Centrodistal Joint Research Articles

Ultrasound-assisted injection of the centrodistal joint in the horse.

Injection of the centrodistal (CD) joint in the horse is a commonly performed procedure for both diagnostic and therapeutic purposes. This procedure can be technically challenging, and while radiographic guidance has been previously used, ultrasound localised injection of the CD joint has not been described. The purpose of this study was to explore the feasibility of using ultrasound localisation to increase the accuracy of CD joint injection. Experimental method assessment. One operator performed the ultrasound and injection of 24 CD joints in 12 sedated horses. The joints were injected with iohexol (2ml), sterile saline (1.5ml) and amikacin (0.5ml). Dorsoplantar and dorsomedial plantarolateral radiographic projections were obtained immediately after injection to evaluate the presence of contrast material in the CD joint. The CD joint was successfully injected in 17/24 joints, representing a 70.8% accuracy. The horses used in this study were from the University research herd, and not clinical cases. One investigator performed all the ultrasonography and CD joint injections. The use of ultrasound localisation could improve success of CD joint injection as well as improve the learning curve of less experienced practitioners learning this procedure.

Comparing the clinical success rate of the dorsolateral approach to the medial approach for injection of the centrodistal joint in the horse.

Centrodistal joint injection is an important component of lameness evaluation and treatment. Successful injection is poor for the medial approach. The dorsolateral approach is an alternative but has not been validated with contrast medium. Radiograph-guidance has not been studied to determine its necessity or benefit for either approach. To determine if the dorsolateral approach to the centrodistal joint is more successful than the medial approach. To determine if radiograph-guidance is beneficial. Prospective, randomised study. Three operators injected 98 centrodistal joints in total, each horse served as its own control. In Phase 1, injections were performed by standard technique. In the Phase 2, operators were allowed to use radiography to assist needle placement. Contrast deposition was evaluated by a single radiologist. Without radiographic assistance, 10/25 (40%) joints were successfully injected using either the medial or dorsolateral approach. With radiographic assistance, 19/24 (79%) joints were successfully injected using the medial approach, 11/24 (46%) joints were successfully injected using the dorsolateral approach. The population consisted of aged horses representing a variety of breeds with existing osteoarthritis, and multiple operators were recruited. The dorsolateral approach was equivalent to the medial approach when traditional injection techniques were used. Radiograph-guidance improved success of the medial approach, but not the dorsolateral approach. Many injections performed from the dorsolateral approach (32/49; 65%) resulted in extensive perivascular subcutaneous contrast deposition after infiltration into the tarsal canal. Further research is needed to improve injection success of the centrodistal joint when using the dorsolateral approach.

The centrodistal joint interosseous ligament region in the tarsus of the horse: Normal appearance, abnormalities and possible association with other tarsal lesions, including osteoarthritis.

There have been no detailed descriptions of the radiological appearance of the centrodistal joint interosseous ligament region in horses with and without distal tarsal joint pain. To describe the normal radiological appearance of the centrodistal joint interosseous ligament region; to determine the prevalence of mineralisation or ossification of the interosseous ligament; and to describe radiological abnormalities surrounding the interosseous space and concurrent radiological abnormalities in the tarsus. The association between interosseous ligament region abnormalities and radiological evidence of osteoarthritis of the centrodistal joint was assessed. Retrospective study. Case records and radiographs of all horses/ponies (n=700) that underwent radiographic examination of one/both tarsi over 7years were reviewed. Case history, height, bodyweight and cause(s) of lameness were recorded. Factors associated with abnormalities of the centrodistal interosseous ligament region were assessed using logistic regression analysis. The normal interosseous space was an oval or circular-shaped radiolucent area bordered proximally and distally by a rim of bone of uniform opacity and thickness, which varied in thickness among animals. Abnormalities of the interosseous ligament region of the lame(r) limb were evident in 121/700 (17.3%; 95% confidence interval 14.5-20.1%) animals. Increasing bodyweight was associated with decreased odds of interosseous ligament region abnormalities. Forty-seven animals (6.7%; 95% confidence interval 4.9-8.6%) had radiological evidence of osteoarthritis of the centrodistal joint. A greater proportion of animals with interosseous ligament region abnormalities (36.4%) had radiological evidence of osteoarthritis of the centrodistal joint, compared to those with normal interosseous ligament regions (0.5%; P<0.001). Interosseous ligament region abnormalities and osteoarthritis of the centrodistal joint were not necessarily associated with distal tarsal joint pain. There is an association between abnormalities of the centrodistal joint interosseous ligament region and osteoarthritis. Radiological evidence of abnormalities of the centrodistal intertarsal ligament region alone or in association with osteoarthritis may be present asymptomatically.

