Comparison of a dorsolateral approach and a dorsomedial approach to access the medial malleolus of the distal tibia in horses.

This research investigates two surgical approaches to access a part of the horse’s lower leg, the medial malleolus, via the tarsocrural joint. It concludes that the dorsolateral approach is effective and provides an improved view without any interference between surgical instruments.

Objective and Methodology

• The main goal of this study was to compare the effectiveness and convenience of a dorsolateral arthroscopic approach to the tarsocrural joint (TCJ) for examining and surgically accessing the medial malleolus (MM) – an area in the horse’s lower leg. In comparison, the standard dorsomedial approach was used to access the same part of the equine limb.
• This research was conducted as an experimental cadaver study, using six pelvic limbs acquired from four adult horse cadavers.
• The researchers performed an arthroscopic examination of the dorsal side of the TCJ, followed by the dorsomedial and dorsolateral surgical approaches to the MM, in randomized order, on the collected cadaver limbs.
• In the dorsomedial approach, both the arthroscope and surgical instrument were placed in the dorsomedial pouch, while in the dorsolateral approach, the arthroscope was placed dorsolaterally and the instrument dorsomedially.
• The researchers assessed and recorded identification and surgical access grades for the MM for each approach.

Findings

• With the dorsomedial approach, identification grades were excellent for the MM, and the surgical access to the MM was evaluated as excellent or good in all limbs.
• The dorsolateral approach, however, showed excellent results both in MM identification and surgical access in all limbs tested. Additionally, no interference occurred between the arthroscope and the surgical instrument when using the dorsolateral method, which was noticed in the dorsomedial approach.
• The view of the axial aspect of the MM also improved with the dorsolateral approach, indicating it could be easier for surgeons to observe and operate in this region.

Conclusions

• The study concludes that the dorsolateral approach allows for better identification and surgical access to the MM. Furthermore, it provides an improved view of the axial aspect of the MM without any interference between the surgical instrument and arthroscope.
• This makes the dorsolateral approach a potentially useful and effective method for debridement (removal of damaged tissue or foreign objects) of MM OCD (Osteochondritis Dissecans) lesions in horses.