A Randomized, Self-Controlled Case Series Evaluating Core Osteostixis of Osseous Cyst-Like Lesions of the Navicular Bone to Improve Lameness in Horses with Podotrochlear Syndrome.
Authors: Brock, Greer, Honnas, Gilleland, Barrett, Moore, Cohen
Journal: Veterinary medicine (Auckland, N.Z.)
Summary
Podotrochlear syndrome remains a significant challenge in equine lameness management, particularly in Quarter Horses, as conventional medical therapy and soft tissue–focused surgery often fail to address bony pathology such as navicular bone oedema and osseous cyst-like lesions visible on MRI. Brock and colleagues conducted a randomized, self-controlled trial on seven treatment-resistant horses, surgically treating one randomly assigned forelimb with navicular bursoscopy combined with core osteostixis (needle perforation of the lesion) whilst the contralateral limb received bursoscopy alone, with blinded lameness assessment and repeat MRI at 24 weeks post-operatively. The osteostixis group demonstrated significantly greater lameness improvement compared to bursoscopy-only controls (P = 0.0254), suggesting the technique addresses the osseous pathology contributing to clinical signs. However, three of seven osteostixis-treated limbs developed new deep digital flexor tendon tears versus one in the control group, warranting careful consideration of this complication risk. For practitioners managing chronic podotrochlear cases refractory to conservative management, core osteostixis presents a potentially valuable surgical option, though informed consent regarding DDFT injury risk and further investigation into technique refinement remain essential before widespread adoption.
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Practical Takeaways
- •Core osteostixis shows promise for improving lameness in horses with navicular bone cyst-like lesions when combined with bursoscopy, offering a surgical option for cases resistant to conservative management
- •The technique carries a notable risk of iatrogenic DDFT tears (43% in this series), which must be discussed with owners and weighed against lameness improvement benefits
- •This technique requires advanced imaging (MRI) for diagnosis and surgical expertise; further research is needed before widespread adoption in practice
Key Findings
- •Core osteostixis combined with navicular bursoscopy significantly reduced lameness scores compared to bursoscopy alone (P = 0.0254) in Quarter Horses with navicular cyst-like lesions
- •New DDFT tears occurred in 3 of 7 limbs (43%) treated with core osteostixis versus 1 of 7 limbs (14%) treated with bursoscopy alone
- •Seven Quarter Horses with bilateral MRI-confirmed osseous cyst-like lesions that had failed standard medical management were included in this self-controlled trial