Gábor Bodó

Autologous osteochondral grafting—Technique and long-term results

BACKGROUND Efficacious treatment of chondral and osteochondral defects of weightbearing articular surfaces is a daily challenge in musculoskeletal care. Autogenous osteochondral transplantation represents a possible solution for creating hyaline or hyaline-like repair in the affected area that has a noninflammatory pathoorigin. This paper discusses the experimental background and over 15 years of clinical experience with autologous osteochondral mosaicplasty. METHODS Several series of animal studies and subsequent clinical practice of over 1,000 mosaicplasty patients were assessed to confirm the survival of transplanted hyaline cartilage and fibrocartilage filling of donor sites located on relatively less weightbearing surfaces, as well as donor-site disturbances and morbidity. Histological evaluations of dog and horse implantations as well as several series of clinical evaluations in the human material are summarized in this paper. Clinical scores, different types of imaging techniques, second-look arthroscopies, histological examination of biopsy samples, and cartilage stiffness measurements were used to evaluate the clinical outcomes and quality of the transplanted cartilage. RESULTS Analysis of clinical scores has shown good to excellent results in 92% of patients with femoral condylar implantations, 87% of tibial resurfacements, 74% of patellar and/or trochlear mosaicplasties and 93% of talar procedures. Longterm donor-site complaints measured by the Bandi score were minor and present only in 3% of patients. 81 out of the 98 control arthroscopies represented congruent and good gliding surfaces and histologically proven survival of the transplanted hyaline cartilage as well as fibrocartilage covering of the donor sites. Complications in the entire patient group were four deep infections and four deep venous thromboses. In nearly 8% of the cases excessive intraarticular bleeding was observed in the early postoperative period, as a minor complication of the procedure. Multicentric, comparative, prospective evaluation of 413 arthroscopic resurfacing procedures (mosaicplasty, Pridie drilling, abrasion arthroplasty and microfracture cases in homogenised subgroups) demonstrated that mosaicplasty resulted in favourable clinical outcome in the long-term follow-up compared to other three techniques. Durability of the early results was confirmed in long-term evaluations both of the femoral condylar implantations and talar mosaicplasties. CONCLUSIONS According to our encouraging results in this increasingly large series, supported by similar findings from other centres, it seems that autologous osteochondral mosaicplasty may be an alternative for small and medium-sized focal chondral and osteochondral defects of weightbearing surfaces of the knee and other weightbearing synovial joints.

Assessment of the mineral density and mineral content of the equine third metacarpal and first phalanx bone by dual energy x-ray absorptiometry.

In the first part of this methodological study eleven metacarpi of 9 skeletally normal horses were examined from 4 directions by dual energy x-ray absorptiometry (DXA). The differences between the dorsopalmar-palmarodorsal and lateromedial-mediolateral (opposite sites) bone mineral density (BMD) values were found to be nonsignificant. In the second part of the study the precision of the Norland XR-26 densitometer was tested by measuring 34 metacarpal bones and 34 proximal phalanges, each of them three times, from a single direction. The difference between the individual measurements of the first phalanges and of the metacarpal bones originating from the right or the left side of the same horse were not significant, nor did the age or breed have a significant effect on BMD or bone mineral content (BMC). However, both BMD and BMC are greater in the metacarpal bones than in the proximal phalanges and are higher in geldings than in mares or to stallions, while the BMD or BMC values of mares and stallions did not differ from each other significantly. These data point to the necessity of further BMD studies in a higher number of patients.

Bacterial meningitis after sinus surgery in five adult horses.

OBJECTIVE To report meningoencephalitis as a complication after paranasal sinus surgery in 5 horses. STUDY DESIGN Case series. ANIMALS Adult horses (n = 5). METHODS Medical records (2005-2010) of 5 horses that developed neurologic signs after sinus surgery were reviewed to identify potential risk factors, cause(s), or common pathways for infection. RESULTS Underlying diseases were primary (n = 1) and secondary sinusitis (4) because of apical dental infection (1), sinus cyst (2), or masses in the ethmoturbinate region (2). Horses were treated by conventional surgical approaches and aftercare including repeated sinus lavage. Four horses had undulating pyrexia postoperatively despite antimicrobial therapy. All horses developed neurologic signs, eventually unresponsive to treatment. Suppurative meningoencephalitis was diagnosed macro- and/or microscopically on necropsy in all horses. CONCLUSION Meningitis is a rare but fatal complication after sinus surgery in horses.Objective To report meningoencephalitis as a complication after paranasal sinus surgery in 5 horses. Study Design Case series. Animals Adult horses (n = 5). Methods Medical records (2005–2010) of 5 horses that developed neurologic signs after sinus surgery were reviewed to identify potential risk factors, cause(s), or common pathways for infection. Results Underlying diseases were primary (n = 1) and secondary sinusitis (4) because of apical dental infection (1), sinus cyst (2), or masses in the ethmoturbinate region (2). Horses were treated by conventional surgical approaches and aftercare including repeated sinus lavage. Four horses had undulating pyrexia postoperatively despite antimicrobial therapy. All horses developed neurologic signs, eventually unresponsive to treatment. Suppurative meningoencephalitis was diagnosed macro- and/or microscopically on necropsy in all horses. Conclusion Meningitis is a rare but fatal complication after sinus surgery in horses.

