Superficial Digital Flexor Tendon Research Articles

A retrospective cohort study investigating risk factors for the failure of Thoroughbred racehorses to return to racing after superficial digital flexor tendon injury

A retrospective cohort study was conducted to investigate risk factors for the failure of Thoroughbred racehorses to return to racing after an injury of the superficial digital flexor tendon (SDFT). Successful return was defined as the completion of five or more races after SDFT injury. The official Japan Racing Association (JRA) medical records of racehorses with a core-type SDFT injury were reviewed for clinical variables related to the characteristics of the horse and the severity of SDFT injuries at the time of diagnosis. Data on racing outcomes were obtained from the official JRA racing database. Risk factors were screened using univariable logistic regression and subsequent multivariable model building. Forty-nine of 346 (14.2%) horses successfully returned to racing after SDFT injuries. Multivariable model building revealed that an increase in the total number of injured zones (defined as the total number of zones in which the injured hypoechoic area was observed at the time of ultrasonographic diagnosis of SDFT injury) was associated with an increased risk of failure to return to racing after SDFT injury. Horse characteristics, such as age, body mass and sex, were not associated with a successful return to racing. In the rehabilitation of cases with larger (longer) lesions, more effective and careful medical management may be needed for an improvement in the athletic outcomes.

Variations in internal structure, composition and protein distribution between intra- and extra-articular knee ligaments and tendons.

Tendons and ligaments play key roles in the musculoskeletal system in both man and animals. Both tissues can undergo traumatic injury, age‐related degeneration and chronic disease, causing discomfort, pain and increased susceptibility to wider degenerative joint disease. To date, tendon and ligament ultrastructural biology is relatively under‐studied in healthy, non‐diseased tissues. This information is essential to understand the pathology of these tissues with regard to function‐related injury and to assist with the future development of tissue‐engineered tendon and ligament structures. This study investigated the morphological, compositional and extracellular matrix protein distribution differences between tendons and ligaments around the non‐diseased canine stifle joint. The morphological, structural characteristics of different regions of the periarticular tendons and ligaments (the intra‐articular anterior cruciate ligament, the extra‐articular medial collateral ligament, the positional long digital extensor tendon and energy‐storing superficial digital flexor tendons) were identified using a novel semi‐objective histological scoring analysis and by determining their biochemical composition. Protein distribution of extracellular matrix collagens, proteoglycans and elastic fibre proteins in anterior cruciate ligament and long digital extensor tendon were also determined using immunostaining techniques. The anterior cruciate ligament was found to have significant morphological differences in comparison with the other three tissues, including less compact collagen architecture, differences in cell nuclei phenotype and increased glycosaminoglycan and elastin content. Intra‐ and interobserver differences of histology scoring resulted in an average score 0.7, indicative of good agreement between observers. Statistically significant differences were also found in the extracellular matrix composition in terms of glycosaminoglycan and elastin content, being more prominent in the anterior cruciate ligament than in the other three tissues. A different distribution of several extracellular matrix proteins was also found between long digital extensor tendon and anterior cruciate ligament, with a significantly increased immunostaining of aggrecan and versican in the anterior cruciate ligament. These findings directly relate to the different functions of tendon and ligament and indicate that the intra‐articular anterior cruciate ligament is subjected to more compressive forces, reflecting an adaptive response to normal or increased loads and resulting in different extracellular matrix composition and arrangement to protect the tissue from damage.

Ultrasonographic-based predictive factors influencing successful return to racing after superficial digital flexor tendon injuries in flat racehorses: A retrospective cohort study in 469 Thoroughbred racehorses in Hong Kong.

