Removal Of Osteochondral Fragments Research Articles

Hip Arthroscopy for Synovial Chondromatosis: Tips and Tricks

Hip arthroscopy is an important diagnostic and therapeutic tool in the management of synovial chondromatosis. Removal of osteochondral fragments (OCFs) from the central and peripheral compartments is crucial for the relief of mechanical symptoms and subsequent joint destruction. Direct access to the central compartment is often limited because of the ball-and-socket morphology and limitation of traction. We present our surgical technique for removing OCFs and a new method for the removal of a large loose body using a nitinol stone retrieval basket. The technique facilitates removal of difficult-to-access fragments from the central compartment. Moreover, this technique allows removal of far-medial OCFs from the peripheral compartment.

Arthroscopic Approach and Intraarticular Anatomy of the Stifle inSouthAmerican Camelids

To describe a cranial arthroscopic approach to the stifle of South American camelids and to report our clinical experience with camelid stifle arthroscopy. Experimental study and retrospective case series. (1) Cadaveric alpaca hindlimbs (n = 18; 9 alpacas); (2) 1 alpaca and 1 llama Polymethylmethacrylate joint casts (n = 2) were made to define stifle joint dimensions. Cadaveric stifle joints (n = 16) were evaluated arthroscopically to determine arthroscopic portal locations, describe the intraarticular anatomy, and report potential complications. An alpaca and a llama with stifle joint disease had diagnostic arthroscopy. Successful entry into the stifle joint was achieved in 16 cadaver limbs. Observed structures were: the suprapatellar pouch, articular surface of the patella, femoral trochlear ridges and groove, cranial aspect of the femoral condyles (n = 16); distal aspect of the cranial and proximal aspect of the caudal cruciate ligaments (14); and cranial aspects of the medial and lateral menisci (11), and cranial meniscotibial and intermeniscal ligaments (8). Stifle arthroscopy allowed for joint evaluation and removal of osteochondral fragments in 1 alpaca and 1 llama with naturally occurring stifle disease. Complications of cadaver or live procedures included minor cartilage scoring (3 stifles) and subcutaneous periarticular fluid accumulation (8 stifles). Arthroscopy provides a safe approach for diagnosis and treatment of stifle lesions in South American camelids.

Joint Space Widening in Synovial Chondromatosis of the Hip

One of the radiographic findings in synovial chondromatosis of the hip is widening of the joint space between the femoral head and the acetabulum, although the cause and sequelae of the widening are unclear. Between May 1991 and June 2005, twenty-one patients with synovial chondromatosis of the hip were treated with open synovectomy and removal of osteochondral fragments. Joint space widening was assessed on radiographs made preoperatively, immediately after surgery, and at the time of follow-up. The changes of the radiographic joint space width were evaluated during the mean follow-up period of 5.9 years (range, 2.3 to 12.3 years). Twelve patients had joint space widening on preoperative radiographs of the hip. Medial joint space widening was seen in three patients, and both medial and superior joint space widening was evident in nine patients. Compared with the medial and superior joint spaces in the unaffected, contralateral hip, those in the affected hip were wider by an average of 44.7% and 35.9%, respectively. The medial joint space widths of the affected hip decreased slightly during the early postoperative period; however, widened joint spaces were persistent at the final follow-up visit, without other important changes. The superior joint space widths did not show substantial changes throughout the postoperative follow-up period. Joint space widening is a recognized radiographic finding in primary synovial chondromatosis of the hip. Although there was persistence of joint space widening after synovectomy in all patients, this joint space widening did not influence the clinical results at the time of follow-up.

