Evaluation of cartilage injury in horses with osteochondral fragments in the metacarpo-/metatarsophalangeal joint: A study on 823 arthroscopies.
arthroscopic surgery
cartilage injury
fetlock joint
horse
osteochondral fragments
Journal
Equine veterinary journal
ISSN: 2042-3306
Titre abrégé: Equine Vet J
Pays: United States
ID NLM: 0173320
Informations de publication
Date de publication:
Jan 2024
Jan 2024
Historique:
received:
15
06
2022
accepted:
09
03
2023
medline:
7
12
2023
pubmed:
16
3
2023
entrez:
15
3
2023
Statut:
ppublish
Résumé
Osteochondral fragment removal is commonly performed but there are little scientific data supporting this procedure in the absence of clinical signs. More information is needed to facilitate clinical decision-making regarding fragment removal of the metacarpo-/metatarsophalangeal joint. To assess prevalence of cartilage injury in the equine metacarpo-/metatarsophalangeal joint and its association to fragment size, location, age and lameness. Retrospective observational study. Clinical records, including radiographs of 823 metacarpo-/metatarsophalangeal joints (640 horses) that underwent arthroscopic fragment removal, were reviewed. Fragment size, intra-articular fragment location and cartilage injury score were recorded. Presence of synovitis was retrospectively evaluated in 157 joints. Kruskal-Wallis and Mann-Whitney tests were used for group comparisons, and Dunn's post hoc test was applied for multiple comparisons. Linear regression analysis was used to assess strength of association between age and mean cartilage score. Univariable regression analysis was performed and variables with p < 0.2 were used in the final mixed-effects multivariable model to which backwards stepwise selection was applied. Significance level was p < 0.05. Cartilage injury was present in 28.8% (95% CI = 25.8-32.0) of joints. Lameness was not associated with fragment location or fragment size. Fragment size was not associated with cartilage injury. Age (OR = 1.35, 95% CI = 1.22-1.48, p < 0.001) and lameness (OR = 5.03, 95% CI = 2.27-11.68, p < 0.001) were associated with cartilage injury as well as fragment location (palmar/plantar, OR = 0.22, 95% CI = 0.13-0.38, p < 0.001), with dorsal fragments being more likely to be associated with cartilage lesions than palmar/plantar fragments. There was a significant association between age and mean cartilage score (b = 0.18, 95% CI = 0.14-0.22, p < 0.001). The series included a heterogenous group of horses of different breed, sex, age and use. Data were collected retrospectively and could, in parts, not be fully evaluated. Early fragment removal, especially in joints with dorsal fragmentation, can be beneficial to avoid future cartilage injuries in equine athletes. La extracción de fragmentos osteocondrales es realizada comúnmente, pero hay poca información científica que apoye este procedimiento en la ausencia de signos clínicos. Se necesita más información para facilitar la toma de decisiones clínica con respecto a la extracción de fragmentos de la articulación metacarpo−/metatarso falángica. Evaluar la prevalencia de lesiones cartilaginosas en la articulación metacarpo−/metatarso falángica en el equino y su asociación a tamaño de fragmento, su localización, edad y cojera. DISEÑO DE ESTUDIO: Estudio retrospectivo observacional. MÉTODOS: Se revisaron registros clínicos, incluyendo radiografías de 823 articulaciones metacarpo−/metatarso falángicas (640 caballos) que fueron intervenidas artroscopicamente y fragmentos que fueron extraídos. El tamaño, localización intraarticular de los fragmentos y score de lesión cartilaginosa fueron anotados. La presencia de sinovitis fue evaluada retrospectivamente en 157 articulaciones. Pruebas de Kruskal-Wallis y Mann-Whitney fueron usadas para comparación de grupos y prueba post hoc de Dunn, fueron usadas para comparaciones múltiples. Se utilizo análisis de regresión linear para evaluar la fuerza de asociación entre la edad y el score de lesiones cartilaginosas promedio. Se llevo a cabo un análisis de regresión univariable y las variables con p < 0.2 fueron usadas en el modelo final de efectos mixtos multivariable al cual se le aplico selección por pasos hacia atrás. Nivel significativo fue p < 0.05. Lesiones de cartílago estaban presentes en 28.8% (95% CI = 25.8-32.0) de las articulaciones. No se asoció cojera con ubicación o tamaño del fragmento. El tamaño del fragmento no se asoció con lesiones de cartílago. Edad (OR = 1.35, 95% CI = 1.22-1.48, p < 0.001) y cojera (OR = 5.03, 95% CI = 2.27-11.68, p < 0.001) fueron asociados con lesiones de cartílago tanto como con ubicación de fragmento (palmar/plantar, OR = 0.22, 95% CI = 0.13-0.38, p < 0.001), con los fragmentos dorsales siendo más probablemente asociados con lesiones de cartílago que los fragmentos palmares/plantares. Se encontró una asociación significativa entre edad y score promedio de cartílago. (b = 0.18, 95% CI = 0.14-0.22, p < 0.001). La serie incluyo un grupo heterogéneo de caballos de diferente razas, sexo, edad y uso. Los datos fueron recolectados retrospectivamente y podría ser, en parte, no totalmente evaluados. La extracción temprana de fragmentos, especialmente en articulaciones con fragmentación dorsal, puede ser beneficioso para evitar lesiones cartilaginosas futuras en atletas equinos.
