An alternative, direct approach for arthroscopic removal of osteochondral fragments in the dorsal pouch of the proximal intertarsal joint of horses

Compagnie E, Drumm NJ, de Heer N, Ter Braake F. Vet Surg. 2016 Feb; 45 (2):1 82-6.

OBJECTIVE: To describe an alternative technique and resulting outcomes for arthroscopic removal of osteochondral (OC) fragments from the proximal intertarsal joint (PIJ) using a direct approach without resection of the membrane between the tarsocrural joint (TCJ) and the PIJ.

STUDY DESIGN: Retrospective case series.

ANIMALS: Client owned horses (n = 11) with Category 1 OC fragments in the PIJ.

METHODS: Arthroscopic examination of the dorsal pouch of the TCJ was performed with horses positioned in dorsal recumbency using routine portals. A hook probe placed through one of the standard portals was used to lift the edge of the communication between TCJ and PIJ to help pass the arthroscope into the PIJ from the opposite standard portal. A third direct portal into the PIJ was created under arthroscopic visualization, and loose OC fragments (Category 1) were removed using the direct portal. Medical records, race records, and owner surveys were reviewed for case details and outcome.

RESULTS: The described technique allowed removal of all fragments in all 11 cases. No complications associated with the procedure were observed. Of the 9 horses with long term follow-up available, 7 were used as intended (4/4 riding horses, 3/5 racehorses). Two horses did not enter an athletic career because of reasons unrelated to fragment removal.

CONCLUSION: A direct approach for arthroscopic removal of OC fragments of the PIJ using a third portal into this joint, without resection of the membrane between the TCJ and PIJ is a good alternative for removal of fragments at this site.