SummaryBackgroundSuperficial digital flexor tendon (SDFT) injury is an important health and welfare concern in racehorses. It is generally diagnosed with ultrasonography, but predictive ultrasonographic features have not been reported.ObjectivesTo determine ultrasonographic features of forelimb SDFT injury at initial presentation in Thoroughbred racehorses that could predict a successful return to racing (completing ≥5 races).Study designRetrospective cohort study.MethodsDigitised ultrasonographic images of 469 horses with forelimb SDFT injuries from the Hong Kong Jockey Club (2003–2014) were evaluated, using a previously validated ultrasonographic scoring system. Six ultrasonographic parameters were evaluated (type and extent of the injury, location, echogenicity, cross‐sectional area and longitudinal fibre pattern of the maximal injury zone [MIZ]), as well as horse signalment, retirement date and number of races before and after injury. Data were analysed by generalised linear regression with significance at P<0.05.ResultsCases were divided into two groups: 1) For cases of SDFT tendonitis with core lesions, cross‐sectional area at the MIZ was the most significant factor determining a successful return to racing (P = 0.03). If the lesion was <50% of the total cross‐sectional area, horses had 29–35% probability of successfully racing again, but if it was ≥50% this decreased to 11–16%. 2) For cases of SDFT tendonitis without a core lesion, longitudinal fibre pattern at the MIZ best predicted a successful return to racing (P = 0.002); if the affected longitudinal fibre pattern was <75% of the total, horses had 49–99% probability of successfully return to racing, but if it was ≥75% this decreased to 14%.Main limitationsPrognostic information may not be applicable to other breeds/disciplines.ConclusionsThis is the first study to describe ultrasonographic features of forelimb SDFT injuries at initial presentation that were predictive of successful return to racing. The outcomes will assist with early, evidence‐based decisions on prognosis in Thoroughbred racehorses.

Variations during ageing in the three-dimensional anatomical arrangement of fascicles within the equine superficial digital flexor tendon.

BiTendons are constructed from collagenous fascicles separated by endotenon/interfascicular matrix (IFM). Tendons may be specialised for precision movement or to store energy during locomotion and for the latter the elasticity of the endotenon/IFM is particularly important. The equine superficial digital flexor tendon (SDFT) is a dedicated energy-storing tendon with a similar function to the human Achilles tendon. Classical anatomical descriptions portray fascicles as longitudinally arranged distinct anatomical structures. In the present study, using three-dimensional reconstruction from whole tissue slices and histological sections, the fascicles of the equine SDFT were found to adopt a complex interweaved arrangement. Fascicles were found to fully and partially converge and diverge within the tendon and fascicle bundles were observed. Fascicle morphology was not homogenous with narrowing, broadening and twisted fascicles observed in addition to relatively straight fascicles. The number of fascicle bundles observed in cross-section increased from the proximal to the distal end of the tendon, whilst the number of fascicles decreased with age in the proximal region. Fascicular patterns were not similar between the left and right limbs, across different regions or at different ages. A decrease in thickness of the endotenon/IFM between fascicles with age was found in the distal tendon region. The results provide a rationale for considering fascicular organisation when diagnosing and treating tendon injuries, for bioengineering tendon and when modelling tendon function.

Ultrasonography, computed tomography and magnetic resonance imaging of the bovine metacarpo/metatarsophalangeal joint

The aims of the present study were to describe the normal ultrasonographic, magnetic resonance imaging (MRI) and computed tomographic (CT) appearances of the bovine metacarpo/metatarsophalangeal (MCP/MTP) joints and to assess the normal cross-sectional dimensions of the superficial (SDFT) and deep (DDFT) digital flexor tendons. A systematic ultrasound examination was performed on the MCP/MTP joints of 22 healthy cattle and two bovine cadavers, and the cross-sectional dimensions of the SDFT and DDFT were recorded. The cadaveric MCP/MTP joints (n=8) were scanned using a 16-slice multi-detector CT scanner and a 1.5 Tesla MRI scanner, injected with green latex and sectioned into transverse (n=4), sagittal (n=2) and dorsal (n=2) slices. Ultrasonographic, CT and MRI images were correlated with corresponding findings in anatomical dissections for the distal aspects of the third and fourth metacarpal/metatarsal bones, proximal aspects of the proximal phalanges, proximal sesamoid bones, lateral, common and medial digital extensor tendons, SDFT, DDFT, axial and abaxial collateral ligaments, suspensory, palmar/plantar, interdigital intersesamoidean and interdigital phalangosesamoidean ligaments, and collateral, cruciate and short sesamoidean ligaments. The axial and collateral sesamoidean ligaments could not be evaluated by ultrasonography. The articular cartilage, and the short and cruciate sesamoidean ligaments, were not identified in CT images. The cross-sectional dimensions of the SDFT and DDFT differed significantly between the forelimbs and hind limbs (P<0.05); there were no significant differences between the contralateral limbs. The annotated ultrasonographic, CT and MRI images are intended as a normal reference that could be useful for interpretation of clinical disease in the bovine MCP/MTP joint.

