Arthroscopic laser extirpation of metacarpophalangeal synovial pad proliferation in eleven horses

Abstract

Summary A new surgical technique for treatment of chronic metacarpophalangeal synovial pad proliferation in the horse and the findings and long‐term follow‐up from 11 clinical cases are described. The medical records of all equine lameness cases attributed to metacarpophalangeal synovial pad proliferation admitted to the College of Veterinary Medicine at Cornell University (1991–1996) were reviewed and all those treated surgically by laser extirpation were included in this study. Retrieved data included subject details, preoperative lameness, ultrasonography, radiography and synovial fluid evaluations and lesion histopathology. Lesions were ablated using a CO2 or a Nd:YAG laser intra‐articularly with arthroscopic guidance. Long‐term follow‐up was provided by telephone conversation with owners or trainers. All horses had fetlock joint effusion and were lame at presentation. Mean synovial pad thickness measured ultrasonographically was 9.0 mm (range 6–15 mm). Seven horses (64%) had radiographic evidence of remodelling of the dorsal cortex of distal McIII and 3 horses (27%) had concurrent dorsal proximal P1 fractures. No postoperative complications were noted. All 11 horses returned to training within 90 days of surgery without recurrence of the lesion(s). Laser extirpation of metacarpophalangeal synovial pad proliferation using arthroscopic guidance provided a rapid, safe and efficient method for surgical removal of such lesions without complications or recurrence. This surgical technique provides a suitable alternative to more conventional treatments for chronic metacarpophalangeal synovial pad proliferation in horses, particularly for removal of very large, fibrotic masses.

Severe supracondylar lysis of the third metatarsal bone due to intra‐articular haemorrhage with similarities to human pigmented villonodular synovitis: A differential diagnosis to intra‐articular neoplasia

“…; Rose ; Dabareiner et al . ; Murphy and Nixon ). Proliferation of the synovial pad is a condition that is reported to affect the forelimb MCPJ exclusively and is predominantly seen in horses used for racing (Dabareiner et al .…”

Diagnostic and Surgical Arthroscopy of the Metacarpophalangeal and Metatarsophalangeal Joints

“…The condition initially designated as villonodular synovitis (Nickels et al, 1976) and later described as chronic proliferative synovitis (van Veenendaal & Moffatt, 1980;Kannegieter, 1990) is seen in the metacarpophalangeal joint. It involves a proliferative response from the synovial pad (plica) in the proximal dorsal aspect of the joint and, therefore, the term synovial pad fibrotic proliferation (Dabereiner et al, 1996) is preferred.…”

“…Originally the condition was demonstrated with contrast arthrography and treated with arthrotomy (Nickels et al, 1976;Haynes, 1980). Neither contrast arthrography nor arthrotomy are used anymore because of the development of ultrasound examination in diagnosis (Steyn et al, 1989) and arthroscopic surgery for treatment.…”

“…Arthroscopically guided CO 2 or an Nd:YAG laser extirpation of metacarpophalangeal synovial pad proliferation has been described in 11 horses (Murphy and Nixon, 2001). Mean synovial pad thickness, measured ultrasonographically, was 9 mm, and 7 (64%) of the horses had radiographic evidence of remodeling of the dorsal cortex of distal McIII; 3 horses (27%) had concurrent dorsal fragmentation of the proximal phalanx.…”

Sinovite proliferativa crônica da articulação metacarpofalangiana em equinos: relato de caso

“…As lesões erosivas observadas na cortical óssea resultam, segundo Kannegieter (1990), da necrose causada pela compressão da massa nodular sobre o terceiro metacarpo. Uma outra teoria afirma que a concavidade produzida é resultante de crescimento de tecido sinovial por meio do forame vascular do osso (Nickels et al, 1976). Figura 1.…”