Gary M. Baxter

Development of subchondral cystic lesions after articular cartilage and subchondral bone damage in young horses

The objective of this study was to determine if damage to the articular cartilage alone or articular cartilage plus subchondral bone of the distal medial femoral condyle of young, exercised horses resulted in the formation of subchondral cystic lesions. Twelve Quarter Horses (age 1-2 years), free of clinical and radiographic signs of osteochondrosis and lameness were used. In 6 horses (Group 1), a 15 times 1 mm linear full thickness defect in the articular cartilage was made arthroscopically on the weightbearing surface of the distal aspect of the medial femoral condyle. In the other 6 horses (Group 2), a 15 times 3 mm full thickness elliptical cartilage defect was made, followed by burring a 5 mm diameter, 4 mm deep hole into the subchondral bone. Three weeks after surgery, all horses were hand walked and trotted for 2 weeks and then exercised for 6 min daily, 5 days a week for the next 14 weeks on a treadmill. They were then turned onto a small paddock for 6 weeks (6 months total). The development of subchondral cystic lesions was determined using radiography. Bone activity in the femoral condyle was monitored with nuclear scintigraphy. All horses that developed subchondral cystic lesions radiographically were subjected to euthanasia for gross and histological examination of the lesions. No subchondral cystic lesions and no clinical abnormalities were detected in the horses in Group 1. Subchondral cystic lesions developed radiographically in 5 of 6 horses in (Group 2). Scintigraphic findings of horses with subchondral cystic lesions were inconsistent. Histological examination of lesions revealed variable quantities of fibrous connective tissue, fibrocartilage and bone, with evidence of bone remodelling adjacent to the subchondral cystic lesion. The results suggest that damage to articular cartilage plus subchondral bone, but not articular cartilage alone, of the distal medial femoral condyle may lead to the development of subchondral cystic lesions. These findings indicate that all subchondral cystic lesions in horses may not be osteochondrosis-type lesions and that trauma to weightbearing articular surfaces of young horses may be a predisposing factor.

Arthroscopic injection of corticosteroids into the fibrous tissue of subchondral cystic lesions of the medial femoral condyle in horses: A retrospective study of 52 cases (2001–2006)

REASONS FOR PERFORMING STUDY There are no published results of subchondral cystic lesions (SCLs) in the medial femoral condyle (MFC) treated with arthroscopic injection of corticosteroids into the lining of the cyst. OBJECTIVES 1) To determine the success rate for treatment of SCLs in the MFC with arthroscopic injection of the fibrous tissue of the cyst with corticosteroids. 2) To identify any factors that may predict outcome. HYPOTHESES Injection of the fibrous tissue of SCLs of the MFC with corticosteroids utilising arthroscopic guidance yields a similar or higher chance for intended performance than does arthroscopic debridement as previously reported; this technique will be effective for treating SCLs in older horses. METHODS Horses with clinical and radiographic evidence of a SCL in the MFC were injected with corticosteroids under arthroscopic guidance, and case records and radiographs were reviewed retrospectively. A telephone survey of referring veterinarians, owners and trainers was conducted. RESULTS Thirty-five of 52 (67%) cases were classified as successful involving 73 SCLs of which 56 (77%) were classified as successful. There was no significant association between age group (age<or=3 years vs. >3 years) and outcome, or cyst configuration and outcome. Significantly more unilateral SCLs (28/31 [90%] SCLs) were classified as successful than bilateral (28/42: 67%). There were significant differences in outcome based on the surgeon operating the case and an association between pre-existing radiographic findings of osteophytes and negative outcome. CONCLUSIONS Injection of SCLs utilising arthroscopic guidance is an effective alternative method of surgical treatment of SCL. POTENTIAL RELEVANCE This technique offers a similar chance of success as has been reported with debridement and may allow for a shorter period of convalescence. If unsuccessful, the option remains to debride the cyst in a second surgery.