Detection of early osteoarthritis in the centrodistal joints of Icelandic horses: Evaluation of radiography and low-field magnetic resonance imaging.

Validated noninvasive detection methods for early osteoarthritis (OA) are required for OA prevention and early intervention treatment strategies. To evaluate radiography and low-field magnetic resonance imaging (MRI) for the detection of early stage OA osteochondral lesions in equine centrodistal joints using microscopy as the reference standard. Prospective imaging of live horses and imaging and microscopy of cadaver tarsal joints. Centrodistal (distal intertarsal) joints of 38 Icelandic research horses aged 27-29 months were radiographed. Horses were subjected to euthanasia approximately 2 months later and cadaver joints examined with low-field MRI. Osteochondral joint specimens were classified as negative or positive for OA using light microscopy histology or scanning electron microscopy. Radiographs and MRIs were evaluated for osteochondral lesions and results compared with microscopy. Forty-two joints were classified OA positive with microscopy. Associations were detected between microscopic OA and the radiography lesion categories; mineralisation front defect (P<0.0001), joint margin lesion (P<0.0001), central osteophyte (P = 0.03) and the low-field MRI lesion categories; mineralisation front defect (P = 0.01), joint margin lesion (P = 0.02) and articular cartilage lesion (P = 0.0003). The most frequent lesion category detected in microscopic OA positive joints was the mineralisation front defect in radiographs (28/42 OA positive joints, specificity 97%, sensitivity 67%). No significant differences were detected between the sensitivity and specificity of radiography and low-field MRI pooled lesion categories, but radiography was often superior when individual lesion categories were compared. Early stage centrodistal joint OA changes may be detected with radiography and low-field MRI. Detection of mineralisation front defects in radiographs may be a useful screening method for detection of early OA in centrodistal joints of young Icelandic horses.

Mineralisation or Ossification of the Interosseous Ligament of the Centrodistal Joint of the Horse: Is There an Association with Osteoarthritis?

Reasons for performing studyThere have been no detailed descriptions of the radiological appearance of the centrodistal joint interosseous ligament in horses with and without distal hock joint pain.Objectives1) To describe the normal radiological appearance of the region of the centrodistal joint interosseous ligament; 2) to determine the frequency of occurrence of mineralisation or ossification of the interosseous ligament and to describe radiological abnormalities surrounding the interosseous space; 3) to describe concurrent radiological abnormalities in the tarsus. It was hypothesised that ossification of the interosseous ligament will be associated with radiological evidence of osteoarthritis of the centrodistal joint.Study designSystematic radiological analysis using a predefined grading system, after a repeatability study, and descriptive statistics.MethodsCase records and radiographs of all horses which underwent radiographic examination of one or both tarsi over 7 years were reviewed.ResultsThere were 700 horses, including 470 examined bilaterally. The normal interosseous space was an oval‐shaped radiolucent area surrounded by subchondral bone of uniform opacity and thickness. Changes in the region of the interosseous ligament of the centrodistal joint were evident in 190/1170 (16.2%) tarsi, including 50 horses examined bilaterally. In 33/190 (17.4%) tarsi there was complete loss of the oval‐shaped radiolucent area, together with increased thickness of the adjacent subchondral bone, endosteal irregularity and increased opacity of the adjacent trabecular bone. In addition 157/190 tarsi had patchy increased opacity within the interosseous space and alterations of the adjacent subchondral and trabecular bone. There was radiological evidence of osteoarthritis of the centrodistal joint in 27/33 (81.8%) of tarsi with complete ossification of the centrodistal interosseous ligament, 17 of which (51.5%) had distal tarsal pain, and in 29/157 (18.5%) tarsi with other abnormalities of the centrodistal interosseous ligament.ConclusionsWhen evaluating the tarsus radiologically the region of the centrodistal joint interosseous ligament should be assessed.Ethical animal research: The study was approved by the Ethical Review Committee of the Animal Health Trust and there was informed owner consent. Sources of funding: None. Competing interests: None.

