Needle tenoscopy of the digital flexor tendon sheath in a standing equine cadaver model using a novel approach and guided palmar/plantar annular ligament desmotomy.
- Journal Article
Summary
The research paper evaluates the practicality of using needle tenoscopy—a minimally invasive procedure—to study the digital flexor tendon sheath (DFTS) in standing equine cadaver limbs. It also assesses the effectiveness of the procedure in performing guided surgeries and reports on related damages.
Research objective and methodology
In this experimental study, the scientists focused on the following objectives:
- To evaluate the feasibility of needle tenoscopy using two unique approaches—basisesamoid (BS) and proximolateral (PL)—for analyzing the DFTS.
- To report on the visualization of intrathecal DFTS anatomy achieved through both approaches.
- To determine the efficacy of needle scope-guided palmar/plantar annular ligament (PAL) desmotomy, a surgical procedure for tendon issues.
- To document any iatrogenic (caused by the treatment process itself) damage linked with the procedure.
The scientists used ten equine cadaver limbs in this study. They placed the limbs in a Kimzey leg-saver splint and the procedure was performed using the BS and PL approaches. Following the exploratory needle tenoscopy, a needle scope-guided PAL desmotomy was performed. The limbs were then dissected and checked for the presence of iatrogenic damage and completeness of the PAL desmotomy.
Key findings
The researchers found that:
- Performing needle tenoscopy of the DFTS on a standing model is viable from both the BS and PL approaches.
- Excellent visualization of vital intrathecal anatomy within the fetlock canal was achieved through both approaches (p ≤ .001) with minimal iatrogenic damage.
- The PL approach allowed for the visualization of more structures compared to the BS approach (p = .025).
- All the PAL desmotomies were successfully completed, with no associated iatrogenic damage.
Conclusions
The study concluded that needle tenoscopy of the DFTS in a standing model yielded excellent visualization of the intrathecal sites within the fetlock canal and enabled a complete PAL desmotomy. The method can therefore be used to assess the DFTS and guide PAL desmotomy in a standing horse.
Cite This Article
Publication
Researcher Affiliations
- The Philip Leverhulme Equine Hospital, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Liverpool, UK.
- The Philip Leverhulme Equine Hospital, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Liverpool, UK.
- The Philip Leverhulme Equine Hospital, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Liverpool, UK.
- The Philip Leverhulme Equine Hospital, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Liverpool, UK.
References
- Denoix JM. The equine fetlock. 2000:243‐341.
- Arensburg L, Wilderjans H, Simon O, Dewulf J, Boussauw B. Nonseptic tenosynovitis of the digital flexor tendon sheath caused by longitudinal tears in the digital flexor tendons: a retrospective study of 135 Tenoscopic procedures. Equine Vet J 2011;43(6):660‐668.
- Cender AN, Mählmann K, Ehrle A, Merle R, Pieper L, Lischer CJ. Diagnosis and outcome following Tenoscopic surgery of the digital flexor tendon sheath in German sports and pleasure horses. Equine Vet J 2023;55(1):48‐58.
- Smith MR, Wright IM. Noninfected tenosynovitis of the digital flexor tendon sheath: a retrospective analysis of 76 cases. Equine Vet Educ 2006;38(2):134‐141.
- Thünker F, Oosterlinck M, Vanderperren K, Martens A. Long‐term results of Tenoscopic treatment of lesions in the digital flexor tendon sheath: a retrospective study of fifty horses. Vlaams Diergeneeskd Tijdschr 2019;88(1):9‐18.
- Wilderjans H, Boussauw B, Madder K, Simon O. Tenosynovitis of the digital flexor tendon sheath and annular ligament constriction syndrome caused by longitudinal tears in the deep digital flexor tendon: a clinical and surgical report of 17 cases in warmblood horses. Equine Vet J 2003;35(3):270‐275.
- Wright IM, McMahon PJ. Tenosynovitis associated with longitudinal tears of the digital flexor tendons in horses: a report of 20 cases. Equine Vet J 1999;31(1):12‐18.
- Findley JA, De Oliveira F, Bladon BM. Tenoscopic surgical treatment of tears of the Manica Flexoria in 53 horses. Vet Surg 2012;41(8):924‐930.
- Fiske‐Jackson AR, Barker WH, Eliashar E, Foy K, Smith RK. The use of intrathecal analgesia and contrast radiography as preoperative diagnostic methods for digital flexor tendon sheath pathology. Equine Vet J 2013;45(1):36‐40.
- Kent AV, Chesworth MJ, Wells G. Improved diagnostic criteria for digital flexor tendon sheath pathology using contrast Tenography. Equine Vet J 2020;52(2):205‐212.
- Fortier LA, Nixon AJ, Ducharme NG, Mohammed HO, Yeager A. Tenoscopic examination and proximal annular ligament Desmotomy for treatment of equine “complex” digital sheath tenosynovitis. Vet Surg 1999;28(6):4290‐4435.