Effects of glucosamine hydrochloride and chondroitin sulphate, alone and in combination, on normal and interleukin-1 conditioned equine articular cartilage explant metabolism

REASONS FOR PERFORMING STUDY Clinical trials in human and veterinary literature have documented the benefits of oral nutraceutical joint supplements containing glucosamine (GU) and chondroitin sulphate (CS) to treat mild to moderate osteoarthritis, but the effects of these components have not yet been conclusively determined. OBJECTIVES To assess varying dosages of GU and CS on normal and interleukin-1alpha (IL-1) conditioned equine cartilage explants and rationalise the use of these products. HYPOTHESIS Treatment would not be detrimental to cartilage metabolism and higher dosages and the combination of GU and CS would be more beneficial than lower dosages and. GU or CS alone. METHODS Articular cartilage explants collected from the femoral trochlea and condyles were cultured in normal and IL-1 conditioned media. Treatment groups included 0, 12.5, 25,125 and 250 microg/ml concentrations of GU alone, CS alone, or GU+CS in combination. Glycosaminoglycan (GAG) synthesis and total GAG content in the explants and media were analysed. RESULTS There were no detrimental effects of GU, CS or GU+CS on cartilage metabolism. High dosages of GU+CS reduced total GAG release into the media (degradation). CONCLUSIONS Our results suggests that GU+CS may prevent cartilage GAG degradation. POTENTIAL RELEVANCE The combination of GU and CS may be more effective in preventing or treating osteoarthritis in horses than either product alone.

Effects of dosage titration of methylprednisolone acetate and triamcinolone acetonide on interleukin‐1‐conditioned equine articular cartilage explants in vitro

REASONS FOR PERFORMING STUDY Osteoarthritis is a frequent sequela of joint disease, especially with severe injuries or if attempts at therapy are unsuccessful. Negative and positive effects of corticosteroid treatment of articular cartilage have been demonstrated by in vitro and in vivo studies. OBJECTIVES To assess the metabolic effects of varying dosages of methylprednisolone acetate (MPA) and triamcinolone acetonide (TA) on interleukin-1alpha (IL-1) conditioned equine cartilage explants. Our hypothesis was that lower dosages of corticosteroids would be less detrimental to cartilage metabolism than higher dosages. TA would be less detrimental to cartilage metabolism than MPA. METHODS Treatment groups included articular cartilage explants with no IL-1 (control), IL-1 alone, and IL-1 plus 10, 5, 1 and 0.5 mg/ml MPA or 1.2, 0.6, 0.12 and 0.06 mg/ml TA. Explants were labelled with 35SO4 prior to the beginning and end of the experiment to assess glycosaminoglycan (GAG) degradation and synthesis, respectively. Total GAG content in media and explants and total cartilage DNA were also analysed. RESULTS MPA and TA reduced GAG synthesis compared to control and IL-1 alone. The highest dosage of MPA (10 mg/ml) reduced GAG synthesis less than lower dosages of MPA and all dosages of TA. Compared to IL-1 alone, all dosages of TA and lower dosages of MPA increased GAG degradation. MPA at 10 mg/ml reduced GAG degradation. Both MPA and TA increased media GAG content compared to control and IL-1 explants. Total cartilage GAGs were unchanged with MPA, but reduced with TA, compared with IL-1 alone. Total cartilage DNA was decreased with MPA and increased with TA compared to IL-1 and control explants. CONCLUSIONS MPA and TA did not counteract the negative effects of IL-1 and did not maintain cartilage metabolism at control levels. Lower dosages of MPA and TA were not less detrimental to cartilage metabolism than higher dosages. TA did not appear to be less harmful than MPA on cartilage metabolism. The results of this study differ from the findings of comparable in vivo studies. POTENTIAL RELEVANCE The low numbers of horses used in this study limits extrapolation of these findings to the equine population; however, this study also questions the clinical relevance of this in vitro model.

Current Concepts in Management of Abdominal Adhesions

Adhesions are an important complication after abdominal surgery in horses and foals, especially after small intestinal resection and anastomosis. Prevention therapies used in horses have included nonsteroidal anti-inflammatory drugs, antibiotics, heparin, dimethyl sulfoxide, carboxymethylcellulose, and meticulous surgical technique; however, the ideal surgical technique and prevention therapy has not been determined. Further, treatment of abdominal adhesions has a poor prognosis, emphasizing the need for improvements in prevention methods.

Complications of Unilateral Weight Bearing

The most common and significant complication of excessive unilateral weight bearing in adult horses is support limb laminitis. Young horses with unilateral lameness problems develop support limb laminitis infrequently compared with adult horses.

Incidence of support limb laminitis in horses treated with half limb, full limb or transfixation pin casts: a retrospective study of 113 horses (2000-2009).

