (P > 0.05). CONCLUSION The prevalence of sarcopenia was high in intervertebral disc degeneration, and paravertebral muscles degeneration correlated with the degree of disc degeneration. Compared to those without sarcopenia, intervertebral disc degeneration patients with sarcopenia have more severe pain, poorer mobility and neurological function. Interferential current is effective in intervertebral disc degeneration patients and sarcopenia patients.
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Affiliation(s)
- Hui Yuan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Lini Dong
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Ou Zhang
- Medical Education and Microbiology, California University of Science and Medicine, 1501 Violet Street, Colton, CA, 92324, USA
| | - Xiaoxiao Wang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Zejun Chen
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Yunchao Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Haoyu He
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Guohua Lü
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Jing Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China.
| | - Lei Kuang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China.
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Young N, Barker W, Minshall G, Wright I. Arthroscopically guided lag screw fixation of subchondral bone cysts in the medial femoral condyle in Thoroughbred racehorses: description of technique and comparative results. Vet Surg 2024; 53:330-340. [PMID: 37280742 DOI: 10.1111/vsu.13972] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/25/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe an arthroscopically guided technique for lag screw placement across subchondral bone cyst (SBC) in the medial femoral condyle (MFC) and to compare postoperative racing performance with corticosteroid injection and cyst debridement. STUDY DESIGN Retrospective cohort study. ANIMALS One hundred twenty-three horses with 134 MFC SBCs undergoing treatment at a single referral hospital in the UK between January, 2009, and December, 2020. METHODS Sex, age, limb affected, radiographic cyst dimensions, preoperative and postoperative lameness, surgical technique (lag screw placement, cyst debridement, intralesional corticosteroid injection), and, where applicable, screw positioning were recorded retrospectively. A ratio was calculated using measurements from preoperative and postoperative radiographs. Outcome was assessed by resolution or improvement in lameness, reduction in cyst size, and starting one race after treatment. Outcome data was compared between treatment groups. RESULTS Twenty-six of 45 (57.8%) horses that underwent transcondylar screw placement raced postoperatively, at a median of 403 days between surgery and first postoperative race. There was no difference between treatment groups with regard to racing or preoperative and postoperative lameness. Cysts treated with transcondylar screw placement had a greater reduction in cyst size and a reduced period of convalescence in comparison with those that underwent debridement; the results were similar to those treated by intralesional corticosteroid injection. CONCLUSION Postoperative racing rates were similar for all techniques. Convalescence was reduced for lag screw placement and corticosteroid injection compared to debridement. CLINICAL SIGNIFICANCE The arthroscopically guided technique results in radiographically consistent screw placement and cyst engagement and offers a viable alternative to other treatments.
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Affiliation(s)
- Natalie Young
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
- Newmarket Equine Hospital, Suffolk, UK
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Pérez-Nogués M, López-Sanromán J, Spirito M, Manso-Díaz G. Treatments and Prognosis for Subchondral Cystic Lesions in the Distal Extremities in Thoroughbred Prospect Racehorses. Animals (Basel) 2023; 13:2838. [PMID: 37760238 PMCID: PMC10525349 DOI: 10.3390/ani13182838] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Subchondral cystic lesions (SCLs) in equines and their treatments have been mainly studied in the medial femoral condyle of the femur. SCLs in the distal extremities affecting the fetlock or interphalangeal joints are frequent, but treatment or prognosis studies in horses are currently sparse. Our objective was to compare four treatments for SCLs in the distal extremities (intralesional injection of corticosteroids, transcortical drilling, cortical screw placement, and absorbable hydroxyapatite implant placement) and report the racing prognoses for affected thoroughbred yearlings. Data from 113 thoroughbred yearlings treated for SCLs in the distal extremities were collected from 2014 to 2020. Age at surgery, sex, bone affected, radiographic SCL measurements, SCL shape, and type of treatment were recorded. Sale data and racing performance were collected for the operated horses and for 109 maternal siblings that were free of SCLs. An analysis was conducted to assess if SCL size affected racing prognosis and to detect differences in sale value and selected racing parameters between the cases and controls. The outcomes for the different treatments, the different bones affected, and the SCL shape type were also analyzed. There was no difference in the ability to start in a race between the cases and controls (60.2% vs. 69.7%, respectively). The auction value of the treated horses was significantly lower than that of their siblings. The bone affected did not impact any of the racing variables studied, whereas the height of the SCLs negatively affected the number of wins and placed races. The type of treatment for the horses affected by SCLs did not have an impact on sale prices, ability to start a race, race starts, wins, and places, or age at the time of the first start. In conclusion, yearlings diagnosed with an SCL in the distal extremities had lower auction prices and decreased racing performances, with lower numbers of wins correlated with larger SCL heights compared to the siblings. Similar racing performance was found regardless of the treatment received.