Evaluation of osteochondral sample collection guided by computed tomography and magnetic resonance imaging for early detection of osteoarthritis in centrodistal joints of young Icelandic horses

To evaluate the use of CT and MRI for guidance of osteochondral sample collection for histologic detection of early osteoarthritic lesions in centrodistal (distal intertarsal) joints of horses. Right tarsal joints from the cadavers of 24 Icelandic horses aged 29 to 31 months. CT and MRI were used to evaluate the extent of suspected osteoarthritic changes in centrodistal joints, which were graded with a semiquantitative system. The anatomic regions with the highest grade of change were identified, and osteochondral samples were obtained from these regions. Samples were also obtained from the same centrodistal joints at predetermined sites. Histologic examination of all samples was performed, with samples classified as negative or positive for osteoarthritis, and results were compared between sample collection methods. Histologic examination revealed osteoarthritic lesions in 29% (7/24) of centrodistal joints with the predetermined method and in 63% (15/24) with the image-guided method. Significant associations were identified between histologic osteoarthritis detection and the summed image-guided sample collection site image grades, central osteophytes, articular cartilage thickness abnormalities, grade 2 articular mineralization front defects, and grade 2 marginal osteophytes. CT and MRI aided the detection of focal changes suggestive of early-stage osteoarthritis in the centrodistal joints of equine cadavers and may be useful for detection of similar disease in live horses. The first morphological changes of centrodistal joint osteoarthritis were suspected to be in the articular cartilage and the articular mineralization front regions.

Use of ethanol in the treatment of distal tarsal joint osteoarthritis: 24 cases

REASONS FOR PERFORMING THIS STUDY: Intra-articular ethanol has been described to promote distal tarsal joint ankylosis. Its use and results in clinical cases affected by osteoarthritis (OA) have not been reported. To describe and evaluate the results of treatment of distal tarsal joint OA by facilitated ankylosis stimulated by intra-articular ethanol injection. Twenty-four horses met the inclusion criteria of tarsometatarsal and centrodistal joint OA diagnosed by a positive response to intra-articular analgesia, radiographic evaluation and recurrence of lameness ≤ 4 months after intra-articular medication with a corticosteroid. Horses were sedated and, following a radiographic contrast study of the tarsometatarsal joint, medication with 2-4 ml of either 100% pure ethanol (G100) or a 70% ethanol (G70) solution was applied. Horses were classified as improved based on a 50% reduction from initial lameness grade combined with an increase in exercise level. Of the 24 horses included in this study, 20 had the treatment performed bilaterally and 4 unilaterally. All horses were available for initial follow-up examination and 21 for a second one 6-9 months after treatment. This represented a total of 44 treated limbs and 35 available for long-term follow-up. Of these, 21/35 (60%) were considered improved, which corresponds to 11/21 horses (52%). Of 21 horses, 4 (19%) deteriorated and 2 of these developed significant complications related to treatment. Distal tarsal joint ankylosis with ethanol should be considered a safe and economic treatment in cases of distal tarsal joint OA that fail to show long-term improvement with intra-articular corticosteroid treatment. Ethanol should be considered in the treatment of certain cases of distal tarsal joint OA. The importance of performing an adequate radiographic contrast study of the tarsometatarsal joint prior to treatment is highlighted.

Histopathologic features of distal tarsal joint cartilage and subchondral bone in ridden and pasture-exercised horses

To determine whether histopathologic characteristics of the osteochondral units of equine distal tarsal joints were associated with exercise history in horses without lameness. 30 cadaver tarsi from horses without lameness and with known exercise history were separated into 3 groups: nonridden, pasture exercise (group P); low-intensity, ridden exercise (group L); and high-intensity, elite competition exercise (group E). Standardized sites from the centrodistal and tarsometatarsal joints under went histologic preparation. A grading system was adapted to describe location, depth, and shape of lesions; cellular arrangement; organization at cartilage and subchondral bone (SCB) junctions; and organization of SCB. A high score signified a more severe pathological change than a low score. Exercise groups were compared by calculation of Spearman rank correlations. In the centrodistal joint, lesions were present in groups L and E but only medially. Cellular arrangement scores were higher at the dorsomedial location in group P than in groups L and E. Groups L and E had higher scores than group P for the organization of the cartilage, SCB junctions, and SCB, with higher scores at the dorsomedial location. In the tarsometatarsal joint, lesions were evident across the whole joint surface, with more severe lesions located laterally in all 3 groups. Overall, group E had higher scores for cellular arrangement and SCB organization than groups P and L. Ridden exercise may increase the risk of osteochondral lesions at distal tarsal sites predisposed to osteoarthritis relative to the risk with nonridden exercise.

