Outcome of palmar/plantar digital neurectomy in horses with foot pain evaluated with magnetic resonance imaging: 50 cases (2005-2011).

REASONS FOR PERFORMING STUDY: There is limited knowledge of the foot lesions that influence the outcome of palmar/plantar digital neurectomy (PDN). OBJECTIVES: 1) To report the short- and long-term outcomes of horses that underwent PDN to alleviate chronic foot pain due to lesions diagnosed by magnetic resonance imaging (MRI) and 2) factors that may influence the outcome of PDN. STUDY DESIGN: Multicentre retrospective study. METHODS: Medical records of 50 horses subjected to PDN due to chronic foot pain were reviewed. Age, breed, sex, athletic activity, duration of lameness, affected limb(s), response to anaesthesia of the palmar/plantar digital nerves, MRI findings and surgical technique were analysed together with follow-up data to identify factors that influenced the long-term outcomes. RESULTS: Forty-six of 50 horses (92%) responded positively to surgery; 40 (80%) were able to return to their previous athletic use for a median time of 20 months (range: 12-72 months). Eighteen (36%) horses developed post operative complications including residual lameness, painful neuromas, or early recurrence of lameness. Horses with pre-existing core or linear lesions of the deep digital flexor tendon (DDFT) had significantly shorter periods of lameness resolution after surgery than horses with dorsal border lesions of the DDFT or other foot lesions. CONCLUSIONS: Palmar/plantar digital neurectomy can improve or resolve lameness in horses with foot pain unresponsive to medical therapy without serious post operative complications. However, horses with core or linear lesions of the DDFT should not be subjected to PDN as these horses experience residual lameness or early recurrent lameness after surgery. Magnetic resonance imaging can be used to identify these horses.

Comparison of radiofrequency treatment and mechanical debridement of fibrillated cartilage in an equine model.

OBJECTIVE: To compare a radiofrequency energy (RFE) prototype probe to mechanical debridement (MD) and a commercially available RFE system used for chondroplasty in the treatment of an experimentally created partial thickness cartilage lesion in horses. The study design was experimental, randomized complete block, n=8, using fifteen mature ponies. METHODS: Grade 2 to 3 cartilage lesions were prepared in both patellae. After 10 months duration, the injuries were used to study the effects of MD, a commercially available bipolar RFE device (CoVac 50; ArthroCare Corporation) and a prototype monopolar RFE device (Smith & Nephew Endoscopy). Six months after treatment the patellae were examined for chondrocyte viability and cartilage structure. RESULTS: Mean depth of cell death was significantly different among groups (controls, MD

Comparison of mechanical debridement and radiofrequency energy for chondroplasty in an in vivo equine model of partial thickness cartilage injury.

OBJECTIVE: The purpose of this study was to develop a long-term model of cartilage injury that could be used to compare the effects of radiofrequency energy (RFE) and mechanical debridement as a treatment. METHODS: Partial thickness fibrillation of patellar cartilage was created in 16 mature ponies. Three months after the initial surgery all injured patellae were randomly selected to receive one of the four treatments (n = 8/treatment): (1) control, (2) mechanical debridement with a motorized shaver, (3) TAC-CII RFE probe, and (4) CoVac 50 RFE probe. The ponies were euthanized 22 months after treatment. Macroscopic appearance of the cartilage surface was scored, vital cell staining was used to determine chondrocyte viability and light microscopy was used to grade the morphometric changes within the cartilage. Mechanical properties (aggregate modulus, Poisson's ratio and permeability) also were determined and compared to normal uninjured cartilage. RESULTS: There were no differences in the cartilage surface scores among the treatment groups and control samples (P > 0.05). The maximum depth of cell death and the percentage of dead area in control and mechanical debridement groups were significantly less than those in both RFE groups. There were no significant differences in maximum depth and the percentage of dead area between the two RFE treatment groups. Histologic scores demonstrated better cartilage morphology for the control and mechanical debridement groups than those of RFE groups. However, even with full thickness chondrocyte death, the matrix in the RFE treated sections was still retained and the mechanical properties of the treated cartilage did not differ from the mechanical debridement group. CONCLUSION: RFE caused greater chondrocyte death and more severe morphological changes compared to untreated degenerative cartilage and mechanical debridement in this model.