Structure and collagen crimp patterns of functionally distinct equine tendons, revealed by quantitative polarised light microscopy (qPLM)

Structure-function relationships in tendons are directly influenced by the arrangement of collagen fibres. However, the details of such arrangements in functionally distinct tendons remain obscure. This study demonstrates the use of quantitative polarised light microscopy (qPLM) to identify structural differences in two major tendon compartments at the mesoscale: fascicles and interfascicular matrix (IFM). It contrasts functionally distinct positional and energy storing tendons, and considers changes with age. Of particular note, the technique facilitates the analysis of crimp parameters, in which cutting direction artefact can be accounted for and eliminated, enabling the first detailed analysis of crimp parameters across functionally distinct tendons.IFM shows lower birefringence (0.0013 ± 0.0001 [−]), as compared to fascicles (0.0044 ± 0.0005 [−]), indicating that the volume fraction of fibres must be substantially lower in the IFM. Interestingly, no evidence of distinct fibre directional dispersions between equine energy storing superficial digital flexor tendons (SDFTs) and positional common digital extensor tendons (CDETs) were noted, suggesting either more subtle structural differences between tendon types or changes focused in the non-collagenous components.By contrast, collagen crimp characteristics are strongly tendon type specific, indicating crimp specialisation is crucial in the respective mechanical function. SDFTs showed much finer crimp (21.1 ± 5.5 µm) than positional CDETs (135.4 ± 20.1 µm). Further, tendon crimp was finer in injured tendon, as compared to its healthy equivalents. Crimp angle differed strongly between tendon types as well, with average of 6.5 ± 1.4° in SDFTs and 13.1 ± 2.0° in CDETs, highlighting a substantially tighter crimp in the SDFT, likely contributing to its effective recoil capacity. Statement of SignificanceThis is the first study to quantify birefringence in fascicles and interfascicular matrix of functionally distinct energy storing and positional tendons. It adopts a novel method – quantitative polarised light microscopy (qPLM) to measure collagen crimp angle, avoiding artefacts related to the direction of histological sectioning, and provides the first direct comparison of crimp characteristics of functionally distinct tendons of various ages.A comparison of matched picrosirius red stained and unstained tendons sections identified non-homogenous staining effects, and leads us to recommend that only unstained sections are analysed in the quantitative manner.qPLM is successfully used to assess birefringence in soft tissue sections, offering a promising tool for investigating the structural arrangements of fibres in (soft) tissues and other composite materials.

Fibrillar architecture at three different sites of the bovine superficial digital flexor tendon.

