Arthroscopic approach to the subextensorius recess of the lateral femorotibial joint of the foal.

The research focuses on developing an arthroscopic technique to access the subextensorius recess of the lateral femorotibial (LFT) joint in foals, and applying this approach to treat sepsis in the LFT joint. The results demonstrate that it is possible to safely access this area in foals and successfully treat sepsis.

Study Design and Methods

• The study is divided into two parts: an anatomic study and a retrospective case series. Both parts were designed to understand the anatomy of the subextensorius recess and treat sepsis in the LFT joint, respectively.
• The first part used cadaveric hind limbs from 32 foals for anatomical delineations and 13 for simulated surgeries. These exploratory surgeries helped in understanding the approach to the subextensorius recess.
• The second part of the study included real-life applications of this procedure in eight foals suffering from LFT joint sepsis. The medical history and data from these foals were closely scrutinized and analyzed.

Procedure and Results

• The LFT joint was expanded and analyzed through ultrasound imaging. After this, a designated dissection procedure was employed to identify landmarks, potential portals for the arthroscopic procedure, and to assess any damage post-surgery.
• The optimal entry point to access the subextensorius recess was determined to be craniolaterally, 8-10 cm away from the tibial plateau. The entry should be immediately behind the peroneus tertius muscle, passing through the muscle belly of the long digital extensor muscle and entering the distal section of the subextensorius recess. This approach, tested on 13 limbs, did not cause any damage to the peroneus tertius muscle or the peroneal nerve.
• In the case series of foals with LFT joint sepsis, two foals had to be euthanized. However, in six of the foals, sepsis was successfully treated and all of these foals were in good health even 9 months after the surgery.

Conclusion

• The study concludes that it is possible to safely access the subextensorius recess in foals. The arthroscopic approach developed in the study has significant potential and application in the treatment of LFT joint sepsis. This finding and the subsequent development of arthroscopic technique could bring about advancements in veterinary surgery for foals.