Arthroscopy is a technique used by equine surgeons to evaluate and treat disease within joints. Similar techniques are also used to evaluate and treat disease within tendon sheaths (known as tenoscopy) and bursae (bursoscopy). A narrow, rigid instrument called an endoscope is placed through a small incision (~1cm) to examine the inside of a joint, tendon sheath, or bursa. The image is then transmitted to a camera for viewing on a monitor. Specially designed surgical instruments are passed through separate small incisions to assist in treatment of disease within these structures.
- Osteochondral ‘chip’ fragments (Figure 1): Osteochondral fragments, also known as ‘chips’ are small pieces of bone and cartilage that result from small fractures within the articular surfaces of joints. They are usually due to repetitive trauma or repetitive exercise. When these fragments are small enough, they can be removed using arthroscopy, however some are big enough that they should be repaired within the joint using arthroscopic guidance.
- Osteochondrosis dissecans (Figure 2): Osteochondrosis dissecans, also known as “OCD”, is a developmental disease that occurs during the formation of bones. This is a common disease in horses however the cause is not completely understood. This disease leads to the formation of fragments within joints and can lead to joint effusion and swelling, lameness, and arthritis. Arthroscopy is used to remove OCD fragments and evaluate the overall health of the joint.
- Bone cysts (Figure 3A, 3B): Subchondral bone cysts can also arise after a disruption in the normal development of bones and joints. These lesions are usually seen on the weight-bearing surface of bones within joints and can result in lameness and joint effusion. Arthroscopy can be used to evaluate and treat these types of lesions depending on their location within the joint.
Infections of a joint, tendon sheath, or bursa: Infections can develop within synovial structures (joints, tendon sheaths, bursae) due to a bacterial spread from the bloodstream, due to wounds or lacerations into these structures, or rarely after injection of these structures. Arthroscopy, tenoscopy, and bursoscopy can be used to perform lavage or ‘flushing’ of these structures to remove bacteria, debris, and inflammatory products. These procedures can also be used to evaluate the overall health of the cartilage and other structures within the joint, tendon sheath, or bursa.
Soft tissue injuries that occur within joints, tendon sheaths, and bursae such as tendon tears, ligament tears, meniscal tears, adhesions, and synovial masses can also be evaluated and treated using arthroscopy, tenoscopy, or bursoscopy.
Arthroscopy can also be used to assist in reduction and repair of intra-articular fractures (Figure 4)
Alternate procedures/techniques: Prior to the use of arthroscopy, the above conditions would be treated by an “open” technique called an arthrotomy. This was done by making large incisions into joints, tendon sheaths, or bursas. Because arthroscopy has become more readily available, has decreased complication rates and faster healing times, it is the treatment of choice for these conditions & typically arthrotomies are not recommended for most conditions in horses anymore.
Prior to the use of arthroscopy, the above conditions would be treated by an “open” technique called an arthrotomy. This was done by making large incisions into joints, tendon sheaths, or bursas. Since arthroscopy has become more available, it is the treatment of choice for these conditions & typically arthrotomies are not recommended for most conditions in horses anymore.
Utilizes smaller incisions (~1 cm)
Easier post-operative incision care
Decreased risk of infection
Less lay-up time, quicker return to work
- Not all surgeries can be done arthroscopically
- Requires specialized equipment and facilities
- Requires advanced training for the veterinary surgeon