Superficial digital flexor tendon (SDFT) of the bovine hindlimb originates from the caudolateral aspect of the distal femur and finally inserts onto the plantar aspect of the middle phalanges. In the present study, morphology and morphometry of the bovine SDFT at the muscle-tendon junction (MTJ), middle metatarsus (mM) and tendon-bone interface (TBI) were investigated. Cross-sectional morphology at the three regions of SDFT were oval, semioval and ring-formed, respectively. Significant difference in cross-sectional area was found only between MTJ-mM and mM-TBI (P<0.05). Functional compression and friction from the adjacent structures could be the most potential interactions affecting such appearances. Morphometric data of tenocyte number, water content, and glycosaminoglycan (GAG) length and angle were found increasing in the proximodistal direction, except the fibril diameter and collagen fibril index (CFI). Statistical analyzes could reveal significant differences in average number of tenocytes (P<0.0001), CFI (between MTJ-mM and MTJ-TBI, P<0.05), water content (between MTJ-TBI, P<0.05), length of GAG chains (between MTJ-TBI, P<0.05), and angle of GAG chains (P<0.0001), respectively. The fibrillar characteristics at the three different areas, including fibril diameter distribution and interfibrillar distance, existed in conforming to the tensional axes in situ. In addition, length and angle of GAG chains were relevant to moving directions of the collagen fibrils.

Correlations between the equine metacarpophalangeal joint angulation and toe conformation in statics.

The angulation of the equine fetlock determines the load of associated tendons and probably their predisposition for injuries. However, it is questionable how the individual toe conformation and tendon properties interact with the dorsal metacarpophalangeal joint angle (DMPJ). Data are needed for a tangible evaluation of the equine limb conformation for more specific orthopaedic treatment. The aim was to evaluate the correlation between the DMPJ, toe conformation and cross-sectional area (CSA) of both flexor tendons; the superficial digital flexor tendon (SDFT) and deep digital flexor tendon (DDFT). Thirty Warmblood horses were available for the study. Lateromedial radiographs of the toe and fetlock and transverse ultrasound images of both flexor tendons were obtained from three zones. The DMPJ, length and angle of the phalanges and CSA SDFT/DDFT were measured. In addition, hoof angle, wither height, age, and sex were documented. Correlations were calculated using Pearson’s test. A paired t-test was used to evaluate left–right differences. Length and angle of the proximal and middle phalanx were significantly associated with the DMPJ (r = -0.28 – -0.45, p<0.001-0.04). Neither the angle of the hoof and distal phalanx nor the CSA SDFT/DDFT, showed a noticeable correlation with the DMPJ. Significant left–right differences occurred for the DMPJ (p<0.002) and the angle of the proximal and middle phalanx (p<0.01 – 0.002). A moderate negative correlation was shown between the DMPJ and wither height (r = - 0.31, p=0.04). Results represent only a specific population. The study provides only a static evaluation of a dynamic situation. In a clinical context, it might be useful to focus on the angulation and length of the pastern to evaluate the individual load affecting the DMPJ and its associated structures. These findings might be relevant for orthopaedic treatments and shoeing recommendations.

Computed tomographic contrast tenography of the digital flexor tendon sheath of the equine hindlimb.

Pre-surgical investigation of digital flexor tendon sheath pathology remains challenging with current standard imaging techniques. The aim of this prospective, anatomical, pilot study was to describe the anatomy of the equine hind limb digital flexor tendon sheath using a combination of computed tomography (CT) and computed tomographic contrast tenography in clinically normal cadaver limbs. Ten pairs of hind limbs with no external abnormalities were examined from the level of the tarsometatarsal joint distally. Limbs initially underwent non-contrast CT examination using 120kVp, 300mAs, and 1.5mm slice thickness. Sixty millilitres of ioversol iodinated contrast media and saline (final concentration 100mg/ml) were injected using a basilar sesamoidean approach. The computed tomographic contrast tenography examination was then repeated, before dissection of the specimens to compare gross and imaging findings. The combined CT and computed tomographic contrast tenography examinations provided excellent anatomical detail of intra-thecal structures. The borders of the superficial and deep digital flexor tendons, and the manica flexoria were consistently identifiable in all limbs. Detailed anatomy including that of the mesotenons, two of which are previously undescribed, and the plantar annular ligament were also consistently identifiable. Dissection of all 10 pairs of limbs revealed there to be no pathology, in accordance with the imaging findings. In conclusion, the combination of CT and computed tomographic contrast tenography may be useful adjunctive diagnostic techniques to define digital flexor tendon sheath pathology prior to surgical exploration in horses.

