Arthroscopy of the Dorsal and Plantar Pouches of the Tarsocrural Joint for the Treatment of Osteochondritis Dissecans in the Horse: Clinical Features and Follow‐Up

James, Oliver; Payne, Richard J.; Bathe, A. P.; Greet, T. R. C.; Wylie, C. E.

doi:10.1111/vsu.12560

Cited by 3 publications

(5 citation statements)

References 25 publications

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“…The initial management of this case reflects the standard approach to bacterial synovial sepsis with arthroscopic lavage, and systemic and local antimicrobials (Pille & Martens, 2009). It should be noted that OCD lesions are typically managed with arthroscopic debridement rather than intra‐articular corticosteroids (James et al, 2016). Within 6 days of the initial surgery, the causal organism had been identified as a Candida species which then underwent further typing.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and unsuccessful management of iatrogenic fungal septic arthritis caused byWickerhamomyces anomalous(formerlyCandida pelliculosa) and concurrent osteochondral lesion in Ireland

Duggan

Gibbons

Offereins³

et al. 2023

Equine Veterinary Education

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Summary Equine septic fungal arthritis is poorly documented in the literature. There is an absence of efficacy and safety data for antifungal medications, highlighting the importance of documenting this case. A 15‐year‐old Irish sport horse gelding presented 4/5 (AAEP) left hindlimb lame 13 days after intra‐articular medication of the left tarsocrural joint with triamcinolone and hyaluronic acid. Radiography revealed an osteochondral fragment at the distal intermediate ridge of the tibia and shallow subchondral bone defect on the medial trochlear ridge. Synoviocentesis yielded a turbid sample with an elevated total nucleated cell count (49 × 109cells/L; total neutrophil count of 62.8%). Arthroscopic lavage of the tarsocrural joint (TCJ) was performed. Ceftriaxone was administered and systemic antimicrobials initiated. The fungus Wickerhamomyces anomalus was identified on culture. The horse was subsequently intensively treated with antimicrobial and antifungal medications, both systemically and intra‐articularly over the following 60 plus days. Multiple subsequent synovial cultures revealed the persistence of the fungal organism, until a negative culture on day 55. However, on day 113, a grade 5/5 lameness was present, and a further positive synovial fungal culture. Radiographs revealed a lytic lesion at the distal tibia with marked progression. The horse was euthanised on day 126.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and unsuccessful management of iatrogenic fungal septic arthritis caused byWickerhamomyces anomalous(formerlyCandida pelliculosa) and concurrent osteochondral lesion in Ireland

Duggan

Gibbons

Offereins³

et al. 2023

Equine Veterinary Education

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“…Pathology is uncommonly found within the plantar pouches of the TCj, but arthroscopic evaluation may occasionally be indicated . The plantaromedial approach allowed a limited evaluation of the joint in cadavers tested in phase 1 of our study and was discarded during phase 2.…”

Section: Discussionmentioning

confidence: 99%

“…Pathology is uncommonly found within the plantar pouches of the TCj, but arthroscopic evaluation may occasionally be indicated. 19 The plantaromedial approach allowed a limited evaluation of the joint in cadavers tested in phase 1 of our study and was discarded during phase 2. The results obtained during phase 2 on the plantarolateral compartment were not what we had anticipated and refuted our hypothesis for this compartment.…”

Section: Discussionmentioning

confidence: 99%

“…Other benefits of needle arthroscopy are the portability of the system, direct joint visualization, excellent maneuverability in the standing patient, and the intrinsic minimal invasiveness of the technique when this small arthroscope is used . For these reasons, the commonly affected tarsocrural joint (TCj) may benefit from developing a standing arthroscopic procedure . Standing arthroscopy of this joint has been reported only anecdotally, and the description of the technique was limited to the dorsomedial aspect of the joint .…”

Section: Introductionmentioning

confidence: 99%

“…15,16 For these reasons, the commonly affected tarsocrural joint (TCj) may benefit from developing a standing arthroscopic procedure. 8,[19][20][21] Standing arthroscopy of this joint has been reported only anecdotally, and the description of the technique was limited to the dorsomedial aspect of the joint. 17,22 Complete standing evaluation of the dorsal and plantar joint recesses of the TCj has not been described.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic needle arthroscopy of the tarsocrural joint in standing sedated horses

Bonilla

2020

Veterinary Surgery

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Objective To develop and assess a needle arthroscopic technique to diagnose conditions of the tarsocrural joint (TCj) in standing sedated horses. Study design Experimental study. Sample population Six cadaveric hind limbs (phase 1) and six healthy horses (Phase 2). Methods In phase 1, each TCj was examined with a 1.2‐mm‐needle arthroscope. Suitability of the needle arthroscope and degree of joint visualization with traditional arthroscopic approaches were assessed. In phase 2, the feasibility of the procedure was assessed in six standing healthy horses. A custom‐made splint and base were developed to maintain joint flexion during the procedure. Results Thorough evaluation of the dorsal intra‐articular structures of the TCj via dorsomedial and dorsolateral approaches was possible in both phases. The procedure was feasible, quickly performed, and well tolerated by all horses. Complications consisted of moderate movement (2/6 horses) and hemarthrosis (3/6 horses). Conclusion Diagnostic standing needle arthroscopy of the TCj allowed thorough evaluation of the dorsal aspect of the joint while avoiding the cost and risks associated with general anesthesia. Inadvertent puncture of the dorsomedial vasculature with the cannula and obturator led to significant hemarthrosis. Clinical impact Needle arthroscopy of the TCj offers an alternative diagnostic tool when traditional imaging techniques (radiography and ultrasonography) are unrewarding or nondiagnostic. The technique is conceived mainly for diagnostic purposes, but its use during short interventions warrants investigation.

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Tarsus

Lischer¹,

Auer²

2019

Equine Surgery

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Arthroscopy of the Dorsal and Plantar Pouches of the Tarsocrural Joint for the Treatment of Osteochondritis Dissecans in the Horse: Clinical Features and Follow‐Up

Abstract: Routine plantar pouch investigation is warranted in cases of tarsocrural OCD to provide further information on the health of the joint and allows for removal of fragments from the plantar pouch that may not have been identified by routine diagnostic radiography.

Cited by 3 publications

References 25 publications

Diagnosis and unsuccessful management of iatrogenic fungal septic arthritis caused byWickerhamomyces anomalous(formerlyCandida pelliculosa) and concurrent osteochondral lesion in Ireland

Diagnosis and unsuccessful management of iatrogenic fungal septic arthritis caused byWickerhamomyces anomalous(formerlyCandida pelliculosa) and concurrent osteochondral lesion in Ireland

Diagnostic needle arthroscopy of the tarsocrural joint in standing sedated horses

Tarsus

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