Arthrodesis of the equine proximal interphalangeal joint: a biomechanical comparison of three 4.5-mm and two 5.5-mm cortical screws.

OBJECTIVE: To compare the biomechanical characteristics and mode of failure of 2 parallel-screw techniques for proximal interphalangeal joint arthrodesis in horses. STUDY DESIGN: Randomized block design, blocking for horse (1-5), method of screw fixation (three 4.5-mm vs two 5.5-mm), side (left limb vs right limb), and end (front limb vs hind limb). Constructs were loaded to failure in 3-point bending in a dorsal-to-palmar (plantar) direction. SAMPLE POPULATION: Twenty limbs (10 limb pairs) from 5 equine cadavers. METHODS: A combined aiming device was used to facilitate consistent screw placement. Three parallel 4.5-mm cortical screws were placed in lag fashion in 1 limb of a pair, and 2 parallel 5.5-mm cortical screws were placed in lag fashion in the contralateral limb. Arthrodesis constructs were tested in 3-point bending in a dorsal-to-palmar (plantar) direction using a materials-testing machine. Loading rate was 19 mm/s. Maximal bending moment at failure and composite stiffness were obtained from bending moment-angular deformation curves. Data were analyzed using ANOVA and chi(2) analysis. RESULTS: There were no significant differences in bending moment (P >.05, power = 0.8 @ delta = 19%) or composite stiffness (P >.05, power = 0.8 @ delta = 19%) between the 2 fixation techniques. Higher maximal bending moment was found in front limbs than hind limbs, and front limbs with two 5.5-mm screws than hind limbs with two 5.5-mm screws. In all cases, constructs completely failed. A greater number of 4.5-mm cortical screws failed than 5.5-mm cortical screws. CONCLUSIONS-In pastern arthrodesis constructs loaded in 3-point bending, end (front limb vs hind limb) affected maximal bending moment at failure of constructs. There was no significant effect of horse, treatment, or side on maximal bending moment or stiffness. Two 5.5-mm cortical screws should provide a surgically simpler pastern arthrodesis than three 4.5-mm cortical screws while maintaining similar biomechanical characteristics. CLINICAL RELEVANCE: Three 4.5-mm screws or two 5.5-mm screws will provide similar biomechanical characteristics in bending when performing equine pastern arthrodesis.

Histomorphometric description of allograft bone remodeling and union in a canine segmental femoral defect model: a comparison of rhBMP-2, cancellous bone graft, and absorbable collagen sponge.

The purpose of this study was to determine the effect of recombinant human bone morphogenetic protein type 2 (rhBMP-2) on the histomorphometry of femoral allograft-host bone union and allograft remodeling. A 6 cm mid-diaphyseal femoral defect was created and filled with an allograft stabilized with an interlocking nail in 21 dogs. Dogs were randomly divided into three equal groups and the allograft-host bone junctions and the mid-diaphyses of the allografts were treated with either an absorbable collagen sponge (ACS) loaded with rhBMP-2 (BMP group), an autogenous cancellous bone graft (CBG group), or ACS loaded with buffer solution (ACS group). All dogs received daily tetracycline until sacrifice at 24 weeks to label new bone formation. Histomorphometric analyses on sections of proximal and distal allograft-host bone junctions and the mid-diaphyseal portion of allografts were performed using fluorescent and regular light microscopy. Analyses of the host bone and junctions between allograft and host bone revealed significantly greater new bone formation and larger osteon radii in the BMP group compared to CBG and ACS groups and contralateral intact bone. Porosity in CBG and ACS groups was significantly higher than in the BMP group, which had similar values to intact bone. In transverse sections of allografts, the largest pore diameters were present in the CBG group. Based on all parameters measured, significantly higher bone turnover occurred in the outer cortical area of the allograft in all groups as compared to the inner cortical and mid-cortical areas. New bone formation and osteon radius/osteon width in allografts were similar for all three groups. Higher porosity and larger pore diameters in the CBG and ACS groups suggested higher bone resorption versus formation in these groups compared to the BMP group. The results of this study reveal more balanced allograft bone resorption and bone formation in the BMP group, with greater resorptive activity in the CBG and ACS groups. However, neither rhBMP-2 nor autogenous bone graft increased allograft incorporation when compared to the negative control (ACS group).