- Hibner‐Szaltys M, Cavallier F, Cantatore F, Withers JM, Marcatili M. Ultrasonography can Be used to predict the location of Manica Flexoria tears in horses. Equine Vet Educ 2023;35(3):200‐207.
- Marcatili M, Cantatore F, Hibner‐Szaltys M, Withers JM. Static, dynamic and non‐weightbearing ultrasound evaluation of the digital flexor tendon sheath improves sensitivity and specificity of Manica Flexoria tears diagnosis in cobs and ponies. Equine Vet Educ 2024;36(2):74‐81.
- Daniel AJ, Leise BS, Selberg KT, Barrett MF. Enhanced ultrasonographic imaging of the equine distal limb using saline injection of the digital flexor tendon sheath: a cadaver study. Vet J 2019;247:26‐31.
- Shanklin AJ, Baldwin CM, Ellesmere L, Stack JD. Computed tomographic contrast tenography aids pre‐operative diagnosis in clinical conditions of the digital flexor tendon sheath. Equine Vet Educ 2024;36(4):197‐205.
- Aßmann AD, Ohlerth S, Torgerson PR, Bischofberger AS. Sensitivity and specificity of 3 tesla magnetic resonance imaging and multidetector computed tomographic Tenography to identify artificially induced soft tissue lesions in the equine cadaveric digital flexor tendon sheath. Equine Vet Educ 2023;35(7):507‐516.
- Bonilla AG. Standing needle arthroscopy of the metacarpophalangeal and metatarsophalangeal joint for removal of dorsal osteochondral fragmentation in 21 horses. Vet Comp Orthop Traumatol 2019;32(5):420‐426.
- Frisbie DD, Barrett MF, McIlwraith WC, Ullmer J. Diagnostic stifle joint arthroscopy using a needle arthroscope in standing horses. Vet Surg 2014;43(1):12‐18.
- Kadic DT, Miagkoff L, Bonilla AG. Needle arthroscopy of the radiocarpal and middle carpal joints in standing sedated horses. Vet Surg 2020;49(5):894‐904.
- Pérez‐Nogués M, Vaughan B, Phillips KL, Galuppo LD. Evaluation of the caudal cervical articular process joints by using a needle arthroscope in standing horses. Vet Surg 2020;49(3):463‐471.
- Canola PA, Cardenas JJ, Sá GC, de Paula VB. Needle arthroscopy of the scapulohumeral joint and bicipital Bursa in horses: an ex vivo study. J Equine Vet Sci 2021;101:103432.
- Morgane P, Bonilla AG. Diagnostic needle arthroscopy of the scapulohumeral joint in standing sedated horses. Vet Surg 2021;50(1):29‐37.
- Miagkoff L, Bonilla AG. Diagnostic Tenoscopy of the carpal sheath with a needle arthroscope in standing sedated horses. Vet Surg 2020;49(1):38‐O44.
- Mählman K, Koch C, Bodó G. Diagnostic endoscopy of the navicular Bursa using a needle endoscope by direct or Transthecal approach: a comparative cadaver study. Vet Surg 2015;44(7):816‐824.
- Barnes HK, Sinovich M, Baldwin CM, Gillen A, Stack JD. Ex vivo pilot study evaluating needle Tenoscopy of the digital flexor tendon sheath and its suitability to assist palmar annular ligament transection. Equine Vet Educ 2023;35(8):417‐423.
- McIlwraith WC, Nixon AJ, Wright IM. Tenoscopy. 2014:344‐386.
- Horne CR, Redding WR, Ru H, Schnabel LV. Ultrasound‐guided proximolateral approach for digital flexor tendon sheath injection in the horse: a cadaver study. Vet Comp Orthop Traumatol 2019;2(2):37‐43.
- Baldwin CM, Morgan RE, Crawford AL, Villarino NF, Rubio‐Martínez LM. Gross, computed tomographic, and endoscopic anatomy of the equine carpal extensor tendon sheaths. Vet Surg 2022;51(1):202‐213.
- Johnston GM, Eastment JK, Wood J, Taylor PM. The confidential enquiry into perioperative equine fatalities (CEPEF): mortality results of phases 1 and 2. Vet Anaesth Analg 2002;29(4):159‐170.
- McGhee JD, White NA, Goodrich LR. Primary Desmitis of the palmar and plantar annular ligaments in horses: 25 cases (1990‐2003). J Am Vet Med Assoc 2005;226(1):83‐86.
- Espinosa P, Nieto JE, Snyder JR, Galuppo LD, Katzman SA. A novel ultrasonographic assisted technique for Desmotomy of the palmar/plantar annular ligament in horses. Vet Surg 2017;46(5):611‐620.
- De Gasperi D, Guo D, Lu Y, Brounts SH. Ex vivo evaluation of a percutaneous thread‐transecting technique for Desmotomy of Normal palmar/plantar annular ligaments in horses. Vet Surg 2023;52(3):388‐394.
- Owen K, Dyson S, Parkin T, Singer E, Kristoffersen M, Mair T. Retrospective study of palmar/plantar annular ligament injury in 71 horses: 2001–2006. Equine Vet J 2008;2008(40):237‐244.