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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. [PMID: 38819517 DOI: 10.1111/vsu.14105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Pérez-Nogués M, Manso-Díaz G, Spirito M, López-Sanromán J. Treatment Comparison for Medial Femoral Condyle Subchondral Cystic Lesions and Prognosis in Yearling Thoroughbred Racehorse Prospects. Animals (Basel) 2024; 14:1122. [PMID: 38612360 PMCID: PMC11010810 DOI: 10.3390/ani14071122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Subchondral cystic lesions (SCL) in the medial femoral condyle are a usual finding in Thoroughbred survey and auction repository radiographs. Several treatments with different outcomes have been studied over the years to improve soundness and racing prognosis. Our objective was to report the racing prognosis in Thoroughbred yearlings intended for racing that were diagnosed with SCL in the medial femoral condyle and were treated using four current and different techniques: intralesional injection of corticosteroids, SCL debridement through the joint with a drill bit, translesional cortical screw placement, and absorbable hydroxyapatite implant placement. Data from 182 Thoroughbred yearlings treated for SCL in the medial femoral condyle were collected from 2014 to 2020. Limb affected, age at surgery, sex, and radiographic measurements of the SCL were recorded. Auction price and racing performance were collected for treated horses and compared to 154 maternal siblings free of medial femoral condyle SCL. Analyses were conducted to assess if racing prognosis was affected by SCL size, to detect differences in auction price and selected flat racing outcome parameters between cases and controls, and to compare racing prognosis between the studied treatments. Mares and lesions located in the right stifle were significantly overrepresented. The auction price of treated horses was significantly lower than that of their siblings. Horses treated for SCL had significantly lower chances to start in a race than controls (59% vs. 74% respectively). Wider SCL negatively affected the chances to start at least in one race, and negatively affected the earnings made in the 2-year-olds' racing year. Horses with SCL treated using a bioabsorbable implant had a significantly higher median in starts as 3-year-olds (seven starts) than horses that had the SCL debrided with a drill bit (three starts). In conclusion, Thoroughbred yearlings treated for a medial femoral condyle SCL had lower auction prices and decreased ability to start a race compared to siblings' wider cysts had worse prognosis to start a race and might affect earnings as 2-year-olds; and horses treated with bioabsorbable composite implant placement had more starts as 3-year-olds than with other techniques.
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Affiliation(s)
| | - Gabriel Manso-Díaz
- Department of Animal Medicine and Surgery, Universidad Complutense de Madrid, Avenida Puerta de Hierro s/n, 28040 Madrid, Spain;
| | - Michael Spirito
- Hagyard Equine Medical Institute, 4250 Iron Works Pike, Lexington, KY 40511, USA;
| | - Javier López-Sanromán
- Department of Animal Medicine and Surgery, Universidad Complutense de Madrid, Avenida Puerta de Hierro s/n, 28040 Madrid, Spain;
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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: 0] [Impact Index Per Article: 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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Canonici F, Marcoccia D, Bonini P, Monteleone V, Innocenzi E, Zepparoni A, Altigeri A, Caciolo D, Tofani S, Ghisellini P, Rando C, Pechkova E, Rau JV, Eggenhöffner R, Scicluna MT, Barbaro K. Arthroscopic Treatment of a Subchondral Bone Cyst via Stem Cells Application: A Case Study in Equine Model and Outcomes. Biomedicines 2023; 11:3307. [PMID: 38137527 PMCID: PMC10741679 DOI: 10.3390/biomedicines11123307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Subchondral bone cysts in horses represent one of the main causes of lameness that can occur in different anatomical locations. The study describes the treatment in regenerative therapy of the intracystic implantation of adipose tissue mesenchymal stromal cells (AMSCs) included in platelet-rich plasma (PRP). The ability of AMSCs to differentiate in osteogenic cells was tested in vitro and in vivo. Given the aim to investigate the application of AMSCs in bone defects and orthopedic pathologies in horses, a four-year-old male thoroughbred racing horse that had never raced before was treated for lameness of the left hind leg caused by a cyst of the medial femoral condyle. The horse underwent a new surgery performed with an arthroscopic approach in which the cystic cavity was filled with AMSCs contained in the PRP. Radiographs were taken 3, 5, and 10 months after the surgery to assess the development of newly regenerated bone tissue in the gap left by the cyst. Twelve months after the operation and after six months of regular daily training, the horse did not show any symptoms of lameness and started a racing career. According to the study, the use of AMSCs and PRP suggests promising benefits for treating subchondral bone cysts.
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Affiliation(s)
- Fernando Canonici
- Equine Practice srl, Campagnano, Strada Valle del Baccano 80, 00063 Roma, Italy;
| | - Daniele Marcoccia
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Pamela Bonini
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Valentina Monteleone
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Elisa Innocenzi
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Alessia Zepparoni
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Annalisa Altigeri
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Daniela Caciolo
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Silvia Tofani
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Paola Ghisellini
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Genova University, Corso Europa 30, 16132 Genova, Italy; (P.G.); (C.R.); (R.E.)
| | - Cristina Rando
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Genova University, Corso Europa 30, 16132 Genova, Italy; (P.G.); (C.R.); (R.E.)
| | - Eugenia Pechkova
- Consorzio Interuniversitario INBB, Viale delle Medaglie d’Oro, 305, 00136 Roma, Italy;
- Laboratories of Biophysics and Nanotechnology, Department of Experimental Medicine (DIMES), Genova University, Via Pastore 3, 16132 Genova, Italy
| | - Julietta V. Rau
- Istituto di Struttura della Materia, Consiglio Nazionale delle Ricerche (ISM-CNR), Via del Fosso del Cavaliere 100, 00133 Rome, Italy;
| | - Roberto Eggenhöffner
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Genova University, Corso Europa 30, 16132 Genova, Italy; (P.G.); (C.R.); (R.E.)
| | - Maria Teresa Scicluna
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
| | - Katia Barbaro
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova 1411, 00178 Rome, Italy; (D.M.); (P.B.); (V.M.); (E.I.); (A.Z.); (A.A.); (D.C.); (S.T.); (M.T.S.)
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