Sections du résumé
BACKGROUND
BACKGROUND
Osteochondral fragment removal is commonly performed but there are little scientific data supporting this procedure in the absence of clinical signs. More information is needed to facilitate clinical decision-making regarding fragment removal of the metacarpo-/metatarsophalangeal joint.
OBJECTIVES
OBJECTIVE
To assess prevalence of cartilage injury in the equine metacarpo-/metatarsophalangeal joint and its association to fragment size, location, age and lameness.
STUDY DESIGN
METHODS
Retrospective observational study.
METHODS
METHODS
Clinical records, including radiographs of 823 metacarpo-/metatarsophalangeal joints (640 horses) that underwent arthroscopic fragment removal, were reviewed. Fragment size, intra-articular fragment location and cartilage injury score were recorded. Presence of synovitis was retrospectively evaluated in 157 joints. Kruskal-Wallis and Mann-Whitney tests were used for group comparisons, and Dunn's post hoc test was applied for multiple comparisons. Linear regression analysis was used to assess strength of association between age and mean cartilage score. Univariable regression analysis was performed and variables with p < 0.2 were used in the final mixed-effects multivariable model to which backwards stepwise selection was applied. Significance level was p < 0.05.
RESULTS
RESULTS
Cartilage injury was present in 28.8% (95% CI = 25.8-32.0) of joints. Lameness was not associated with fragment location or fragment size. Fragment size was not associated with cartilage injury. Age (OR = 1.35, 95% CI = 1.22-1.48, p < 0.001) and lameness (OR = 5.03, 95% CI = 2.27-11.68, p < 0.001) were associated with cartilage injury as well as fragment location (palmar/plantar, OR = 0.22, 95% CI = 0.13-0.38, p < 0.001), with dorsal fragments being more likely to be associated with cartilage lesions than palmar/plantar fragments. There was a significant association between age and mean cartilage score (b = 0.18, 95% CI = 0.14-0.22, p < 0.001).
MAIN LIMITATIONS
CONCLUSIONS
The series included a heterogenous group of horses of different breed, sex, age and use. Data were collected retrospectively and could, in parts, not be fully evaluated.
CONCLUSIONS
CONCLUSIONS
Early fragment removal, especially in joints with dorsal fragmentation, can be beneficial to avoid future cartilage injuries in equine athletes.
HISTORIAL
UNASSIGNED
La extracción de fragmentos osteocondrales es realizada comúnmente, pero hay poca información científica que apoye este procedimiento en la ausencia de signos clínicos. Se necesita más información para facilitar la toma de decisiones clínica con respecto a la extracción de fragmentos de la articulación metacarpo−/metatarso falángica.
