Arthroscopic approach to the subextensorius recess of the lateral femorotibial joint of the foal.
Authors: Hennessy Simon E, Cudmore Lucy, Jackson L Paige, Vasey James R, Russell Thomas
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Septic arthritis of the lateral femorotibial joint in foals presents a clinical challenge, particularly when infection involves the difficult-to-access subextensorius recess where debris and infected material can accumulate despite arthroscopic lavage via conventional portals. Hennessy and colleagues developed an arthroscopic technique by first mapping the anatomy of this recess in 32 cadaveric foal limbs, then validating a safe surgical approach through 13 additional cadaver specimens before applying the method clinically. The optimal portal was established craniolaterally, 8–10 cm distal to the tibial plateau, positioned immediately caudal to the peroneus tertius muscle and directed through the long digital extensor to reach the distal subextensorius recess; crucially, no iatrogenic damage to the peroneus tertius or peroneal nerve occurred in any of the 13 dissected limbs. In their retrospective series of 8 foals treated for lateral femorotibial sepsis using this approach, six resolved their infection completely and returned to soundness at follow-up beyond nine months, with only two requiring euthanasia. This work provides equine surgeons with a safe, anatomically validated technique for achieving complete drainage of a joint compartment that conventional approaches cannot adequately address, improving outcomes in what remains one of the most time-sensitive conditions in foal orthopaedics.
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Practical Takeaways
- •This arthroscopic approach provides a safe, reproducible method for accessing and treating lateral femorotibial joint infections in foals with favorable long-term outcomes
- •Precise anatomical landmark identification (8-10 cm distal to tibial plateau, craniolateral approach caudal to peroneus tertius) minimizes risk of neurovascular complications
- •Early arthroscopic intervention for foal femorotibial joint sepsis appears effective, with 75% of cases resolving and returning to soundness
Key Findings
- •Safe arthroscopic portal to the distal subextensorius recess of the lateral femorotibial joint is located 8-10 cm distal to tibial plateau, craniolaterally, immediately caudal to peroneus tertius muscle
- •Cadaveric dissection of 13 limbs post-surgery demonstrated no iatrogenic damage to peroneus tertius muscle or peroneal nerve using this approach
- •Of 8 foals with lateral femorotibial joint sepsis treated arthroscopically, 6 achieved sepsis resolution with all 6 remaining sound at follow-up >9 months