Arthroscopic removal of osteochondral fragments in the dorsal pouch of the proximal intertarsal joint in 29 horses.
Authors: Espinosa-Mur Pablo, Coté Nathalie, Desjardins Marc R
Journal: Veterinary surgery : VS
Summary
Osteochondral fragments (OCF) in the proximal intertarsal joint (PIJ) present a diagnostic and surgical challenge, particularly given their frequent association with osteochondritis dissecans lesions in the overlying tarsocrural joint—a pattern observed in 27 of the 29 horses studied. Espinosa-Mur and colleagues reviewed surgical records from 32 tarsi with radiographically confirmed PIJ fragments, documenting arthroscopic removal via a technique centred on capsular resection of the proximal intertarsal joint to access fragments typically located distal to the medial trochlear ridge of the talus. All fragments were successfully retrieved, with only minor intraoperative complications (moderate bleeding in three cases) and one instance of postoperative swelling managed conservatively; notably, a third arthroscopic portal was required in just three tarsi to address fragments positioned distal to the lateral ridge. Among the 16 horses with documented long-term outcomes, all resumed training or returned to competitive use, suggesting the procedure carries acceptable risk. Whilst the technical approach proves effective and reproducible, the authors appropriately acknowledge that the true clinical significance of PIJ fragments—particularly whether they warrant intervention in asymptomatic cases—remains undefined and warrants further investigation.
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Practical Takeaways
- •Arthroscopic fragment removal from the PIJ via capsule resection is a reliable surgical technique with good functional outcomes; expect most horses to return to work
- •When imaging OCD in the tarsocrural joint, scrutinize the proximal intertarsal joint carefully as fragments frequently migrate between these adjacent articulations
- •This procedure typically involves minimal complications, though be prepared for moderate intra-articular bleeding in some cases when capsule resection is performed
Key Findings
- •93% of horses (27/29) with PIJ osteochondral fragments also had radiographic evidence of OCD lesions in the tarsocrural joint
- •Fragments were most commonly located distal to the medial trochlear ridge of the talus
- •Arthroscopic retrieval via proximal intertarsal joint capsule resection was successful in all 32 tarsi treated
- •16 of 16 horses with long-term follow-up (100%) returned to training or athletic careers with only minor postoperative complications