Needle arthroscopy of the radiocarpal and middle carpal joints in standing sedated horses

Development and Validation of an Examination Protocol for Arthroscopic Evaluation of the Temporomandibular Joint in Dogs

Due to the previously limited intra-articular diagnostic possibilities of the canine temporomandibular joint, an examination protocol for the canine temporomandibular joint (TMJ) was developed and tested in this study using a needle arthroscope. In total, the discotemporal (DTJ) and discomandibular (DMJ) joint compartments of 32 animals (64 TMJs) were examined arthroscopically. During the examinations, 15 anatomical landmarks per joint side were evaluated in regard to their visibility and accessibility. All arthroscopies were performed by the same examiner and the same assistant to ensure standard methods were applied. The examination procedure which was developed here proved to be a reliable tool for examining this joint. The 15 anatomical landmarks that were to be examined could be reliably visualised and assessed in all TMJs with a certainty of 86% to 100% by both observers. This tool provides clinicians with a reliable examination aid for everyday practice and ensures the comparability of results. In the future, this could provide an opportunity to better diagnose and treat TMJ pathologies.

Standing surgery among equine board certified surgeons: Survey regarding current use and trends

BACKGROUND

Publications about equine standing surgery are flourishing, however, information regarding its use and prevalence among surgeons is still limited.

OBJECTIVES

To determine the current use and recent trends for equine standing surgery among board certified surgeons and to identify the main reasons and limitations for performing a procedure standing.

STUDY DESIGN

Cross-sectional survey.

METHODS

A 139-item questionnaire was sent by email to 733 large animal surgery Diplomates (ACVS and ECVS) from November 2020 to February 2021. The survey collected demographic information and general data regarding standing surgery before being divided into seven identical sections for each body system, involving 36 standing procedures.

RESULTS

The survey response rate was 29.7% (218/733). Most respondents (58.9%, 126/214) had performed standing surgery for <10 years regardless of length of time they were board certified (48.2% board certified <10 years and 51.8% >10 years). Most respondents (range: 50.0%-92.9%, mean 69.5%) changed from performing 14/36 surgeries under general anaesthesia (GA) to standing within the previous 10 years and had always performed 8/36 surgeries standing (51.6%-73.9%, mean 61.4%) regardless of board certification time. Surgeons board certified <10 years ago performed more often 3/36 listed procedures standing than those board certified >10 years ago (p < 0.05). Avoiding GA (179/218) and/or reducing procedure cost (111/218) were the two main reasons to perform standing surgeries whereas the horse's behaviour (183/218) and/or the patient size/age (94/218) were the two main limiting factors.

MAIN LIMITATIONS

Low response rate. Results biased towards the opinion of a subgroup of surgeons, those performing standing surgery. Some standing procedures were not included in the survey.

CONCLUSIONS

The use of standing surgery is well established among board certified surgeons and progressively increasing, especially in the last 10 years and among recent Diplomates. With increased training and awareness, more Diplomates may be encouraged towards performing standing surgeries.

Accuracy of needle arthroscopy for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture

OBJECTIVE

To determine the accuracy of needle arthroscopy (NA) for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture (CCLR).

STUDY DESIGN

Prospective clinical trial.

ANIMALS

Twenty-six client-owned dogs.

METHODS

Dogs with CCLR and scheduled to undergo tibial plateau leveling osteotomy were recruited for the study. Needle arthroscopy was performed by an experienced surgeon; the same dog subsequently underwent standard arthroscopy (SA) by another experienced surgeon who was blinded to the NA findings. The SA arthroscopy findings were used as the gold standard. Arthroscopy time, visibility of the menisci, ability to probe the menisci, and the presence of meniscal tears were recorded for both arthroscopies. The degree of lameness before and after NA was subjectively quantified.

RESULTS

The sensitivity and specificity to diagnose medial meniscal tears with NA was 95% and 100%, respectively. Visibility of the menisci was lower (P < .01), probing of the lateral meniscus was harder (P = .0017), and procedure time was shorter (P = .073) with NA when compared to SA. The lameness scores did not differ before and after NA (P = .25).

CONCLUSION

Needle arthroscopy could be performed rapidly with low morbidity, and had high accuracy for detecting medial meniscal tears in dogs with CCLR.

CLINICAL SIGNIFICANCE

Needle arthroscopy is a promising minimally invasive technique for diagnosing medial meniscal tears in dogs with CCLR.

Standing Surgical Management of Splint Bone Fractures in 13 Horses: A Comparison to Management Under General Anaesthesia

OBJECTIVE

 The aim of this article was to describe the technique and outcomes of standing surgical management of splint bone fractures and to compare outcome variables and hospitalization cost to a group with similar fractures treated under general anaesthesia.