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Affiliation(s)
| | - Javier López-Sanromán
- Department of Animal Medicine and Surgery, Universidad Complutense de Madrid, Avenida Puerta de Hierro s/n, 28040 Madrid, Spain (G.M.-D.)
| | - Michael Spirito
- Hagyard Equine Medical Institute, 4250 Iron Works Pike, Lexington, KY 40511, USA;
| | - Gabriel Manso-Díaz
- Department of Animal Medicine and Surgery, Universidad Complutense de Madrid, Avenida Puerta de Hierro s/n, 28040 Madrid, Spain (G.M.-D.)
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Moshage SG, McCoy AM, Kersh ME. Elastic Modulus and Its Relation to Apparent Mineral Density in Juvenile Equine Bones of the Lower Limb. J Biomech Eng 2023; 145:081001. [PMID: 37144881 DOI: 10.1115/1.4062488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/01/2023] [Indexed: 05/06/2023]
Abstract
Density-modulus relationships are necessary to develop finite element models of bones that may be used to evaluate local tissue response to different physical activities. It is unknown if juvenile equine trabecular bone may be described by the same density-modulus as adult equine bone, and how the density-modulus relationship varies with anatomical location and loading direction. To answer these questions, trabecular bone cores from the third metacarpal (MC3) and proximal phalanx (P1) bones of juvenile horses (age <1 yr) were machined in the longitudinal (n = 134) and transverse (n = 90) directions and mechanically tested in compression. Elastic modulus was related to apparent computed tomography density of each sample using power law regressions. We found that density-modulus relationships for juvenile equine trabecular bone were significantly different for each anatomical location (MC3 versus P1) and orientation (longitudinal versus transverse). Use of the incorrect density-modulus relationship resulted in increased root mean squared percent error of the modulus prediction by 8-17%. When our juvenile density-modulus relationship was compared to one of an equivalent location in adult horses, the adult relationship resulted in an approximately 80% increase in error of the modulus prediction. Moving forward, more accurate models of young bone can be developed and used to evaluate potential exercise regimens designed to encourage bone adaptation.
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Affiliation(s)
- Sara G Moshage
- Department of Mechanical Science and Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801
| | - Annette M McCoy
- Department of Veterinary Clinical Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61801
| | - Mariana E Kersh
- Department of Mechanical Science and Engineering, Beckman Institute for Advanced Science and Technology, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign,, Urbana, IL 61801
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Pál Z, Bodó G. Osteochondral allograft transplantation for treating medial femoral condyle subchondral bone cyst in a 14-year-old standardbred horse: a case report. J Vet Sci 2023. [DOI: 10.4142/jvs.22239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Affiliation(s)
- Zsófia Pál
- Department and Clinic of Equine Medicine, University of Veterinary Medicine Budapest, Dóramajor, Üllő, H-2225, Hungary
| | - Gábor Bodó
- Department and Clinic of Equine Medicine, University of Veterinary Medicine Budapest, Dóramajor, Üllő, H-2225, Hungary
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Wright L, Hernlund E, Fjordbakk C, Ytrehus B, Law E, Uhlhorn M, Rhodin M. Patellar ligament desmopathy in the horse – a review and comparison to human patellar tendinopathy (‘Jumper’s knee’). COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep220011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patellar ligament desmopathy in horses is regarded as an uncommon condition with unclear aetiology. Of the three patellar ligaments in the horse, the intermediate is the one most often diagnosed with desmopathy in horses presenting with chronic lameness. This structure corresponds to the patellar tendon in humans. As diagnostic imaging modalities continuously improve, changes in echogenicity of the patellar ligaments are identified ultrasonographically with increasing frequency. However, disruption of the normal fibre pattern may be present also in patellar ligaments in horses that show no signs of lameness. Similarly, there is a poor correlation between pain and diagnostic imaging findings in human patellar tendinopathy. Consequently, there appears to be a knowledge gap pertaining to normal ultrasonographic variation and diagnostic criteria for disease of the patellar ligaments in horses. Furthermore, local anaesthetic techniques to verify the diagnosis are poorly described, and due to the low number of treated cases, no specific treatment modality can be recommended on a scientific basis. The aim of this paper is to review the current knowledge regarding the pathogenesis, diagnosis and management of patellar ligament desmopathy in horses, compare this condition with patellar tendinopathy in humans, and identify areas for further research to increase the diagnostic accuracy in horses. We conclude that there is a profound need for better descriptions of ultrasonographic variation and pathological changes of the equine patellar ligaments. Identification of areas of maximal ligament strain and descriptions of early histopathological changes could render more information on the possible aetiology, preventive measurements and treatment options of desmopathy. Description of regional innervation could aid in development of methods for diagnostic anaesthesia to verify pain originating from the ligaments.