OBJETIVOS
OBJECTIVE
Evaluar la prevalencia de lesiones cartilaginosas en la articulación metacarpo−/metatarso falángica en el equino y su asociación a tamaño de fragmento, su localización, edad y cojera. DISEÑO DE ESTUDIO: Estudio retrospectivo observacional. MÉTODOS: Se revisaron registros clínicos, incluyendo radiografías de 823 articulaciones metacarpo−/metatarso falángicas (640 caballos) que fueron intervenidas artroscopicamente y fragmentos que fueron extraídos. El tamaño, localización intraarticular de los fragmentos y score de lesión cartilaginosa fueron anotados. La presencia de sinovitis fue evaluada retrospectivamente en 157 articulaciones. Pruebas de Kruskal-Wallis y Mann-Whitney fueron usadas para comparación de grupos y prueba post hoc de Dunn, fueron usadas para comparaciones múltiples. Se utilizo análisis de regresión linear para evaluar la fuerza de asociación entre la edad y el score de lesiones cartilaginosas promedio. Se llevo a cabo un análisis de regresión univariable y las variables con p < 0.2 fueron usadas en el modelo final de efectos mixtos multivariable al cual se le aplico selección por pasos hacia atrás. Nivel significativo fue p < 0.05.
RESULTADOS
RESULTS
Lesiones de cartílago estaban presentes en 28.8% (95% CI = 25.8-32.0) de las articulaciones. No se asoció cojera con ubicación o tamaño del fragmento. El tamaño del fragmento no se asoció con lesiones de cartílago. Edad (OR = 1.35, 95% CI = 1.22-1.48, p < 0.001) y cojera (OR = 5.03, 95% CI = 2.27-11.68, p < 0.001) fueron asociados con lesiones de cartílago tanto como con ubicación de fragmento (palmar/plantar, OR = 0.22, 95% CI = 0.13-0.38, p < 0.001), con los fragmentos dorsales siendo más probablemente asociados con lesiones de cartílago que los fragmentos palmares/plantares. Se encontró una asociación significativa entre edad y score promedio de cartílago. (b = 0.18, 95% CI = 0.14-0.22, p < 0.001).
LIMITACIONES PRINCIPALES
UNASSIGNED
La serie incluyo un grupo heterogéneo de caballos de diferente razas, sexo, edad y uso. Los datos fueron recolectados retrospectivamente y podría ser, en parte, no totalmente evaluados.
CONCLUSIONES
CONCLUSIONS
La extracción temprana de fragmentos, especialmente en articulaciones con fragmentación dorsal, puede ser beneficioso para evitar lesiones cartilaginosas futuras en atletas equinos.
Autres résumés
Type: Publisher
(spa)
La extracción de fragmentos osteocondrales es realizada comúnmente, pero hay poca información científica que apoye este procedimiento en la ausencia de signos clínicos. Se necesita más información para facilitar la toma de decisiones clínica con respecto a la extracción de fragmentos de la articulación metacarpo−/metatarso falángica.
Types de publication
Observational Study, Veterinary
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
89-98Informations de copyright
© 2023 EVJ Ltd.
Références
Grondahl AM. The incidence of bony fragments and Osteochondrosls in the Metacarpo- and metatarsophalangeal joints of standardbred trotters a radiographic study. J Equine Vet. 1992;12:81-5.
Lykkjen S, Roed KH, Dolvik NI. Osteochondrosis and osteochondral fragments in standardbred trotters: prevalence and relationships. Equine Vet J. 2012;44:332-8.
Verwilghen DR, Janssens S, Busoni V, Pille F, Johnston C, Serteyn D. Do developmental orthopaedic disorders influence future jumping performances in warmblood stallions? Impact of DOD on performance. Equine Vet J. 2013;45:578-81.
Hoogmoed LM, Snyder JR, Thomas HL, Harmon FA. Retrospective evaluation of equine prepurchase examinations performed 1991-2000. Equine Vet J. 2010;35:375-81.
McIlwraith CW, Nixon AJ, Wright IM. Diagnostic and surgical arthroscopy of the metacarpophalangeal and metatarsophalangeal joints. Diagnostic and surgical arthroscopy in the horse. Fourth ed. Philadelphia: Elsevier; 2015. p. 111-74.
Yovich JV, McIlwraith CW, Stashak TS. Osteochondritis dissecans of the sagittal ridge of the third metacarpal and metatarsal bones in horses. J Am Vet Med Assoc. 1985;186:1186-91.
McIlwraith CW, Vorhees M. Management of osteochondritis dissecans of the dorsal aspect of the distal metacarpus and metatarsus. Proc Annu Conv Am. Assoc Equine Pract. 1990;25:547-50.
