Equine non‐septic tenosynovitis: A systematic literature review of site‐specific pathological lesions, outcomes and surgical complications

Abstract

BackgroundNon‐septic tenosynovitis is a clinically relevant and often performance limiting musculoskeletal injury in the horse.ObjectivesTo review the published literature to determine which tendon sheaths are commonly affected by non‐septic tenosynovitis and to describe the most frequently reported pathological lesions, outcomes, and surgical complications in equine non‐septic tenosynovitis.Study designSystematic review.MethodsLiterature searches were conducted in July 2021 from the online search engines PubMed, Scopus, Web of Science Core, VetMed Resource and ProQuest Theses & Dissertations. The inclusion criteria followed a participants, interventions, comparisons, outcome and study design (PICOS) approach. For inclusion, studies had to include live equids with non‐septic tenosynovitis of any tendon sheath. Studies were excluded if they only described non‐equine species, if they included data only on non‐tendon sheath structures, or if they included data exclusively on cases of septic or contaminated tendon sheaths. Determination of non‐sepsis relied on the diagnosis of the original authors; however, if non‐sepsis was not explicitly specified, then cases that had a history of contamination of the sheath, a wound near the sheath or a positive bacterial culture were excluded from analysis. Data analysed included the distribution of structures affected by non‐septic tenosynovitis, the most common pathological lesions identified within each sheath, and the most frequently reported surgical complications of non‐septic tenosynovitis. The quality of each study was assessed using a methodological quality analysis.ResultsA total of 85 studies describing non‐septic tenosynovitis in the horse were included. Across all 85 studies, there were a total of 2449 tendon sheaths in 2101 horses reported to be affected by non‐septic tenosynovitis. The digital flexor sheath was the most reported structure to be diagnosed with non‐septic tenosynovitis: 41/85 (48%) studies examined the digital flexor sheath exclusively, followed by the carpal flexor sheath, tarsal flexor sheath, carpal extensor sheaths, tarsal extensor sheaths, and one case of biceps brachii non‐septic tenosynovitis. For most tendon sheaths, the most common pathological lesion was an intrathecal tear of a soft tissue structure, including tears of the deep digital flexor tendon and tears of the manica flexoria. Bilateral disease was most common in the carpal flexor sheath, where distal radial physeal exostoses were the most common pathological lesions. Less common causes of non‐septic tenosynovitis included neoplasia, fracture of a bone adjacent to a tendon sheath, and mineralisation of an intrathecal tendon. The likelihood of return to previous level of athletic function following non‐septic tenosynovitis of most structures was approximately 50%, and the most common complication was persistent effusion following tenoscopy. While iatrogenic infection following surgery was uncommon, it was most likely following tenoscopy of the digital flexor sheath.ConclusionNon‐septic tenosynovitis is commonly reported in equine athletes, with intra‐thecal tears of the deep digital flexor tendon, superficial digital flexor tendon and manica flexoria frequently reported. Directions for future research include more thorough assessment of and reporting of complications following non‐septic tenosynovitis and correlation of characteristics of intrathecal pathological lesions with clinical outcomes.