Third tarsal bone fractures in the greyhound

To describe the signalment, morphology, response to treatment and prognosis of third tarsal bone fractures in the racing greyhound. All third tarsal bone fractures seen by the author over a ten year period were included in the study. Diagnosis was by radiography. Treatments were reconstruction with a lag screw, fragment removal, centrodistal joint arthrodesis or conservative management. Twenty-three cases were included in the study of which 16 cases were recent and seven cases chronic fractures. The chronic cases had been rested from between three and six months before an examination for recurrent lameness. There were five concomitant second tarsal bone fractures. Partial dorsal collapse was present in four cases. Thirteen dogs had lag screw fixation; three were lost to follow-up, seven returned to racing and three, all with partial tarsal collapse, failed to return to racing. Two dogs that had a centrodistal joint arthrodesis and one dog treated by rest alone raced again. Two dogs that had fragment removal failed to return to racing. Veterinary examination of greyhounds with third tarsal bone fractures is often not sought at the time of the initial injury due to the benign presenting signs. Recurrence of lameness after rest is common. The prognosis for a successful return to racing would appear to be good following fragment fixation in both acute and chronic cases without dorsal tarsal collapse. Centrodistal joint arthrodesis may encourage bone union. The prognosis for conconservatively treated cases is guarded. Fragment removal is not recommended as a treatment.

Clinical significance of osseous spurs on the dorsoproximal aspect of the third metatarsal bone

Osseous spurs on the dorsoproximal aspect of the third metatarsal bone (MtIII) are common, but their clinical significance is unknown. To verify the sites of insertion of the dorsal metatarsal ligament and the tendons of tibialis cranialis and fibularis tertius in order to determine if periarticular osteophytes and entheseophytes could be differentiated radiologically; and to determine the frequency of occurrence of osseous spurs on the dorsoproximal aspect of MtIII. The frequency of osseous spurs on the dorsoproximal aspect of MtIII would be higher in lame than in clinically normal horses and higher in horses with distal hock joint pain or proximal suspensory desmitis than in horses with other causes of hindlimb lameness. A retrospective study of data from the clinical work up and tarsal radiographs of 455 horses was performed. Horses were divided into: Group 1, clinically normal horses; Groups 2-5, according to the diagnosis of hindlimb lameness. Radiographs were examined for the presence of an osseous spur on the dorsoproximal aspect of MtIII; pathology of the distal tarsal joints was graded. The associations between the presence of a spur and lameness, diagnosis group and the grade of distal tarsal joint abnormalities were analysed statistically using Chi-squared tests. An osseous spur was present in 25% of horses; 13% of horses with bilateral radiographs had bilateral spurs. There was no significant difference in frequency of the presence of a spur between lame and nonlame horses, or between horses with other causes of hindlimb lameness and horses with proximal suspensory desmitis and/or distal tarsal joint pain. The presence of an osseous spur was significantly associated with the grade of radiological abnormality in the distal tarsal joints (tarsometatarsal joint P = 0.018: centrodistal joint P = 0.027). In many horses it was not possible to differentiate accurately between osteophytes and entheseophytes. The presence of an osseous spur on the dorsoproximal aspect of MtIII in the absence of other radiological abnormalities may be an incidental finding. Osseous spurs occur more frequently in hocks with radiological abnormalities in the distal tarsal joints and may be an indicator of distal tarsal joint osteoarthritis. The clinical significance must be established by intra-articular analgesia.

Dorsolateral approach for arthrocentesis of the centrodistal joint in horses

To develop a dorsolateral approach to the centrodistal (distal intertarsal) joint in horses and compare its success rate with that of the traditional medial approach in that joint. 25 cadaveric equine hind limbs, ultrasonographic images, and radiographic views of the tarsal region of 5 and 59 healthy horses, respectively, and 22 horses with a clinical indication for centrodistal joint centesis. The dorsolateral approach was established anatomically (3 cadaveric limbs), ultrasonographically (5 horses), and radiographically (59 horses). Centrodistal joint arthrocentesis was performed in 22 cadaveric hind limbs and 22 horses; the number of needle repositionings required for procedure completion via the medial (in vitro) and the dorsolateral approach (in vitro and in vivo) was determined. For the dorsolateral approach to the centrodistal joint, the injection site was 2 to 3 mm lateral to the long digital extensor tendon and 6 to 8 mm proximal to a line drawn perpendicular to the axis of the third metatarsal bone through the proximal end of the fourth metatarsal bone. The needle was directed plantaromedially (angle of approx 70 degrees from the sagittal plane). The number of needle repositionings required to complete centrodistal joint centesis via the dorsolateral and medial approaches was not significantly different. In a clinical setting, the dorsolateral approach to the centrodistal joint in horses appears to have some advantages over the traditional medial approach. The success rate of arthrocentesis was similar via either approach, and palpation of the anatomic landmarks was easy.