Effect of bipolar radiofrequency energy on human articular cartilage. Comparison of confocal laser microscopy and light microscopy.

PURPOSE: To evaluate chondrocyte viability using confocal laser microscopy (CLM) following exposure to bipolar radiofrequency energy (bRFE) and to contrast CLM with standard light microscopy (LM) techniques. TYPE OF STUDY: In vitro analysis using chondromalacic human cartilage. METHODS: Twelve fresh chondral specimens were treated with the ArthroCare 2000 bRFE system (ArthroCare, Sunnyvale, CA) coupled with 1 of 2 types of probes and at 3 energy delivery settings (S2, S4, S6). A sham-operated group was treated with no energy delivered. Specimens were analyzed for chondrocyte viability and chondral morphology with CLM using fluorescent vital cell staining and with LM using H&E and safranin-O staining. RESULTS: LM with H&E staining showed smoothing of fine fronds of fibrillated cartilage; thickened fronds were minimally modified. Chondrocyte nuclei were present and not morphologically different than nuclei within sham-operated and adjacent untreated regions. LM with safranin-O staining showed a clear demarcation between treated and untreated regions. CLM, however, showed chondrocyte death: the depth and width of chondrocyte death increased with increasing bRFE settings. CONCLUSIONS: CLM showed that bRFE delivered through the probes investigated created significant chondrocyte death. These changes were not apparent using LM techniques.

Thermal chondroplasty with radiofrequency energy. An in vitro comparison of bipolar and monopolar radiofrequency devices.

The purpose of this study was to examine the in vitro effects of three radiofrequency energy devices (two bipolar devices and one monopolar device) for the performance of thermal chondroplasty. Thirty-two fresh bovine femoral osteochondral sections (approximately 3 x 4 x 5 cm) from eight cows were divided into four groups (three treatment patterns and one sham-operated group with eight specimens per group). The three treatment patterns consisted of 1) radiofrequency energy delivered by a mechanical jig at 1 mm/sec in a contact mode (50 g of pressure), 2) radiofrequency energy delivered by a mechanical jig at 1 mm/sec in a noncontact mode (1 mm between probe tip and articular cartilage surface), and 3) radiofrequency energy smoothing of abraded cartilage during arthroscopic visualization. Thermal smoothing of the abraded cartilage surface was accomplished with all three devices. Significant chondrocyte death, as determined by confocal laser microscopy and cell viability staining, was observed with each device. The bipolar radiofrequency systems penetrated 78% to 92% deeper than the monopolar system. The bipolar systems penetrated to the level of the subchondral bone in all osteochondral sections during arthroscopically guided paintbrush pattern treatment. Radiofrequency energy should not be used for thermal chondroplasty until further work can establish consistent methods for limiting the depth of chondrocyte death while still achieving a smooth articular for thermal chondroplasty until further work can establish consistent methods for limiting the depth of chondrocyte death while still achieving a smooth articular surface.

The effect of monopolar radiofrequency treatment pattern on joint capsular healing. In vitro and in vivo studies using an ovine model.