Ultrasonographic scoring system for superficial digital flexor tendon injuries in horses: intra- and inter-rater variability

Superficial digital flexor tendon (SDFT) tendinopathy is an important musculoskeletal problem in horses. The study objective was to validate an ultrasonographic scoring system for SDFT injuries. Ultrasonographic images from 14...

Didatic approach of ultrasonographic examination for evaluation of the carpal joint in horses

ABSTRACT: The carpus is a complex articulation, which is often involved in injuries in equine athletes. The objective of this study was to suggest a didactic approach for ultrasonography training for the examination of the carpal joint in horses. Ultrasonograhy examination was performed in a healthy 14-year-old horse. The images were compared with those of a dissected anatomic specimen of the carpal region of a senior horse and with those reported in the literature. Identifiable structures were as follows: (dorsal) tendon of the muscle extensor carpi radialis, tendon of the muscle extensor carpi obliquus, tendon of the muscle commom digital extensor, dorsal synovial outpouchings, joint capsule and fat cushion, (lateral) tendon of the muscle lateral digital extensor, lateral collateral ligament (deep and superficial components), (medial) medial collateral ligament (deep and superficial components) and (palmar) palmar intercarpal ligament, carpal sheath, carpal tunnel, superficial digital flexor tendon, proximal origin of the deep digital flexor tendon, and palmar carpal ligament. Prior knowledge of the anatomy in combination with the study of anatomical specimens is essential for recognizing musculoskeletal structures during ultrasound examination, contributing to the training and learning processes.

Effect of track surface firmness on the development of musculoskeletal injuries in French Trotters during four months of harness race training

OBJECTIVE To evaluate the effect of track surface firmness on the development of musculoskeletal injuries in French Trotters during 4 months of race training. ANIMALS 12 healthy 3-year-old French Trotters. PROCEDURES Horses were paired on the basis of sex and body mass. Horses within each pair were randomly assigned to either a hard-track or soft-track group. The counterclockwise training protocol was the same for both groups. Surface firmness of each track was monitored throughout the training period. Radiography, ultrasonography, MRI, and scintigraphy were performed on all 4 limbs of each horse before and after 2 and 4 months of training. Lesions were described, and lesion severity was classified with a 5-point system, where 0 = no lesions and 4 = severe lesion. RESULTS 86 lesions were identified, of which 46 (53.5%) were classified as potentially clinically relevant (grade, ≥ 2). Of the 18 moderate and severe lesions, 15 were identified in horses of the hard-track group, and 10 of those were in forelimbs. Moderate to severe tendinopathy of the superficial digital flexor tendon of the forelimb developed in 3 of the 6 horses of the hard-track group but none of the horses of the soft-track group. Metatarsal condyle injuries were more frequent in horses of the hard-track group than horses of the soft-track group. Severe lesions were identified only in left limbs. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that track surface firmness is a risk factor for musculoskeletal injuries in horses trained for harness racing.

Identification of Equid herpesvirus 2 in tissue-engineered equine tendon.

Background: Incidental findings of virus-like particles were identified following electron microscopy of tissue-engineered tendon constructs (TETC) derived from equine tenocytes. We set out to determine the nature of these particles, as there are few studies which identify virus in tendons per se, and their presence could have implications for tissue-engineering using allogenic grafts. Methods: Virus particles were identified in electron microscopy of TETCs. Virion morphology was used to initially hypothesise the virus identity. Next generation sequencing was implemented to identify the virus. A pan herpesvirus PCR was used to validate the RNASeq findings using an independent platform. Histological analysis and biochemical analysis was undertaken on the TETCs. Results: Morphological features suggested the virus to be either a retrovirus or herpesvirus. Subsequent next generation sequencing mapped reads to Equid herpesvirus 2 (EHV2). Histological examination and biochemical testing for collagen content revealed no significant differences between virally affected TETCs and non-affected TETCs. An independent set of equine superficial digital flexor tendon tissue (n=10) examined using designed primers for specific EHV2 contigs identified at sequencing were negative. These data suggest that EHV is resident in some equine tendon. Conclusions: EHV2 was demonstrated in equine tenocytes for the first time; likely from in vivo infection. The presence of EHV2 could have implications to both tissue-engineering and tendinopathy.

