Arthroscopy is a minimally invasive surgical technique that can be used to accurately explore and treat issues in virtually any joint in the horse.
Arthroscopic surgery generally involves two very small (8mm) keyhole incisions. The first incision is where the surgeon will insert the arthroscope, which is an instrument with a small surgical grade camera installed that allows a complete, clear view of the interior jointsurface. The second small incision is created to insert the surgical instrument to perform the procedure.
Such surgery is used to treat a broad range of injuries in the joint. Chip fracture removal is a procedure that is particularly commonly in both young Warmbloods with developmental disease and racehorses working at high speeds. A small chip fracture is something that can cause persistent irritation in the joint, as well as arthritis, if left untreated and is best removed immediately so that no further damage is created. The surgeon can easily go into the joint, remove the chip, and clean up the cartilage underneath. Most horses heal quickly and return to their normal athletic activity.
Other uses for arthroscopic surgery are meniscal disease in the stifle, subchondral cystic lesions, primary cartilage lesions, and debridement of damaged tendinous/ligamentous tissue (such as deep digital flexor tendon tears in the navicular bursa). Anything from the Temporomandibular Joint (TMJ) of the head to the navicular bursa within the hoof capsule can be explored and treated with this minimally invasive approach.
“Arthroscopy is a preferred treatment measure because it is so minimally invasive that most of those horses get right back to sport,” said Dr Weston Davis, one of three Board-Certified surgeons at Palm Beach Equine Clinic in Wellington, Florida.
“In a normal scenario, we thoroughly explore the joint with the arthroscopic camera, we remove a chip or repair a lesion, and the horse is never lame after surgery. Because of the small incisions, there is minimal aftercare and horses are often back to work quickly,” he said.
Almost all arthroscopies are performed under general anesthesia with the horse on its back. New renovations at Palm Beach Equine Clinic include a set of stocks of adjustable height adjacent to a surgeon’s pit, allowing the surgeons to have eye-level access to the joint they are working on, enabling many new procedures on the legs of standing horses.
“In many horses, we consider arthroscopy as a prophylactic measure, intervening after injury, but before the development of a generalized degenerative arthritic cycle ensues,” Davis said.
“Arthroscopy is definitely something that you want to do early in the game if you feel like the horse has joint disease, or a chip, or cartilage disease, or an undefined injury that is not responding appropriately to medical therapy. Arthroscopy can be curative for some of these horses. But if you do not intervene early on in the course of the disease and there is already advanced arthritis, then you have missed your window.”
Minimally invasive surgery allows for a simple and quick recovery for the horse. After traditional surgery, a horse would be on stall rest with a bandage on until the sutures come out at two weeks, and then start doing some light hand walking and physical therapy. Barring severe damage in the joint or associated tendon/ligament disruption, most cases will undergo a six-week rest and rehabilitation protocol, then return to normal work.
Depending on the injury type, digital radiographs, ultrasound, MRI, and Nuclear Scintigraphy, or a combination thereof, may be used for pre-operative diagnosis and planning. Ultrasound and digital radiography are available for intra-operative use. The Palm Beach Equine Clinic is also looking to add intra-operative CT scanning to its range of diagnostic tools.