Multimodality scoring of chondral injuries in the equine fetlock joint ex vivo.

This research investigates a prototype multimodal arthroscope that combines ultrasound, optical coherence tomography (OCT), and arthroscopic indentation for assessing cartilage lesions in the horse fetlock joint. The study finds that OCT imaging augmented with automated software provides the most reliable lesion scoring, but limitations in light penetration restrict its application in evaluating human cartilage thickness.

Study Design and Methods

• The researchers selected areas of interest from equine fetlock joints and evaluated them independently by two equine surgeons using both a conventional arthroscope and the multimodal arthroscope.
• The multimodal arthroscope had high-frequency ultrasound and OCT catheters attached to it, and cartilage stiffness was measured with an indentation device. OCT images were also scored with the aid of custom software.
• All measurements and scorings were performed twice in two separate sessions, and the scores were later compared with histological International Cartilage Repair Society (ICRS) scores.

Key Findings

• The results showed that OCT and arthroscopic examinations provided the highest average agreement between surgeons’ and histology scores, while ultrasound achieved the lowest.
• Conventional arthroscope achieved the highest intraobserver and interobserver agreement, followed closely by ultrasound, OCT, and automated software.
• Even though OCT imaging supplemented with automated software rendered the most dependable lesion scoring, OCT’s limited light penetration depth hinders its application in determining human cartilage thickness.

Conclusions and Implications

• The results suggest that employing imaging techniques to thoroughly analyze the entire articular surface can help eliminate variability stemming from surgeons’ selection of the most severe lesions.
• Given the limitations of each modality, the use of both OCT and ultrasound could offer a more reliable diagnostic approach. However, further research is needed to validate the effectiveness and practicality of this combination in clinical settings.