Identification of Equid herpesvirus 2 in tissue-engineered equine tendon

Background: Incidental findings of virus-like particles were identified following electron microscopy of tissue-engineered tendon constructs (TETC) derived from equine tenocytes. We set out to determine the nature of these particles, as there are few studies which identify virus in tendons per se, and their presence could have implications for tissue-engineering using allogenic grafts. Methods: Virus particles were identified in electron microscopy of TETCs. Virion morphology was used to initially hypothesise the virus identity. Next generation sequencing was implemented to identify the virus. A pan herpesvirus PCR was used to validate the RNASeq findings using an independent platform. Histological analysis and biochemical analysis was undertaken on the TETCs. Results: Morphological features suggested the virus to be either a retrovirus or herpesvirus. Subsequent next generation sequencing mapped reads to Equid herpesvirus 2 (EHV2). Histological examination and biochemical testing for collagen content revealed no significant differences between virally affected TETCs and non-affected TETCs. An independent set of equine superficial digital flexor tendon tissue (n=10) examined using designed primers for specific EHV2 contigs identified at sequencing were negative. These data suggest that EHV is resident in some equine tendon. Conclusions: EHV2 was demonstrated in equine tenocytes for the first time; likely from in vivo infection. The presence of EHV2 could have implications to both tissue-engineering and tendinopathy.

Spatiotemporal variations in gene expression, histology and biomechanics in an ovine model of tendinopathy.

Flexor tendinopathy is a common problem affecting humans and animals. Tendon healing is poorly understood and the outcomes of conservative and surgical management are often suboptimal. While often considered a localized injury, recent evidence indicates that in the short term, tendinopathic changes are distributed widely throughout the tendon, remote from the lesion itself. Whether these changes persist throughout healing is unknown. The aim of this study was to document gene expression, histopathological and biomechanical changes that occur throughout the superficial digital flexor tendon (SDFT) up to 16 weeks post-injury, using an ovine surgical model of tendinopathy. Partial tendon transection was associated with decreased gene expression for aggrecan, decorin, fibromodulin, tissue inhibitors of metalloproteinases (TIMPS 1, 2 and 3), collagen I and collagen II. Gene expression for collagen III, lumican and matrix metalloproteinase 13 (MMP13) increased locally around the lesion site. Expression of collagen III and MMP13 decreased with time, but compared to controls, collagen III, MMP13 and lumican expression remained regionally high throughout the study. An increase in TIMP3 was observed over time. Histologically, operated tendons had higher pathology scores than controls, especially around the injured region. A chondroid phenotype was observed with increased cellular rounding and marked proteoglycan accumulation which only partially improved with time. Biomechanically, partial tendon transection resulted in a localized decrease in elastic modulus (in compression) but only at 8 weeks postoperatively. This study improves our understanding of tendon healing, demonstrating an early ‘peak’ in pathology characterized by altered gene expression and notable histopathological changes. Many of these pathological changes become more localized to the region of injury during healing. Collagen III and MMP13 expression levels remained high close to the lesion throughout the study and may reflect the production of tendon tissue with suboptimal biomechanical properties. Further studies evaluating the long-term response of tendon to injury (6–12 months) are warranted to provide additional information on tendon healing and provide further understanding of the mechanisms underlying the pathology observed in this study.

Tenogenically Induced Allogeneic Peripheral Blood Mesenchymal Stem Cells in Allogeneic Platelet-Rich Plasma: 2-Year Follow-up after Tendon or Ligament Treatment in Horses.