STUDY DESIGN

 It is a single-institution retrospective study. Surgical technique, surgical time, hospitalization cost and complications were retrieved from the medical records of horses treated surgically for splint bone fractures (2008-2020). Owner telephone follow-up provided data about athletic outcome, client satisfaction and cosmetic appearance.

RESULTS

 Forty-nine horses (13 standing, 36 under general anaesthesia) with 57 fractures (18 contaminated and 39 non-contaminated) were included. Seven fractures were in the proximal third (4 standing, 3 under general anaesthesia), 18 in the middle third (5 standing, 13 under general anaesthesia) and 30 were distal (4 standing, 26 under general anaesthesia). No significant difference between groups in surgical time was found (p= 0.8). Average total cost was 522 CAN$ lower for the standing group for non-contaminated fractures (p= 0.02). Three horses of the general anaesthesia group demonstrated postoperative colic signs and one case of the standing group was re-operated due to sequestration. Based on follow-up information (range: 3.8-151.2 months), no significant differences in cosmetic and athletic outcomes were found between groups.

CONCLUSION

 Surgical management of splint bone fractures in the standing horse is a valuable alternative for horses selected based on behaviour. When compared to general anaesthesia, standing management of splint bone fractures did not alter the surgical time or outcome variables and avoided general anaesthesia-associated risks.

The Impact of Circular Exercise Diameter on Bone and Joint Health of Juvenile Animals

Circular exercise is used in many equestrian disciplines and this study aimed to determine if circle diameter impacts juvenile animal forelimb bone and joint health. On day 0, 24 calves at 9 weeks of age were assigned the following exercise treatments: small circle (12 m clockwise), large circle (18-m clockwise), treadmill, or non-exercised control. Exercise was initiated at 1.1−1.5 m/s for 5 min/d and increased 5 min weekly until reaching 30 min/d. On day 49, synovial fluid was collected from multiple joints, cartilage was collected from the proximal surface of fused third and fourth metacarpi (MC III and IV), and forelimbs underwent computed tomography scans. A statistical analysis (PROC mixed) was performed in SAS 9.4. The inside leg of the small circle treatment had a larger MC III and IV dorsopalmar external diameter than the outside (p = 0.05). The medial proximal phalanx had a greater mediolateral diameter than the lateral proximal phalanx of the small circle treatment (p = 0.01). Fetlock nitric oxide was greater in the large circle and treadmill treatments (p < 0.0001). Cartilage glycosaminoglycan concentration was greater in the outside leg of the small circle exercise treatment than the inside leg (p = 0.03). Even at slow speeds, circular exercise diameter can impact joint and bone health, but faster speeds may have greater alterations.

The Equine Temporomandibular Joint: Comparisons Between Standard and Needle Arthroscopic Examination of Cadaver Specimens and Standing Horses

Background

Definitive diagnosis of equine temporomandibular joint osteoarthritis (TMJ-OA) may require advanced diagnostic imaging. Arthroscopy is a modern, minimally invasive, diagnostic, and treatment modality. Standing arthroscopic treatment of joint disease is a relatively recent advance in equine surgery, despite which there are few published comparisons between the available arthroscopic systems.

Objective

To compare and contrast two arthroscopic systems for assessing the equine temporomandibular joint compartments in cadavers and standing horses.

Study design

Experimental study.

Methods

Phase I involved the assessment of the discotemporal joint (DTJ) and discomandibular (DMJ) joint compartments of both temporomandibular joints (TMJ) of 14 cadaveric equine heads using a caudally placed arthroscopy portal. Joints were initially examined using the needle arthroscope and the results compared to the findings of examination using a 2.5 mm 30° arthroscope system (standard). Three healthy horses were subsequently examined to determine the validity of the procedure in live animals in Phase II.

Results

Needle and standard arthroscopy, in combination with mandibular manipulation, allowed evaluation of the caudal aspects of both joint compartments of the TMJ in Phase I. However, the extreme margins of the joint were more commonly visualized using standard arthroscopy. Live horses in phase II were restrained in stocks and both the rostral and caudal aspects of the DTJ and DMJ compartments of both TMJs were examined successfully understanding sedation and local analgesia. The use of a modified Guenther speculum allowed the mandible to be manipulated and offset, which facilitated a complete examination of the joint compartments. Despite adverse behavior encountered during the procedure in one horse, no surgical complications ensued.

Main Limitations

Not blinded-bias; learning curve.

Conclusions

The needle arthroscope system is a relatively inexpensive diagnostic tool, which can be used to evaluate the TMJ in the absence of advanced diagnostic imaging such as computed tomography or magnetic resonance imaging. However, if arthroscopic treatment is required after advanced imaging and pre-operative diagnosis, superior image quality and ease of manipulation may favor the use of the standard equipment.