REASONS FOR PERFORMING STUDY To determine the incidence of support limb laminitis among horses treated with half limb, full limb or transfixation pin casts and determine potential risk factors. METHODS Medical records of 113 horses treated with half limb, full limb or transfixation pin casts at an equine referral hospital from 2000 to 2009 were reviewed. Associations between potential risk factors and development of support limb laminitis were evaluated by bivariable and multivariable logistic regression analyses. RESULTS Of the 113 horses that received casts, 14 (12%) developed confirmed support limb laminitis. The bodyweight of the horse and duration of casting in weeks were significantly associated with support limb laminitis. Horses requiring full limb casts or transfixation pin casts were more likely to develop this complication than horses requiring half limb casts. There were no significant associations between developing support limb laminitis and weightbearing capacity on presentation to the hospital, the limb affected (fore- or hind), whether there was a fracture present or breed of horse. CONCLUSIONS Support limb laminitis is a relatively common complication among horses treated with half limb, full limb and transfixation pin casts. Greater durations of casting and higher bodyweights increase the likelihood of developing this complication. POTENTIAL RELEVANCE Support limb laminitis may occur secondary to any painful unilateral lameness and is not necessarily more likely to develop in horses with severe orthopaedic conditions such as fractures. However, heavier horses, those requiring casts for longer periods of time and those that require a full limb or transfixation pin cast as opposed to a half limb cast should be considered to have an increased risk for developing support limb laminitis post operatively.

Concurrent or sequential development of medial meniscal and subchondral cystic lesions within the medial femorotibial joint in horses (1996–2006)

UNLABELLED Summary Reasons for performing study: Medial meniscal injuries and subchondral cystic lesions (SCL) are known to occur independently within the medial femorotibial (MFT) joint in horses. However, there are no reports of a potential clinical relationship between these 2 types of lesions. OBJECTIVES To: 1) document the concurrent presence or sequential development of medial meniscal and SCL of the medial femoral condyle within the MFT joint; and 2) determine the prognosis with both types of lesions. METHODS Retrospective case series of horses with both a medial meniscal and SCL of the medial femoral condyle identified concurrently or sequentially by radiography, arthroscopy or post mortem examination. Case records and radiographs were reviewed, and a telephone survey of referring veterinarians, owners and trainers was conducted. RESULTS Twenty-one horses (9.1% of all horses undergoing MFT joint arthroscopy) were identified to have both a medial meniscal injury and SCL of the medial femoral condyle. Thirteen horses had both abnormalities identified concurrently, 6 developed a meniscal lesion subsequent to SCL debridement, and 2 developed a SCL subsequent to a medial meniscal injury. Only 4/19 horses were classified as successful and returned to their intended use. The severity of the meniscal injury was significantly associated with the severity of lameness but not with outcome. CONCLUSIONS A low percentage of horses may develop both a meniscal injury and SCL of the medial femoral condyle within the MFT joint and have a poor prognosis. POTENTIAL RELEVANCE Trauma to the MFT joint may lead to both meniscal and subchondral bone damage of the medial femoral condyle that may be recognised concurrently or sequentially.

Instrumentation and techniques for treating orthopedic infections in horses.

Orthopedic infections-those involving bones, joints, tendon sheaths, or bursae-are some of the most difficult problems for equine surgeons to treat successfully. Sources of the infection are usually hematogenous, traumatic, or iatrogenic and knowledge of the most likely causative bacteria is very useful in selecting the most appropriate antimicrobial(s) to either prevent or treat these infections in horses. This article discusses the clinical findings, diagnosis, treatment, and prevention of orthopedic infections in horses. More recent treatment methods such as synovial drainage techniques (arthroscopy and arthrotomy), intrasynovial antimicrobials, regional perfusion of antimicrobials, and antimicrobial-impregnated polymethylmethacrylate (PMMA) beads or cylinders are also addressed.

Instrument Sterilization, Skin Preparation, and Wound Management

Recent advances in instrument sterilization include the introduction of gas plasma sterilization and the increased use of glutaraldehyde. Gas plasma sterilization has the advantages of no toxic residue effects, reduced turnover time, and applicability for sterilization of heat- and moisture-sensitive instruments. Chlorhexidine gluconate (4%) appears to be a superior preoperative surgical scrub for both the surgeon and the patient because of its increased antimicrobial efficacy, residual activity, and minimal tissue reactions. There are many new wound dressings and topical medications for treatment of wounds, but the efficacy of most of these preparations has been evaluated only in humans, dogs, and cats. The ideal topical wound preparation and dressing for equine wounds, particularly wounds affecting the distal limb, have not yet been found.