Poor healing of tendon and ligament lesions often results in early retirement of sport horses. Therefore, regenerative therapies are being explored as potentially promising treatment for these injuries. In this study, an intralesional injection was performed with allogeneic tenogenically induced mesenchymal stem cells and platelet-rich plasma 5–6 days after diagnosis of suspensory ligament (SL) (n = 68) or superficial digital flexor tendon (SDFT) (n = 36) lesion. Clinical, lameness and ultrasonographic evaluation was performed at 6 and 12 weeks. Moreover, a survey was performed 12 and 24 months after treatment to determine how many horses were competing at original level and how many were re-injured. At 6 weeks, 88.2% of SL (n = 68) and 97.3% of SDFT lesions (n = 36) demonstrated moderate ultrasonographic improvement. At 12 weeks, 93.1% of SL (n = 29) and 95.5% of SDFT lesions (n = 22) improved convincingly. Moreover, lameness was abolished in 78.6% of SL (n = 28) and 85.7% (n = 7) of SDFT horses at 12 weeks. After 12 months (n = 92), 11.8% of SL and 12.5% of SDFT horses were re-injured, whereas 83.8 of SL and 79.2% of SDFT returned to previous performance level. At 24 months (n = 89) after treatment, 82.4 (SL) and 85.7% (SDFT) of the horses returned to previous level of performance. A meta-analysis was performed on relevant published evidence evaluating re-injury 24 months after stem cell-based [17.6% of the SL and 14.3% of the SDFT group (n = 89)] versus conventional therapies. Cell therapies resulted in a significantly lower re-injury rate of 18% [95% confidence interval (CI), 0.11–0.25] 2 years after treatment compared to the 44% re-injury rate with conventional treatments (95% CI, 0.37–0.51) based on literature data (P < 0.0001).

Evaluation of Achilles Tendon Injuries with Findings from Diagnostic Musculoskeletal Ultrasound in Canines – 43 Cases

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective was to describe clinical and ultrasonographic characteristics of canine Achilles tendon injuries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Even though there have been publications describing characteristics of the normal and injured Achilles tendon by diagnostic ultrasound, there has been no previous in-depth ultrasonic evaluation and characterisation of Achilles tendon strains.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Evidentiary value:&lt;/strong&gt; This is a retrospective case series report of 43 dogs that underwent musculoskeletal diagnostic ultrasound evaluation of their strained Achilles tendons, with and without surgical repair.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data was collected from medical records of patients from August 2009 to May 2016. Inclusion criteria for dogs included a diagnosis of Achilles tendon injury based on the presence of fibre pattern modification within one or more components of the Achilles mechanism on initial diagnostic ultrasound.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; It was found on the diagnostic ultrasound that Achilles tendon injuries were strictly unilateral in 51.2% (n=22/43) of cases and bilateral on presentation in 48.8% (n=21/43) of cases. 18.2% of the unilateral case progressively became bilateral over time (n=4/22). The injury was partial in 90.7% (n=39/43) of the cases and all three components of the Achilles mechanism were completely disrupted in only 9.3% of the cases (n=4/43). The partial injuries incorporated changes within the fibre patterns of all 3 components of the Achilles in 53.8% (n=21/39) of the cases and alteration of both the gastrocnemius tendon (GT) and common tendon (CT) in 41.0% (n=16/39) of the cases. Grade III strains were predominant (44.3%), followed by grade I (28.6%) and grade II (27.1%). Damage occurred most commonly at the tendino-osseous insertion (77%), with injury occurring less frequently diffusely along the body of the tendon (12.5%) or at the musculotendinous junction (10.5%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Diagnostic musculoskeletal ultrasound was used to identify lesions of Achilles tendon consistent with different grade of strain, as well as identifying the specific region of injury. Diagnostic ultrasound findings were correlated to the surgical findings and previous literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Application:&lt;/strong&gt; Diagnostic musculoskeletal ultrasound provides a non-invasive diagnostic modality for patients suspected of having Achilles tendon strain. Further investigation is needed to establish treatment protocols based on ultrasonographic 3-tier grading scheme for Achilles tendon strain injury.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Abbreviations: &lt;/strong&gt;Common tendon (CT), computed tomography scan (CT scan), gastrocnemius tendon (GT), magnetic resonance imaging (MRI), myotendinous junction (MTJ), superficial digital flexor tendon (SDFT).&lt;/p&gt;&lt;br /&gt; &lt;img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /&gt; &lt;img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" /&gt;

