Comparison Between Computed Tomographic Arthrography, Radiography, Ultrasonography, and Arthroscopy for the Diagnosis of Femorotibial Joint Disease in Western Performance Horses

Abstract

The femorotibial joints are a common source of lameness in Western performance horses. The objective of this prospective study was to compare the radiography, ultrasonography, computed tomographic arthrography (CTA), and arthroscopy findings in horses with lameness localized to the femorotibial joints. Twenty-five stifles in 24 horses were included and were evaluated with all four of these diagnostic methods. Defects detected in femorotibial joint structures were compared between diagnostic methods using a McNemar's test to evaluate for disagreement. Cranial medial meniscotibial desmopathy was most detected on arthroscopy (in 14/25 cases) and was only detected on ultrasonography in three out of 11 (27.3%) arthroscopically observed cases, but was detected on CTA in nine out of 12 (75%) arthroscopically observed cases. Medial meniscal injury located on the craniolateral border was most detected on arthroscopy (n = 9) and was detected on CTA in five cases, but on ultrasonography in 0 cases. Detection of articular cartilage defects on the medial femoral condyle was most detected with arthroscopy (24/25, 96% cases) and was also detected on CTA in 12/20 (60%) cases with a significant disagreement identified between modalities (P = 0.02). Cranial and caudal cruciate ligament defects were detected on CTA in 6/22 (27.3%) and 7/19 (36.8%) cases, respectively, and with arthroscopy in 3/25 (12%) and 2/25 (8%) cases, respectively. The use of CTA detected more defects in the cruciate ligaments, proximal tibia, and ligament entheses than the other diagnostic methods, but was not reliable for detection of articular cartilage damage on the medial femoral condyle.

Recent advances in articular cartilage evaluation using computed tomography and magnetic resonance imaging

“…There is a significantly higher detection of focal surface bone production (e.g. enthesophytes or osteophytes) on CT compared with radiography . This difference is particularly notable with smaller areas of bone change; for example central osteophytes are detected in the metacarpophalangeal joint with CT and MRI but not on radiography .…”

“…This difference is particularly notable with smaller areas of bone change; for example central osteophytes are detected in the metacarpophalangeal joint with CT and MRI but not on radiography . Subchondral bone defects, sclerosis and lysis (including cystic lesions) are also easily detected on CT and are associated with lameness .…”

“…Use of CECT has been explored in normal and diseased synovial structures in the horse, although in vivo CTA studies are currently exclusive to the stifle . Despite thick articular cartilage, the firm apposition between cartilage and the meniscus required during CTA positioning complicated identification of mild cartilage defects . This challenge in evaluating two opposing articular surfaces is also recognised in the metacarpophalangeal joint .…”

Highlights of recent clinically relevant papers

“…The objective of this prospective study by Brad Nelson and colleagues in the USA was to compare the radiography, ultrasonography, computed tomographic arthrography (CTA), and arthroscopy findings in Western performance horses with lameness localised to the femorotibial joints .…”

Computed tomography angiography on the stifle region of the sheep

“…Angiographic studies can be used to diagnose a variety of vascular diseases of the digits and hoof in the cattle, such as regional thrombosis, alter circulation in the dermis, undeveloped arterial arches and little or no arterial enlargement in corium coronae (Gantke et The diagnosis of osteoarthritic changes has been made by detecting the joint cartilage defects of the trochlea femoris, kneecap, lateral and medial condyles of tibia and femur, cruciate ligament defects, meniscus injuries in sheep and horses. CT arthrography is recommended as a convenient imaging diagnostic method (Hontoir et al, 2017;Nelson et al, 2016). The surgery of femoropatellar and femorotibial joints in the sheep is still being developed in order to refine the least invasive method with the least possible post-operative complications (Orth and Madry, 2013).…”