Laparoscopic cryptorchidectomy and ovariectomy in standing horses using the EnSeal® tissue-sealing device

In the present series of cases, 8 laparoscopic cryptorchidectomies and 4 laparoscopic ovariectomies were carried out in sedated standing horses. Sedation involved a lesser anaesthesiological risk than does general anaesthesia. As compared to laparotomic exposure, the minimally invasive laparoscopic intervention provided better visualisation, shorter operative time and faster recovery. The blood vessels supplying the testes and ovaries and the suspensory ligaments of the organs were sealed and cut with EnSeal®, an adaptive bipolar electrosurgical blood vessel- and tissue-sealing device. The clinical use of the blood vessel- and tissue-sealing device proved to be successful in all cases. Gradual separation of the intact tissue from the treated, compacted, dehydrated and homogenised tissue areas and occlusion of the lumen of blood vessels treated with the device could be observed in all histological sections. To the best of our knowledge, this is the first report on the use of EnSeal® for laparoscopic cryptorchidectomy and ovariectomy in horses.

Diagnostic endoscopy of the navicular bursa using a needle endoscope by direct or transthecal approach: A comparative cadaver study.

OBJECTIVES To compare the practicability, visualization of structures, and iatrogenic damage of direct and transthecal approaches to the navicular bursa for diagnostic needle endoscopy. STUDY DESIGN Descriptive study. SAMPLE POPULATION Equine cadaver forelimbs (n = 30). METHODS Direct and transthecal approaches for insertion of a needle endoscope into the navicular bursa were performed. Video recordings of endoscopic procedures were assessed to determine all structures visualized within the navicular bursa. Number of attempts to gain access to the navicular bursa and total time for insertion and examination were recorded. Distribution and severity of iatrogenic lesions were assessed and scored after dissection. RESULTS There were no statistical differences for number of attempts or time needed for insertion and examination between direct and transthecal approaches. The direct approach offered significantly increased visibility of the ipsilateral abaxial and proximal margins of the navicular bone, and ipsilateral collateral sesamoidean ligament. Iatrogenic lesions were superficial and focal, regardless of approach taken, or whether a blunt or sharp trocar tip was used. CONCLUSIONS The direct approach provided significantly better visualization of the ipsilateral structures within the navicular bursa compared to the transthecal approach. Needle endoscopy offers a reliable technique to evaluate the navicular bursa and may complement or replace other diagnostic modalities in horses with lameness localized to the navicular region.

Evaluation of biomarkers following autologous osteochondral transplantation in the equine stifle joint — An experimental study

The purpose of this study was to evaluate changes in biomarker and synovial parameters following autologous osteochondral transplantation (AOT) in the equine stifle joint, to test the hypothesis whether synovial parameters would show significant differences at selected time points following the surgery (at days 3, 14, 60 and 180) compared to baseline level (at day 0). Surgical intervention was performed in both stifles of nine horses (n = 18). The joints were randomly assigned to operated and sham-operated groups. Grafts 8.5 mm in diameter were harvested from the femoropatellar (FP) joint under arthroscopic control and the medial femorotibial (MFT) joints had AOT using mosaicplasty (MP) instrumentation, while the sham FP and sham MFT joints underwent arthroscopy and miniarthrotomy without transplantation, respectively. Synovial fluid (SF) parameters were evaluated at days 4, 14, 60 and 180. Data were analysed by two-way repeated- measures analysis of variance (ANOVA), and P < 0.05 was considered significant. During the first 10-14 days after surgery, lameness of degree 2-3/5 [American Association of Equine Practitioners (AAEP) scores] was present, which disappeared after 60 days. Joints with transplantation showed significant increases in synovial white blood cell count (WBC), total protein (TP), substance P, C1,2C and CS846 epitope concentration at day 3 compared to baseline and shamoperated joints (P < 0.05). These parameters returned to the baseline values by two months after surgery and remained within normal levels at 6 months postoperatively.

Bacterial Meningitis After Sinus Surgery in Five Adult Horses: Bacterial Meningitis After Sinus Surgery

OBJECTIVE To report meningoencephalitis as a complication after paranasal sinus surgery in 5 horses. STUDY DESIGN Case series. ANIMALS Adult horses (n = 5). METHODS Medical records (2005-2010) of 5 horses that developed neurologic signs after sinus surgery were reviewed to identify potential risk factors, cause(s), or common pathways for infection. RESULTS Underlying diseases were primary (n = 1) and secondary sinusitis (4) because of apical dental infection (1), sinus cyst (2), or masses in the ethmoturbinate region (2). Horses were treated by conventional surgical approaches and aftercare including repeated sinus lavage. Four horses had undulating pyrexia postoperatively despite antimicrobial therapy. All horses developed neurologic signs, eventually unresponsive to treatment. Suppurative meningoencephalitis was diagnosed macro- and/or microscopically on necropsy in all horses. CONCLUSION Meningitis is a rare but fatal complication after sinus surgery in horses.Objective To report meningoencephalitis as a complication after paranasal sinus surgery in 5 horses. Study Design Case series. Animals Adult horses (n = 5). Methods Medical records (2005–2010) of 5 horses that developed neurologic signs after sinus surgery were reviewed to identify potential risk factors, cause(s), or common pathways for infection. Results Underlying diseases were primary (n = 1) and secondary sinusitis (4) because of apical dental infection (1), sinus cyst (2), or masses in the ethmoturbinate region (2). Horses were treated by conventional surgical approaches and aftercare including repeated sinus lavage. Four horses had undulating pyrexia postoperatively despite antimicrobial therapy. All horses developed neurologic signs, eventually unresponsive to treatment. Suppurative meningoencephalitis was diagnosed macro- and/or microscopically on necropsy in all horses. Conclusion Meningitis is a rare but fatal complication after sinus surgery in horses.