Outcome of conservative and surgical treatment for luxations of the equine superficial digital flexor tendon from the calcaneal tuber

SummaryThe objective of this study was to report the outcome of horses treated either conservatively or surgically for luxation of the superficial digital flexor tendon (SDFT) from the calcaneal tuber. Medical records of horses with diagnosed SDFT luxations from the calcaneal tuber were reviewed (1993–2015) and long‐term follow‐up examinations and owner questionnaires performed. Survival to hospital discharge, complications, final SDFT position, soundness and return to intended use were compared between conservatively or surgically treated horses. Following conservative treatment all horses (n = 8) survived to hospital discharge. At long‐term follow‐up 71.4% (5/7) had returned to intended use. The SDFT was unstable in all of them resulting in a mild mechanical lameness. Nine horses underwent surgical treatment. The SDFT was reduced and maintained in position with a synthetic mesh and sutures (n = 2), with a synthetic mesh, sutures and suture screws (n = 6) or with sutures and suture screws (n = 1). Only 66.7% (6/9) of the horses survived to hospital discharge. Fatal complications including support limb laminitis (1/9), implant infection (1/9), and support limb laminitis plus infection (1/9) occurred. All horses available for long‐term follow‐up (n = 5) were clinically sound and 80% (4/5) had returned to intended use. Following conservative treatment, a mild mechanical lameness will persist but will not prevent the horses from returning to their intended use. Surgical repair can result in a stable fixation of the SDFT with long‐term soundness and return to intended use; however, fatal complications (support limb laminitis, infection) can occur leading to the euthanasia of the horse in the immediate post‐operative period.

Influence of Platelets Rich Plasma on Repair of Superficial Digital Flexor Tendon Rupture in Donkeys (An Experimental Study)

This study was planned to prospectively evaluate the influence of platelets rich plasma (PRP) on the restoration of superficial digital flexor tendon (SDFT) in donkeys. Eighteen apparently clinically healthy male donkeys of 3-6 years old, weighing 150-200 kg, were used. The animals were classified into two equal groups; control group and PRP group. One cm transection of the full thickness of middle portion of the SDFT was made in all animals. First, all animals were subjected to sedation via xylazine HCl injection in a dose of 1 mg/kg body weight then the animals were deeply narcotized with chloral hydrate 10% in a dose of 5 gm/50 kg body weight. A linear skin incision in the palmar aspect of the right fore limb at the mid cannon region was performed in all operated animals. The animals in PRP group were subjected to intratendinous injections of 4 mL PRP with weekly interval (day 0, w1, w2, w3) under the guidance of ultrasonography. Representative tendon specimens from all animals were collected 30, 60, and 90 days post operation (PO) for histopathological examination. The obtained clinical and histopathological results reveled that PRP application improved the healing of SDFT compared to the control group, through increasing and acceleration of angiogenesis, fibrogenesis, collagen deposition and remodeling in the injured tendon matrices.

Ultrasonographic‐Based Predictive Factors Influencing Successful Return To Racing After Superficial Digital Flexor Tendon Injuries In Flat Racehorses: A Retrospective Cohort Study In 469 Thoroughbred Racehorses in Hong Kong

Ultrasonographic‐Based Predictive Factors Influencing Successful Return To Racing After Superficial Digital Flexor Tendon Injuries In Flat Racehorses: A Retrospective Cohort Study In 469 Thoroughbred Racehorses in Hong Kong