Centrodistal joint lameness in dogs

Lameness attributable to pathology of the centrodistal joint was investigated in five racing greyhounds, five Border collies and two other dogs. Diagnosis was made by the induction of pain from rotationally stressing the medial aspect of the tarsus, and by the exclusion of tarsal fractures and instabilities. Radiographic changes included plantar ligament entheslopathy and centrodistal joint osteophytosis. In many of the cases, the lameness was poorly responsive to rest and non-steroidal anti-inflammatory drugs. One dog was managed conservatively and became sound. In 10 of 11 cases, surgical promotion of centrodistal ankylosis was associated with a return to soundness.

Concentration of methylprednisolone in the centrodistal joint after administration of methylprednisolone acetate in the tarsometatarsal joint

The centrodistal (CD) and tarsometatarsal (TMT) joints are often injected individually with a corticosteroid to resolve lameness caused by osteoarthritis (OA). There are no data available regarding diffusion of methylprednisolone (MP) from the TMT joint to the CD joint. A therapeutic concentration of MP diffuses into the CD joint after methylprednisolone acetate (MPA) is administered into the TMT joint. To measure the concentration of MP in the CD joint after MPA was administered into the TMT joint. MPA was administered into a TMT joint of 16 horses. At different times, the ipsilateral CD joint of these horses was injected with a small amount of saline and recovered saline was measured for concentration of MP using high performance liquid chromatography. Six hours after administration of MPA into the TMT joint, a therapeutic concentration of MP was found in all 10 CD joints sampled at this time. Horses with pain arising from the distal 2 joints of the hock can be treated by administering MPA into the TMT joint alone. Administering MPA into the TMT joint only, to treat OA of the distal 2 hock joints, reduces the difficulties and risks associated with centesis of the CD joint.

Diffusion of mepivacaine between adjacent synovial structures in the horse. Part 2: tarsus and stifle.

This paper tests the hypothesis that the local analgesic agent mepivacaine diffuses between adjacent equine synovial structures in the hindlimb and with greater frequency than latex, gelatine dye or contrast media. We report the incidence of diffusion of mepivacaine between the tarsometatarsal, centrodistal and tarsocrural joints, and the 3 synovial compartments of the stifle in 33 fresh equine cadavers. The tarsometatarsal joint and one synovial compartment of the stifle in the left limb and the centrodistal joint and a different synovial compartment of the stifle in the right limbs were injected with mepivacaine. Following flexion and extension of the limb, synovial fluid was aspirated from the noninjected centrodistal and tarsometatarsal joints and the tarsocrural joints of the hock and the noninjected compartments of the stifle. Concentrations of mepivacaine in these samples were assayed using an enzyme linked immunosorbent assay. For samples obtained by dilution of synovial fluid the concentration of mepivacaine was determined by comparing the concentration of urea in the diluted synovial fluid and the concentrations of the serum urea. Mepivacaine was detected in 25/25 (100%) adjacent tarsometatarsal and centrodistal joints after diffusion in both directions, in 23/25 (92%) of tarsocrural joints after diffusion from tarsometatarsal joints and in 22/25 (88%) tarsocrural joints after diffusion from centrodistal joints in the hocks. Diffusion from the femoropatellar to medial and lateral femorotibial joints and between the medial and lateral femorotibial joints in both directions were 20/20 (100%). Diffusion from the lateral femorotibial to the femoropatellar joint was 18/20 (90%) and from the medial femorotibial to femoropatellar joints 17/20 (85%). Mepivacaine was detected at concentrations >0.3 mg/l in a proportion of samples ranging from 15/25 (60%) in the tarsocrural joint following tarsometatarsal joint injection to 18/20 (90%) in the lateral femorotibial joint after femoropatellar joint injection. At mepivacaine concentrations >100 mg/l, detection ranged from 3/20 (15%) in the lateral femorotibial joint from the medial femorotibial joint to 19/25 (76%) in the centrodistal joint from the tarsometatarsal joint. At mepivacaine concentrations >300 mg/l, detection ranged from 1/25 (4%) in the tarsocrural joint from the tarsometatarsal joint to 16/25 (64%) in the from centrodistal joint the tarsometatarsal joint. The results show greater diffusion of mepivacaine between these adjacent synovial structures than assumed from previous anatomical, latex injection and contrast arthrographic studies. Therefore, commonly performed intrasynovial local analgesic techniques in the hindlimb of the horse are not as specific as first thought.