Direct arthroscopic approach to the distal pouch of the palmar/plantar recess of the metacarpophalangeal/metatarsophalangeal joint in horses.
Authors: Foucaud Mathieu, Haegeman Liesbeth, Kadic Dimitri, Vinardell Tatiana, Mariën Tom, Declercq Jeroen
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Fragments within the distal pouch of the palmar/plantar recess of the fetlock joint have historically presented a surgical challenge due to the anatomical complexity of this region; researchers at this institution developed and validated a novel direct arthroscopic approach on cadaveric specimens before applying it clinically to improve visualisation and fragment retrieval. The technique was evaluated retrospectively across 25 fetlock joints in 23 horses, with all animals undergoing pre-operative orthopaedic assessment and intra-operative documentation of cartilage damage and synovial inflammation. Complete removal of free-floating fragments was achieved in all cases; however, post-operative evaluation revealed inflammation in every joint examined, with 18 of the 25 (72%) demonstrating varying degrees of cartilage pathology, indicating that fragment presence correlates with significant articular surface changes. The direct approach proves safe and effective for accessing the distal pouch, which may be particularly valuable for treating chip fractures and osteochondral fragments in this notoriously difficult-to-access region, though practitioners should counsel owners that pre-existing cartilage damage is common even when fragments are removed promptly. This technique expands the arthroscopic toolkit available for fetlock pathology and provides evidence supporting early surgical intervention to prevent progressive joint degeneration.
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Practical Takeaways
- •This new direct approach offers a safer and more effective method for removing fragments from the distal pouch of the fetlock compared to previous arthroscopic techniques
- •Early fragment removal may help limit progressive joint damage, as inflammation and cartilage changes were present in all examined joints
- •Consider this technique for horses presenting with fetlock joint disease where imaging confirms free-floating fragments in the palmar/plantar recess
Key Findings
- •A direct arthroscopic approach to the distal pouch of the palmar/plantar recess of the fetlock was successfully developed and clinically applied in 25 joints from 23 horses
- •All 25 free-floating fragments were successfully removed using this technique
- •Signs of inflammation were present in all 25 operated joints, with cartilage damage observed in 18 of 25 fetlocks (72%)