The purpose of this study was to compare joint capsular healing after two delivery patterns of monopolar radiofrequency energy: 1) uniform treatment of the joint capsule (paintbrush pattern) and 2) multiple single linear passes (grid pattern). First, an in vitro study was performed to compare the percent shrinkage of these two treatment patterns using the femoropatellar joints (stifles) of six sheep. Monopolar radiofrequency energy (settings, 70 degrees C/15W) was applied to the lateral joint capsule; the treated area was approximately 10 x 10 mm. There was no significant difference in shrinkage between the grid (27% +/- 8.7%) and paintbrush (29% +/- 7.9%) patterns. In the in vivo study, stifles of 24 sheep were randomly assigned to the paintbrush or the grid pattern groups and treatment was performed arthroscopically. Sheep were sacrificed immediately after surgery, or at 2, 6, or 12 weeks after surgery. At 6 weeks after surgery, confocal microscopy demonstrated that treated areas had almost completely repaired in the grid group; some nonviable areas were still present in the paintbrush group. Mechanical testing at 6 weeks indicated that joint capsule in the grid group had better mechanical properties than capsule in the paintbrush group. This study revealed that radiofrequency treatment of joint capsule in a grid pattern allowed faster healing than tissue treated in a paintbrush pattern.

The effect of monopolar radiofrequency energy on partial-thickness defects of articular cartilage.

PURPOSE: To evaluate the effect of monopolar radiofrequency (RF) energy on partial-thickness defects of articular cartilage, comparing the outcome of partial-thickness defects treated with monopolar RF energy with that of treatment by conversion of partial-thickness defects to full-thickness defects by curettage and microfracture. TYPE OF STUDY: Randomized trial using adult female sheep. MATERIALS AND METHODS: Thirty-six sheep were used in this study. Both stifles in each animal were randomly assigned to 1 of the following 3 procedures: (1) partial-thickness defect without any treatment to serve as a sham-operated control, (2) partial-thickness defect with RF energy treatment, and (3) partial-thickness defect treated by conversion of the defect to a full-thickness defect by curettage and microfracture. Nine sheep were euthanized at 0, 2, 12, and 24 weeks after surgery (n = 6 per group). After euthanasia, cartilage samples were harvested from the defect sites, and chondrocyte viability was analyzed by confocal laser microscopy using a triple-labeling technique. Cartilage samples also were decalcified and stained with hematoxylin and eosin and safranin-O for histologic analysis. Surface properties of cartilage samples were analyzed using scanning electron microscopy. RESULTS: The analysis of chondrocyte viability showed that RF treatment caused death of almost all chondrocytes in the defect. Histologic analysis showed that RF treatment caused detrimental effects to chondrocytes and proteoglycan concentration that progressed over time, and that full-thickness defects were repaired by fibrocartilage by 24 weeks after surgery. Scanning electron microscopy analysis indicated that RF-treated groups were significantly smoother and less irregular than control groups at 2, 12, and 24 weeks after surgery. CONCLUSIONS: This study showed that monopolar RF energy caused long-term damage to cartilage in this sheep model and did not appear to have the beneficial effects reported in a previous study that evaluated application of this technique using a bipolar RF probe.

Calciphylaxis: a rare limb and life threatening cause of ischaemic skin necrosis and ulceration.

Calciphylaxis (uraemic gangrene syndrome) is a rare complication of chronic renal failure and secondary hyperparathyroidism. Patients present with painful purple skin lesions which undergo necrosis and ulceration. The histology is specific. There is medial calcification with intimal hyperplasia and thrombosis of the lumen of small sized arteries in the underlying subcutaneous tissue. Death frequently arises from overwhelming sepsis. Early recognition of this condition and prompt parathyroidectomy can lead to rapid relief of symptoms and ulcer healing and may be life saving.

Human interphotoreceptor matrix contains serum albumin and retinol-binding protein.