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Affiliation(s)
- L. Wright
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
| | - E. Hernlund
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
| | - C.T. Fjordbakk
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oluf Thesens vei 24, 1432 Ås, Norway
| | - B. Ytrehus
- Department of Biomedicine and Veterinary Public Health, Swedish University of Agricultural Sciences, P.O. Box 7028, 750 07 Uppsala, Sweden
| | - E. Law
- University Animal Hospital, P.O. Box 7040, 750 07 Uppsala, Sweden
| | - M. Uhlhorn
- University Animal Hospital, P.O. Box 7040, 750 07 Uppsala, Sweden
| | - M. Rhodin
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
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Moreno CR, Santschi EM, Janes J, Liu J, Kim DG, Litsky AS. Compression generated by cortical screws in an artificial bone model of an equine medial femoral condylar cyst. Vet Surg 2022; 51:833-842. [PMID: 35394080 PMCID: PMC9321887 DOI: 10.1111/vsu.13814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/11/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022]
Abstract
Objective Determine compression generated by lag and neutral screws over 12 h using two bone analogs. Study design Experimental study. Sample population Bone analogs were made of composite synthetic bone (CSB) or three‐dimensional printed polylactic acid (PLA). Analogs had a 2 mm exterior shell with a 10 mm thick internal layer of open‐cell material. Methods Bone analogs were opposed, making a 4‐sided box with open ends. A central channel contained the sensor and the screws passed through it to engage both paired analogs. Four screw/analog conditions were tested: neutral and lag screw with bicortical engagement, neutral and lag screw with unicortical engagement. All screws were tightened to 2 Nm torque and compression values recorded at 0, 0.5, 1, 2, 6, and 12 h (six trials per condition). Medians were compared across groups for statistical significance. Results There was no difference in median compression between lag and neutral bicortical screws. For PLA, greater median compression was generated by neutral (median 437 N) and lag (median 379 N) bicortical screws compared to neutral unicortical screws (median 208 N, p < .001); lag bicortical screws generated greater median compression than lag unicortical screws (median 265 N, p = .012). For CSB, lag bicortical screws (median 293 N) generated greater median compression than neutral unicortical screws (median 228 N, p = .008). Conclusion Lag and neutral screws generated similar compression. Bicortical screws had higher median compression than unicortical screws in bone analogs. Clinical significance Neutral screws generate compression in cancellous bone analogs that can be increased with bicortical bone engagement.
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Affiliation(s)
- Caitlin R Moreno
- Department of Clinical Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Elizabeth M Santschi
- Department of Clinical Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Jennifer Janes
- Equine Programs, University of Kentucky, Lexington, Kentucky, USA
| | - Jie Liu
- Division of Orthodontics, The Ohio State University, Columbus, Ohio, USA
| | - Do-Gyoon Kim
- Division of Orthodontics, The Ohio State University, Columbus, Ohio, USA
| | - Alan S Litsky
- Departments of Orthopaedics and Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA.,Orthopaedic BioMaterials Laboratory, The Ohio State University, Columbus, Ohio, USA
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Moreno CR, Santschi EM, Younkin JT, Larson RL, Litsky AS. The failure mode of a mechanically loaded equine medial femoral condyle analog with a void and the impact of lag and neutral screw placement. Vet Surg 2022; 51:474-481. [PMID: 35102588 DOI: 10.1111/vsu.13765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the failure method of simulated equine medial femoral condyle (MFC) subchondral bone defects under compression and the influence of screw placement on failure resistance. STUDY DESIGN In vitro study. SAMPLE POPULATION Composite disks (CD) simulating the moduli of yearling bone in the MFC. METHODS Four CD conditions were tested, all with a 12.7 mm void (n = 6 per condition): intact (no void), void only, void with a 4.5 mm screw placed in neutral fashion, and void with a 4.5 mm screw placed in lag fashion. Composite disks of each condition were tested under monotonic compression to 6000 N and cyclic compression to 10 000 cycles. Observable failure, load at first observable failure, and displacement at peak 2000 N load were compared among conditions. RESULTS Specimens failed by cracking at the superior aspect of the void or the screw exit hole. After monotonic loading, cracks were observed 6/6 CD with a void, 6/6 CD with a void/lag screw, and 5/6 CD with a void/neutral screw. After cyclical testing, cracks were noted only on the superior aspect of 6/6 CD with a void and 3/6 CD with a void/lag screw. Displacement at peak load was 0.06 mm (intact), 0.32 mm (void), 0.24 mm (void/lag screw), and 0.11 mm (void/neutral screw). CONCLUSION Model MFC voids failed by superior cracking that was resisted by lag and neutral screw placement. CLINICAL SIGNIFICANCE Neutral screws may be an acceptable treatment for subchondral lucencies in the MFC.