Wright IM, Minshall GJ. Identification and treatment of osteochondritis dissecans of the distal sagittal ridge of the third metacarpal bone. Equine Vet J. 2014;46:585-8.
Beeman GM, McIlwraith CW. Summary of panel findings. In: McIlwraith CW, editor. AQHA developmental orthopedic disease symposium. Amarillo, American Quarter Horse Association: TX; 1986. p. 55-63.
McIlwraith CW. Arthroscopic surgery for osteochondral chip fragments and other lesions not requiring internal fixation in the carpal and fetlock joints of the equine athlete: what have we learned in 20 years? Clin Techniq Equine Prac. 2002;1:200-10.
Krook L, Maylin GA. Fractures in Thorougbred racebred racehorses. The Cornell Veterinarian Supplement. 1988;11:5-47.
Foerner JJ, Barclay WP, Phillips TN, MacHarg MA. Osteochondral fragments of the palmar and plantar aspects of the fetlock joint. Proc Annu Conv Am. Assoc Equine Pract. 1987;33:739-44.
Dalin G, Sandgren B, Carlsten J. Plantar osteochondral fragments in the metatarsophalangeal joints in standardbred trotters; result of osteochondrosis or trauma? Equine Vet J. 1993;25:62-5.
Pettersson H, Rydén G. Avulsion fractures of the caudoproximal extremity of the first phalanx. Equine Vet J. 1982;14:333-5.
Birkeland R. Chip fractures of the first phalanx in the metatarsophalangeal joint of the horse. Acta Radiol Suppl. 1972;319:73-7.
Nixon AJ. Osteochondrosis and osteochondritis dissecans of the equine fetlock. Compend Contin Educ Pract Vet. 1990;12:1463-74.
Sönnichsen HV, Kristoffersen J, Falk-Rønne J. Joint mice in the fetlock joint- osteochondritis dissecans. Nord Vet Med. 1982;34:399-403.
Houttu J. Arthroscopic removal of osteochondral fragments of the palmar/plantar aspect of the metacarpo/metatarsophalangeal joints. Equine Vet J. 1991;23:163-5.
Grondahl AM. Incidence and development of ununited Proximoplantar tuberosity of the proximal phalanx in standardbred trotters. Vet Radiol Ultrasound. 1992;33:18-21.
Declercq J, Hauspie S, Saunders J, Martens A. Osteochondral fragments in the metacarpo- and metatarsophalangeal joint and their clinical importance. Vlaams Diergeneeskundig Tijdschrift. 2011;80:271-80.
Frisbie DD. Surgical treatment of joint disease. In: Auer JA, Stick JA, editors. Equine Surgery. Fourth ed. Missouri: Elsevier, St. Louis; 2012. p. 1123-9.
Kawcak CE, Barrett MF. Fetlock. In: McIlwraith CW, Frisbie DD, Kawcak CE, van Weeren R, editors. Joint disease in the horse. 2nd ed. Missouri: Elsevier, St. Louis; 2016. p. 302-17.
Declercq J, Martens A, Maes D, Boussauw B, Forsyth R, Boening KJ. Dorsoproximal proximal phalanx osteochondral fragmentation in 117 warmblood horses. Vet Comp Orthop Traumatol. 2009;22:1-6.
Nixon AJ. Phalanges and the metacarpophalangeal and metatarsophalangeal joints. In: Auer JA, Stick JA, editors. Equine Surgery. 4th ed. Missouri: Elsevier, St. Louis; 2012. p. 1300-24.
Carmalt JL, Borg H, Näslund H, Waldner C. Racing performance in standardbred trotting horses with proximal palmar/plantar first phalangeal fragments relative to the timing of surgery: proximal palmar/plantar first phalangeal fragments. Equine Vet J. 2015;47:433-7.
Jørgensen HS, Proschowsky H, Falk-Rønne J, Willeberg R, Hesselholt M. The significance of routine radiographic findings with respect to subsequent racing performance and longevity in standardbred trotters. Equine Vet J. 1997;29:55-9.