It is usually assumed that IRBP (interphotoreceptor retinoid-binding protein) is the only protein present in the interphotoreceptor matrix (IPM) capable of shuttling visual-cycle retinoids between photoreceptors and the retinal pigment epithelium. However, this laboratory previously presented qualitative evidence (Western blots) that serum albumin is present in human IPM. Furthermore, Ong and coworkers (1994) found that cultured RPE cells synthesize serum retinol-binding protein (RBP) and secrete it, mainly into the apical culture medium, which would correspond to the IPM in intact eyes. As both of these proteins can bind all- trans -retinol and 11- cis -retinal, it was of interest to quantify the amounts of albumin and RBP in human IPM. We used radial immunodiffusion to accomplish this. The average molar ratio of serum albumin to IRBP in these samples was 1.9; that of RBP to IRBP was 0.015. The presence of a high concentration of serum albumin in the IPM in situ was confirmed by the intense immunohistochemical staining seen in sections of fresh human eyes. The human case is not unique; various concentrations of albumin were found in the IPM of all vertebrate species examined (by gel electrophoresis). These results indicate that both serum albumin, because of its very high concentration in the IPM, and RBP, because of its comparatively tight binding to retinoids, need to be considered, along with IRBP, as proteins that may participate in visual-cycle transport. The accompanying paper addresses this concern.

IRBP enhances removal of 11- cis -retinaldehyde from isolated RPE membranes.

Interphotoreceptor retinoid-binding protein (IRBP) greatly enhances the conversion of all- trans -retinol to 11- cis -retinal by the retinal pigment epithelium (RPE) and facilitates 11- cis -retinal release from the RPE. However, the mechanisms by which IRBP exerts these effects are not clear. Using a model system of purified bovine IRBP and isolated bovine RPE membranes, we investigated the possibility that IRBP may favor the delivery of all- trans -retinol to, or the release of 11- cis -retinal from, RPE membranes. As the interphotoreceptor space contains serum retinol-binding protein (RBP) and serum albumin in addition to IRBP, we similarly examined the exchange of retinoids between RPE membranes and human RBP or bovine serum albumin (BSA). Isolated RPE membranes were loaded with radioactive 11- cis -retinal and incubated with solutions of IRBP, RBP, BSA or with buffer alone. Membranes (pellet) and retinoid-binding protein or buffer (supernatant) were separated by centrifugation and analysed for radioactive 11- cis -retinal. Membranes incubated with buffer alone released only 4-5% of their 11- cis -retinal, while 25 microm IRBP removed 18-35%. More retinal was released as the membrane concentration was reduced. In contrast, RBP and BSA removed little retinal, even though both proteins are capable of binding this retinoid. Similar results were obtained with bovine liver membranes, consistent with the idea that the effects of IRBP do not depend on an RPE surface receptor for IRBP. IRBP was also markedly superior to RBP and BSA in removing all- trans -retinol from RPE membranes. In addition, IRBP efficiently delivered bound all- trans -retinol to membranes; however, in contrast to their differential removal of retinoids, all three binding proteins delivered comparable amounts of retinol to membranes. (This result supports the practice of using BSA as a retinoid carrier in in vitro experimental systems). We conclude that, whereas IRBP shares with other retinoid-binding proteins the ability to deliver retinol to membranes, IRBP is unique in its capacity to remove 11- cis -retinal from membranes. This may be the feature of IRBP that drives the vitamin A cycle to efficiently produce 11- cis -retinal.

Intramuscular desmoid tumor (musculoaponeurotic fibromatosis) in two horses.

Intramuscular desmoid tumors (musculoaponeurotic fibromatosis) were discovered in two young adult horses. The tumor in one horse was in the lateral cervical musculature, and that in the second horse occurred in the pectoral musculature. Histopathologic features were similar in both horses and included proliferation of fibroblasts and cells expressing muscle actin (myofibroblasts), with extensive dissecting fibrosis within muscle. These features are similar to those of desmoid tumors in humans, particularly those also known as musculoaponeurotic fibromatosis. Dissection of these lesions revealed a single central (horse No. 1) or multiple central (horse No. 2) fluid-filled cavities with associated sterile inflammation. The presence of these cavities supports the hypothesis that equine desmoid tumors are traumatic in origin, possibly occurring at sites of injections or bursal rupture. Surgical excision of the tumor in horse No. 1 was apparently curative, but the extent of the tumor in horse No. 2 precluded surgical excision.