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Affiliation(s)
- Caitlin R Moreno
- Department of Clinical Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Elizabeth M Santschi
- Department of Clinical Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Jarrod T Younkin
- Department of Clinical Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Robert L Larson
- Department of Clinical Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Alan S Litsky
- Departments of Orthopaedics and Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA.,Orthopaedic BioMaterials Laboratory, The Ohio State University, Columbus, Ohio, USA
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Effects of Internal Fluid Pressure on Stresses in Subchondral Bone Cysts of the Medial Femoral Condyle. Ann Biomed Eng 2022; 50:86-93. [PMID: 34993698 DOI: 10.1007/s10439-021-02883-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/26/2021] [Indexed: 11/01/2022]
Abstract
The etiology of subchondral bone cysts (SBCs) is not fully understood. Mechanical trauma and fluid pressure are two mechanisms believed to cause their formation and growth. The equine stifle joint provides a natural animal model for studying SBCs. Computed tomography images of an extended yearling cadaveric stifle joint were segmented using ScanIP to isolate bones and relevant soft tissues. Three model geometries were created to simulate cyst sizes of approximately 0.03 cm3 (C1), 0.5 cm3 (C2), and 1 cm3 (C3). A uniform pressure resulting in 3000 N force was applied at the proximal end of the femur. Two types of simulations, filled-cyst and empty-cysts with uniform pressure loads, were used to simulate fluid pressurization. Our models suggest that shear stresses are likely the cause of failure for the subchondral bone and not pressurized fluid from the joint. Bone stresses did not begin to increase until cyst pressures were greater than 3 MPa. For all cyst sizes, fluid pressure must rise above what is likely to occur in vivo in order to increase bone shear stress, shown to be most critical. Synovial fluid pressure acts upon a porous trabecular bone network, soft tissue, and marrow, so the continuum nature of our model likely overestimates the predicted effects of fluid pressures.
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Corraretti G, Meulyzer M, Simon O. Treatment of a subchondral cystic‐like lesion in the distal scapula with a translesional bone screw in a horse. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - O. Simon
- Equine Clinic De Morette Asse Belgium
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13
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Jenner F. Treatment of osseous cyst‐like lesions. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- F. Jenner
- Equine Surgery University of Veterinary Medicine Vienna Vienna Austria
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14
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Santschi EM, Juzwiak JS, Honnas C, Walker WT, Hunter B, Whitman JL, Prichard MA, Morehead JP. Management of Subchondral Lucencies of the Medial Aspect of the Equine Antebrachiocarpal Joint. J Equine Vet Sci 2020; 94:103266. [PMID: 33077089 DOI: 10.1016/j.jevs.2020.103266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022]
Abstract
The objective of this study is to describe the management and outcomes of eight horses with subchondral lucencies (SCLs) of the medial aspect of the antebrachiocarpal (ABC) joint. The medical records and radiographs of the carpi of 8 horses with SCLs of the medial aspect of the ABC joint were reviewed. Follow-up clinical information was obtained for 6-60 months (the median duration of 14 months). Treatment was successful if radiographic healing was apparent or lameness was reduced or eliminated. Four horses had SCLs in the distomedial radius (DMR) and four in the proximal aspect of the radiocarpal bone (RCB). Lameness was present in all horses with DMR SCLs and in one horse with an RCB SCL. Treatments included restriction of exercise (n = 3), intra-articular administration of corticosteroids (n = 2), or placement of a screw across the SCL (n = 3). Exercise restriction alone was successful in three nonlame horses younger than one year with proximal RCB SCL and intra-articular corticosteroid administration in the ABC joint in two horses aged 2 years or younger with DMR SCLs. A yearling with a large proximal RCB SCL and two horses aged 5 years or older with DMR SCLs were successfully treated with screw placement across the SCL. Exercise restrictions and intra-articular administration of corticosteroids were successful in management of DMR SCLs in five horses. Placing a screw across the SCL of three horses resulted in resolution of lameness and substantial improvement of the radiographic appearance of the lesion in the RCB or DMR.