Colón JL, Bramlage LR, Hance SR, Embertson RM. Qualitative and quantitative documentation of the racing performance of 461 thoroughbred racehorses after arthroscopic removal of dorsoproximal first phalanx osteochondral fractures (1986-1995). Equine Vet J. 2000;32:475-81.
Committee AHS. Guide to veterinary services for horse shows. 7th ed. Lexington: American Association of Equine Practitioners. 1999.
Outerbridge RE. The etiology of chondromalacia patellae. J Joint Bone Surg Br. 1961;43:752-7.
Brittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Joint Bone Surg Am. 2003;85-A Suppl 2:58-69.
Brown LD, Cai TT, DasGupta A. Interval estimation for a binomial proportion. Statis Sci. 2001;16:101-33.
Buckwalter JA. Articular Cartilage Injuries. Clin Orthop Relat Res. 2002;402:21-37.
McIlwraith CW. Traumatic arthritis and posttraumatic osteoarthritis in the horse. In: McIlwraith CW, Frisbie DD, Kawcak CE, van Weeren PR, editors. Joint disease in the horse. 2nd ed. Missouri: Elsevier, St. Louis; 2016. p. 33-47.
Ortved KF, Nixon AJ. Cell-based cartilage repair strategies in the horse. Veterinary J. 2016;208:1-12.
Jackson DW, Lalor PA, Aberman HM, Simon TM. Spontaneous repair of full-thickness defects of articular cartilage in a goat model. A preliminary study. J Joint Bone Surg Am. 2001;83:53-64.
Brommer H, Weeren PR, Brama PAJ, Barneveld A. Quantification and age-related distribution of articular cartilage degeneration in the equine fetlock joint. Equine Vet J. 2003;35:697-701.
van Weeren PR. General anatomy and physiology of joints. In: McIlwraith CW, Frisbie DD, Kawcak CE, van Weeren PR, editors. Joint disease in the horse. 2nd ed. Missouri: Elsevier, St. Louis; 2016. p. 1-24.
Kawcak CE, Mcilwraith CW. Proximodorsal first phalanx osteochondral chip fragmentation in 336 horses. Equine Vet J. 1994;26:392-6.
Whitton R, Kannegieter N. Osteochondral fragmentation of the plantar/palmar proximal aspect of the proximal phalanx in racing horses. Aust Vet J. 1994;71:318-21.
Brama PAJ, Tekoppele JM, Bank RA, Karssenberg D, Barneveld A, van Weeren PR. Topographical mapping of biochemical properties of articular cartilage in the equine fetlock joint. Equine Vet J. 2000;32:19-26.
Evans CH, Mears DC, Cosgrove JL. Release of neutral proteinases from mononuclear phagocytes and synovial cells in response to cartilaginous wear particles in vitro. Biochim Biophys Acta. 1981;677:287-94.
Boniface RJ, Cain PR, Evans CH. Articular responses to purified cartilage proteoglycans. Arthritis Rheum. 1988;31:258-66.
McIlwraith CW. Joint injuries and disease and osteoarthritis. In: Baxter GM, editor. Adam and Stashak's lameness in horses. 6th ed. Chichester, West Sussex: Wiley-Blackwell; 2011. p. 871-89.
Lacourt M. Relationship between cartilage and subchondral bone lesions in repetitive impact trauma-induced equine osteoarthritis. Osteoarthr Cartil. 2012;20:572-83.
McCoy AM, Secor EJ, Roady PJ, Gray SM, Klein J, Gutierrez-Nibeyro SD. Plantar osteochondral fragments in young standardbreds are associated with minimal joint inflammation at the time of surgical removal. Equine Vet J. 2023;55(1):33-41. https://doi.org/10.1111/evj.13575
McIlwraith CW. Surgical versus conservative management of osteochondrosis. Vet J. 2013;197:19-28.
Yovich JV, McIlwraith CW. Arthroscopic surgery for osteochondral fractures of the proximal phalax of the metacarpophalangeal and metatarsophalangeal (fetlock) joints in horses. J Am Vet Med Assoc. 1986;188:273-9.
Boyce MK, Trumble TN, Carlson CS, Groschen DM, Merritt KA, Brown MP. Non-terminal animal model of post-traumatic osteoarthritis induced by acute joint injury. Osteoarthr Cartil. 2013;21:746-55.