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Communique: Diagnostic and Surgical Arthroscopy
FOR IMMEDIATE RELEASE
Equine
Research Coordination Group White Paper
May 6, 2008
Contact Anne Dadds, Research Coordinator
adadds@aaep.org
Illustration and Photos Available
On behalf of the Equine Research Coordination Group
Arthroscopic surgery, developed in the horse in the 1970s, is the keyhole
technique by which surgery is performed on equine joints for traumatic injury,
fractures within joints, soft tissue injury, and abnormal joint development in
young horses, such as osteochondritis dissecans (OCD). Arthroscopic surgery
involves inserting a four-millimeter in diameter instrument known as an
arthroscope through small stab incisions to view and complete surgery within a
joint, such as removing a cartilage fragment.
Diagnostic arthroscopy was developed for human orthopedics, and involved the
insertion of a small endoscope within a sheath into the joint, distending the
joint with liquid, and enabling a clear view of the inside of the joint. At
first, examination of the human knee was used to confirm a suspected tear of the
meniscus (a fibrocartilaginous pad within a joint). Once confirmed, the meniscus
was removed through an open incision known as an arthrotomy. Arthrotomies, which
were the commonly accepted technique before arthroscopy, gave very poor
visualization of the joint, and consequently, some normal menisci were
inadvertently removed before the use of arthroscopy. Now, clear definition of
the injury is made with the arthroscope, and, depending on the location and size
of the tear, a portion of meniscus may be removed or alternatively the meniscus
may be repaired. Fortunately, open incisions for joint surgery are no long used.
Dr. C.W. Cassells, a human orthopedic surgeon, in his 1987 article "The Early
Days of Arthroscopy," wrote: "In the United States, diagnostic arthroscopy and
even more important, arthroscopic surgery constitute what is probably the
outstanding achievement in orthopedic surgery in the past decade." The same
statement could be made for arthroscopic surgery in thehorse. Use of the
arthroscope for diagnosis of equine joint disease commenced in the mid-1970s,
while performing surgery under arthroscopic visualization began in the late
1970s. By 1984, both diagnostic and surgical arthroscopy were being performed
clinically in the horse with arthroscopic techniques completed successfully in
the carpus (knee), fetlock, hock and stifle joints, with techniques for other
joints following shortly thereafter. Currently, arthroscopy is used to diagnose
and treat diseased joints more successfully than with incisional techniques used
earlier.
During arthroscopic surgery in the horse, a complete examination of as much of
the joint as can be visualized is completed first. Even though radiographs may
have detected a fracture fragment or an obvious OCD lesion, it is common for the
surgeon to find other changes or injuries with the arthroscope. The advent of
arthroscopic surgery techniques gained more prominence for this procedure once
Spend a Buck won the 1985 Kentucky Derby by six lengths, just five months after
arthroscopic surgery for removal of a small fracture fragment in his knee.
Diagnostic arthroscopy is a critical part of every surgical procedure and also
in joints such as the femorotibial joint in the stifle where the arthroscope is
used to detect problems that cannot be diagnosed with radiographs or ultrasound.
Arthroscopic techniques have now been developed to treat all joint conditions in
the horse. Descriptions of diagnostic and surgical arthroscopy were first
detailed in textbook form in 1984. The use of arthroscopic surgery combined with
screw fixation of third carpal slab fractures was reported in 1986 and its use
to treat medial condyle cysts of the femur in these small medial femorotibial
joints of the horse was originally described in 1987. Techniques for arthroscopy
of the shoulder to treat OCD were also described in 1987. By 1990, arthroscopy
was also being performed on the distal interphalangeal, proximal interphalangeal,
elbow, femorotibial and hip joints, as well as being used in tendon sheaths.
More importantly, success rates have been defined based on retrospective studies
with large numbers of cases for these common conditions.
Arthroscopy is a good example of how research into new techniques can help
provide improved diagnostic techniques and treatments for horses. Though some of
the information on human arthroscopy was used to help develop the technique for
horses, the techniques and procedures used today were developed through research
and collaboration among researchers and clinicians. New knowledge about joint
injury and arthritis has also been made possible with the use of arthroscopy. It
is important for horse owners to understand that this type of research requires
funding for dedicated investigators to make new discoveries that can be applied
to medical care for the horse.
More than 50 joints and conditions can now be operated on arthroscopically. For
a complete list, visit
http://www.aaep.org/equine_research_co_group.htm.
The veterinary community needs your assistance to increase funding for research
joint disease and other equine diseases. Please contact the Grayson-Jockey Club
Research Foundation (www.grayson-jockeyclub.org),
the American Quarter Horse Foundation (www.aqha.com/foundation),
the Morris Animal Foundation (www.morrisanimalfoundation.org),
the American Association of Equine Practitioners Foundation (www.aaepfoundation.org)
or your favorite veterinary school to make a contribution.
This is just one of the many efforts that the AAEP is coordinating on behalf of
the industry through the Equine Research Coordination Group (ERCG), which is
comprised of researchers and organizations that support equine research.
Formally organized in 2006, the ERCG has a mission of advancing the health and
welfare of horses by promoting the discovery and sharing of new
knowledge, enhancing awareness of the need for targeted research, educating the
public, expanding fundraising opportunities and facilitating cooperation among
funding agencies.
By C. Wayne McIlwraith, BVSc, PhD, DSc, FRCVS, Diplomate ACVS
The ERCG is a group comprised of researchers and organizations that support
equine research. Participants in the ERCG include equine foundations and
multiple university research representatives. Current participants include: the
AAEP Foundation, American Horse Council, AQHA Foundation, Grayson-Jockey Club
Research Foundation, Maxwell H. Gluck Equine Research Center, Morris Animal
Foundation, Havemeyer Foundation, United States Equestrian Federation Foundation
and university researchers: Rick Arthur, DVM; Noah Cohen, VMD, MPH, PhD, Dipl.
ACVIM (Texas A & M University); Gregory Ferraro, DVM (University of
California-Davis); Eleanor Green, DVM, DACVIM, DAVBP (University of Florida);
Joan Hendricks, VMD, PhD, Dipl. ACVIM (University of Pennsylvania); Richard
Mansmann, VMD, PhD (North Carolina State University); C. Wayne McIlwraith, BVSc,
PhD, DSc, FRCVS, Dipl. ACVS (Colorado State University); James Moore, DVM, PhD,
Dipl. ACVS (University of Georgia); Rustin Moore, DVM, PhD, Dipl. ACVS (The Ohio
State University); Corinne Sweeney, DVM, Dipl. ACVIM (University of
Pennsylvania); and Nathaniel White II, DVM, MS, Dipl. ACVS (Virginia
Tech/University of Maryland).
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