Arthroscopic Removal of Palmar/Plantar Osteochondral Fragments from the Proximal Interphalangeal Joint in Four Horses

To describe anatomic considerations and arthroscopic technique in horses for arthroscopic removal of palmar/plantar osteochondral fragments from the proximal interphalangeal (PIP) joint. Retrospective study. Adult horses (n=4) with osteochondral fragments of the palmar/plantar PIP joint. Arthroscopic removal of palmar/plantar osteochondral fragments within the PIP joint was performed with horses in dorsal recumbency under general anesthesia. Medical records of affected horses were reviewed to determine history; physical, lameness, and radiological findings; surgical technique; complications and outcome. Two horses had lameness localized to the PIP joint. Two other horses had lameness suspected, but not confirmed to the pastern region. One of these horses had a history of intermittent lameness, but was not lame on admission. All horses had radiographic evidence of palmar/plantar osteochondral fragmentation within the PIP joint. Fragmentation was located abaxially in 2 horses in the hind limb and axially in 2 horses in the left forelimb. Osteochondral fragments were successfully removed via a palmar/plantar arthroscopic approach in all horses. Three horses returned to previous levels of athletic performance; 1 horse was used for trail riding instead of reining. Arthroscopy of the palmar/plantar pouch of the PIP joint allowed limited assessment of the joint and removal of osteochondral fragments. Arthroscopy of the palmar/plantar PIP joint pouch for assessment and removal of osteochondral fragments is possible and should be considered when lameness is localized to this joint.

118 TYPE II COLLAGEN SYNTHESIS TO DEGRADATION IMBALANCE IN SYNOVIAL FLUID AFTER OSTEOCHONDRAL INJURY IN THOROUGHBRED RACEHORSES

Purpose: High mobility group box chromosomal protein 1 (HMGB1) is a nuclear protein that functions both as a regulator of gene transcription and as a proinflammatory cytokine. HMGB1 mediates many inflammatory diseases, including many forms of arthritis. The purposes of this study were to investigate the effects of osteochondral (OC) injury on HMGB1 concentrations in synovial fluid (SF) from Thoroughbred (TB) racehorses. Methods: SF was taken from 2 groups of TB racehorses: (1) rested horses (n = 40) and (2) OC injured horses: racehorses that had arthroscopic surgery for removal of OC fragments resulting from racing injury (n = 44). From group 1 horses, SF was obtained from 20 metacarpophalangeal joints (MCP), 10 middle carpal joints (MCJ), and 10 radiocarpal joints (RCJ) (n = 40). SF samples from group 2 horses were from 16 MCP, 6 metatarsophalangeal joints (MTP), 12 MCJ, and 10 RCJ (n = 44). SF samples were assayed using a commercially available ELISA (HMGB1, Shino-Test Corp.). Differences between groups were determined by an unpaired t-test for the metacarpo/metarsophalangeal (MP) and carpal joints. Positive and negative predictive value of SF HMGB1 for identifying OC injury was determined by Fisher’s exact test. P< 0.05 was considered significant. Results: SF HMGB1 concentrations in OC injured MP and carpal joints were significantly higher than in normal joints (P< 0.0001; Figure 1). SF HMGB1 concentrations 11 ng/mL for MP joints and 10 ng/mL for carpal joints were arbitrarily chosen to determine predictive value for discriminating OC injured horses from normal horses. This yielded a positive predictive value of 89% and a negative predictive value of 68% for MP joints, and positive predictive value of 90% and negative predictive value of 81% for the carpus. Conclusions: OC injury caused a significant increase in SF HMGB1 concentrations in MP and carpal joints compared to normal joints. The assay yielded good positive and negative predictive values. Based on these findings, SF HMGB1 analysis may be useful for evaluation of joint injury.

134 Horses with osteochondritis dissecans of the tarso-crural joint: Clinical considerations and results following arthroscopic surgery

Summary A retrospective study was performed on a sample of 134 horses diagnosed with osteochondritis dissecans (OCD) of the tarso-crural joints that underwent surgery for the removal of osteochondral fragments. Breed, age, site of the lesion, amount of synovial effusion and its resolution following surgery were evaluated. In more than 70 percent of cases the lesion involved the distal intermediate ridge of the tibia. The lateral trochlea ridge of the talus was involved in 6 percent of cases studied. OCD of the lateral trochlea ridge of the talus was frequently associated with OCD in other anatomical sites. Eighty-four percent of surgically treated cases that had post-op following returned to training exercise or racing activity.