Concurrent or sequential tibial subchondral cystic lesions in 4 horses with medial femoral condyle subchondral cystic lesions

Journal
Bonilla AG, Bertone AL, Brokken MT, Santschi EM. J Am Vet Med Assoc. 2016 Dec 1; 249 (11): 1313-1318.

Source
http://avmajournals.avma.org/doi/abs/10.2460/javma.249.11.1313

CASE DESCRIPTION: 4 horses were examined because of signs of chronic hind limb lameness.

CLINICAL FINDINGS: 3 horses had a history of lameness for > 6 months; specific duration was unknown for 1 horse. On initial evaluation, grade 3 to 4 (on a scale from 1 to 5) hind limb lameness was present in all 4 horses. Radiography of the stifle joint of the affected limb revealed medial femoral condyle subchondral lucencies or subchondral cystic lesions (SCLs) in all 4 horses, medial femorotibial osteoarthritis in 3 horses, and medial tibial condyle SCLs in 3 horses.

TREATMENT AND OUTCOME: 2 horses were treated medically (stall rest and oral NSAID administration), and 2 horses were treated surgically by means of medial femoral transcondylar lag screw placement through the medial femoral condyle SCLs. The 2 horses treated medically did not improve and were euthanized. Necropsy confirmed the presence of medial femoral condyle and medial tibial condyle SCLs. Surgical treatment did not resolve the lameness in 1 horse with SCLs in the medial tibial condyle and medial femoral condyle, and euthanasia was performed 150 days after surgery. In the second horse, a medial tibial condyle SCL was evident on radiographs obtained 3 months after surgery; however, this was not addressed surgically, and signs of lameness resolved 11 months after surgery.

CLINICAL RELEVANCE: Results of this small case series suggested that SCLs in the medial tibial condyle can occur in association with SCLs of the medial femoral condyle, with a poor prognosis for return to athletic function in affected horses. Further investigation is indicated.

Equine
Bone
Epidemiology
Lameness

Related Article

The relationship between sagittal hoof conformation and hindlimb lameness in the horse
Corrective farriery to improve PADP may be investigated further as one component in the treatment of hindlimb lameness localised to regions proximal to the foot.
Use of a locking compression plate for equine proximal interphalangeal joint arthrodesis: 29 cases (2008–2014)
Surgical arthrodesis of the PIPJ was successful in most horses of the study population. Various nuances of the system for fracture repair need to be understood prior to its use.
In vitro comparison of linear vs triangular screw configuration to stabilize complete uniarticular parasagittal fractures of the proximal phalanx in horses
Triangular lag screw repair likely improves biomechanical conditions during postoperative weight bearing.
Use of an aiming device and computed tomography for assisted debridement of subchondral cystic lesions in the limbs of horses
CT-guided surgical debridement of SCL of the equine digit appears to result in a favorable outcome.
SNP-based heritability and genetic architecture of tarsal osteochondrosis in North American Standardbred horses
Future identification of the genes/variants that have the most impact on disease risk may allow early recognition of high-risk individuals.
Comparison of Metzenbaum scissors and Y-shaped fasciotome for deep metatarsal fasciotomy for the treatment of proximal suspensory ligament desmopathy in horses
A Y-shaped fasciotome may be the preferred surgical instrument for successful desmopathy of the PSL fasciotomy.