VCS809TendonLigamentDiseases_2023.pptx

Equine and Bovine Tendon/Ligament Disorders Timothy B. Lescun BVSc, MS, PhD, Diplomate ACVS Professor of Large Animal Surgery Contact Details    Office: G406 – large animal hospital E-mail: [email protected] Phone: 494-6653 – office What will we cover? Anatomy, Injury and Healing SDF tendinitis...

Equine and Bovine Tendon/Ligament Disorders Timothy B. Lescun BVSc, MS, PhD, Diplomate ACVS Professor of Large Animal Surgery Contact Details    Office: G406 – large animal hospital E-mail: [email protected] Phone: 494-6653 – office What will we cover? Anatomy, Injury and Healing SDF tendinitis DDF tendinopathy Suspensory desmitis Flexural deformities Lacerations Ruptures Luxations Microscopic anatomy Microscopic anatomy Relaxed (crimp) Tensioned (no crimp)  Definitions: o o o o o o o tendon / tendinitis ligament / desmitis tendon sheath / tenosynovitis paratenon annular ligament strain – partial fiber disruption rupture – complete failure; loss of function Healing  ???? Healing  Inflammation  prolonged Healing  Inflammation  Debridement  Dense collagen - slow Healing  Inflammation  Debridement  Repair  Proliferative phase  Fibroplasia Healing  Inflammation  Debridement  Repair  Maturation  Remodeling phase  Realignment of fibers Healing  Inflammation  Debridement  Repair  Maturation  Slow / type 3 collagen  Type 1 collagen increases slowly  Sparse blood supply  Low cellular activity SDF tendinitis  common athletic injury  undetectable low grade tearing  major injuries  diagnosis “Bowed tendon” Tendon ultrasonography  Good equipment  Understand principles  Know the anatomy  Measure  length of lesion  cross-sectional area  Echogenicity  Save images SDF tendinitis – type 1 SDF tendinitis – type 2 SDF tendinitis – type 3 SDF tendinitis – type 4 Treatments (basic medical)  REST, REST, REST, REST, REST  REHABILITATION, REHABILITATION….  Anti-inflammatory drugs  Cold therapy  Pressure / support bandaging  Platelet rich plasma (PRP)  ECSW therapy  Stem cell / bone marrow injection Treatments (other medical)  Platelet rich plasma (PRP)  ECSW therapy  Cold laser  Amnion / matrix products  Stem cell / bone marrow injection  More coming B o n Stem e m a r r o w i n cells and other treatments Mesenchymal stem cells Re-injury rate = 27% 2 years follow up Anti-inflammatory effects of stem cells??? J Orth Res, 2010 24 wks Treated PRP Placebo treated control PRP treatment - 80% return to use in 12 months, 60% in 24 months Saline treatment – 50% return to use in 12 months, 50% in 24 months Treatments (surgical)  Superior check ligament desmotomy - 10 - 25% improvement  Palmar annular ligament desmotomy - constriction  Tendon splitting - acute Vs. chronic Prognosis Multiple factors – Lesion severity – Age – Previous athletic history – Rehabilitation DDF Tendinitis – cannon region Deep Digital Flexor Tendinitis Pastern and foot Associated with “Navicular syndrome” Ultrasound MRI Deep Digital Flexor Tendinitis 11yo Paint Horse Suspensory ligament desmitis  common in S’breds and performance horses  3 areas:  Origin  mid-body  branch  REST  Similar treatment options to tendon injuries  Fasciotomy/neurectomy is a surgical option Tendon lacerations  Examine the whole horse  Examine the whole wound  To suture or not to suture  Debride, lavage, immobilize & protect  Consider the loss of function when immobilizing/stabilizing Extensor tendons  Common digital extensor tendon  Long digital extensor tendon  Lateral digital extensor tendon  Prognosis usually favourable Flexor tendons  Serious, life threatening injuries (80% survival)  SDF tendon  DDF tendon  Suspensory ligament Flexor tendons From: Theoret & Schumacher, Equine Wound Management, 3rd Ed., 2017 Flexor tendons  Treatment  Wound debridement  Suture tendons?  Antimicrobials Cast for immobilization - ideal  Tendon sheath? Carpal / tarsal sheath?  Prognosis is guarded for use when complete transection is present Flexor tendons Ruptured tendons  Suspensory apparatus  Reciprocal apparatus  Extensor tendons  Foals  Diseased tendons  DDFT  Pre-pubic tendon Ruptured tendons - suspensory Ruptured tendons - CDET Ruptured tendon - Prepubic Flexural deformities Flexor tendon laxity foals and calves S D F t e n d o n o f f Luxated tendons SDF tendon luxation surgery Questions? London – Parliament on Thames Magna Carta