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Affiliation(s)
| | | | | | | | | | - Jeremy L Whitman
- Equine Medical Associates, 996 Nandino Blvd, Lexington, KY, 40583
| | | | - James P Morehead
- Equine Medical Associates, 996 Nandino Blvd, Lexington, KY, 40583
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Frazer LL, Santschi EM, Ring SJ, Hewitt RE, Fischer KJ. Impact of Size and Shape of Equine Femoral Subchondral Bone Cysts With a Transcondylar Screw on Predicted Bone Formation Area in a Finite Element Model. J Biomech Eng 2020; 142:061010. [PMID: 31901159 DOI: 10.1115/1.4045892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Indexed: 11/08/2022]
Abstract
Equine subchondral bone cysts (SBCs) develop most often in the medial femoral condyle (MFC) of yearlings intended for performance. SBCs often cause lameness and can cause secondary injuries to the meniscus and tibial cartilage. A novel surgical technique using a transcondylar lag screw (TLS) across an MFC SBC has shown success in lameness resolution and radiographic healing of MFC SBC. In a previous study using finite element analysis, our lab showed that a TLS stimulated bone formation on the inner surface of the SBC and altered third principal stress vectors to change the direction of surface compression to align with the screw axis. This work extended the previous study, which was limited by the use of only one idealized SBC. Our objective was to test SBCs of several sizes and shapes in a newly developed equine stifle FEM with a TLS to determine how cyst size affects bone formation stimulation. This study found that a transcondylar screw is most effective in stimulating bone formation in cysts of greater height (proximal-distal). The TLS increases stress stimulus in the bone around the cyst to promote bone apposition and directs compression across the cyst. If full penetration of the screw through the cyst is possible, it is recommended that the transcondylar screw be used to treat subchondral bone cysts. For the treatment of smaller cysts that are not accessible by the current screw surgical approach, future work could study the efficacy of a dual-pitch headless screw that may reach smaller cysts.
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Affiliation(s)
- Lance L Frazer
- Bioengineering Program, University of Kansas, Lawrence, KS 66045
| | | | - Scott J Ring
- Department of Mechanical Engineering, University of Kansas, Lawrence, KS 66045
| | - Ross E Hewitt
- School of Management, University of Missouri-Kansas City, Kansas City, MO 64110
| | - Kenneth J Fischer
- Department of Mechanical Engineering, University of Kansas, Lawrence, KS 66045; Bioengineering Program, University of Kansas, Lawrence, KS 66045
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Santschi EM, Whitman JL, Prichard MA, Lopes MAF, Pigott JH, Brokken MT, Jenson PW, Johnson CR, Morrow C, Brusie RW, Juzwiak JS, Morehead JP. Subchondral lucencies of the proximal tibia in 17 horses. Vet Surg 2020; 49:778-786. [PMID: 32031290 DOI: 10.1111/vsu.13387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/18/2019] [Accepted: 01/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe subchondral lucencies (SCL) in the equine proximal tibia, several treatment options, and clinical outcomes. STUDY DESIGN Retrospective study. ANIMALS Seventeen horses with proximal tibial SCL. METHODS Medical record and radiograph review. Follow-up was obtained via examination and radiography when possible and by telephone and race records when required. The median duration of follow-up was 20 months (range, 0-48). RESULTS Proximal tibial SCL were associated with lameness in 14 of 17 horses. Subchondral lucencies were primary in 11 horses and secondary to an ipsilateral medial femoral condyle SCL in six horses. One foal with a primary SCL was euthanized because of osteomyelitis. Six horses ≤1 year old with primary SCL were managed with exercise restrictions only; SCL in three horses without lameness decreased in size, whereas three horses with lameness did not improve. One young horse treated with surgical debridement failed to improve and was euthanized. Lameness resolved in three horses with primary tibial SCL treated with screw fixation. Screw fixation of secondary SCL in five horses led to a reduction in SCL size and degree of lameness. CONCLUSION Primary tibial SCL healed with rest in 3 non-lame young horses with small SCL, but was not successful in lame horses with larger SC. Radiographic size and associated lameness improved or resolved with screw fixation in primary and secondary proximal tibial SCL. CLINICAL SIGNIFICANCE Primary tibial SCL that did not cause lameness healed with conservative management, but persistent primary and secondary tibial SCL required screw fixation to reduce lameness.
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Affiliation(s)
| | | | | | - Marco A F Lopes
- Equine Health and Performance Centre, University of Adelaide, South Australia, Australia
| | - John H Pigott
- Wisconsin Equine Clinic and Hospital, Oconomowoc, Wisconsin
| | - Matthew T Brokken
- Veterinary Medical Center, The Ohio State University, Columbus, Ohio
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Wright S. Highlights of recent clinically relevant papers. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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