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1.
Reasons for performing study: Injuries of the calcaneal insertions of the superficial digital flexor tendon and their relationship to displacement of the tendon from the calcaneus have not previously been reported. Objectives: To describe findings made on clinical cases with disruption of the calcaneal insertions of the superficial digital flexor tendon (SDFT) including observations on their role in horses with unstable subluxation of the tendon. To describe novel surgical techniques and the results of treatment. Hypotheses: Disruption of the calcaneal insertions of the SDFT is associated with lameness and distension of the calcaneal bursa. Unstable displacement of the SDFT from the calcaneus is a more complex injury than incomplete disruption of one of its calcaneal insertions. Methods: The case records and diagnostic images of horses with lesions involving the calcaneal insertions of the SDFT, which were confirmed by endoscopic evaluation of calcaneal bursa between 2005 and 2009, were reviewed. Results: Nineteen horses were identified including 7 that had unstable displacement of the tendon from the calcaneus. Following endoscopic surgery, 9 of 12 horses with stable tendons and 6 of 7 horses with unstable displaced SDFTs returned to work. Conclusion: Tearing of the calcaneal insertions of the SDFT is associated with lameness and distension of the calcaneal bursa; endoscopic removal of the torn tissue carries a good prognosis. Horses with unstable displacement of the tendon have also disruption of the tendon fibrocartilage cap. Removal of this results in stable subluxation and can return horses to athletic activity. Both lesions can be detected by preoperative ultrasonography. Potential relevance: Tearing of the calcaneal insertions of the SDFT should be included in the differential diagnoses of lame horses with distended calcaneal bursae. Tearing of the tendon fibrocartilage cap in horses with unstable displacement of the SDFT is a plausible explanation of the clinical features of the injury and explains previously unreliable results of reconstructive surgeries. Subtotal resection is a technically demanding technique but appears to offer an improved prognosis.  相似文献   

2.
Despite the great progress in the field of tendon injuries and chronic tendinopathies in recent years, treatment of these conditions is still challenging. Research utilising animal models is crucial for further advancement in tendon research, with the rabbit being a commonly used species in this field. The objective of the present study was to comprehensively describe the macro‐ and microanatomy of the common calcanean tendon (tendo Achillei), together with associated structures. Eight female New Zealand rabbits were subjected to anatomical dissection and histologic analysis, revealing significant species‐specific features. The soleus muscle presented a thin, spindle shape with no tendon of insertion and attached directly to the lateral gastrocnemius muscle. Therefore, it does not contribute to the formation of the common calcanean tendon. The calcaneal tendon of the semitendinosus muscle was identified as a strong tendinous band at the medial side of the medial gastrocnemius muscle and the superficial digital flexor muscle and tendon distally. The saphenous artery was accompanied by the medial saphenous vein and characteristic accessory medial saphenous vein. The complex structure of the paratendinous connective tissue is described, with the paratenon being contiguous with the epitenon of the individual tendons and epimysium of associated muscles. At the level of the calcaneal tuber, the retromalleolar fat pad was identified, adhering to the cranial surface of the conjoint gastrocnemius tendon. Histologic studies confirmed the presence of the subtendinous calcaneal bursa of superficial digital flexor tendon and the bursa of calcaneal tendon.  相似文献   

3.
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4.
OBJECTIVE: To correlate quantitative analysis of ultrasonographic images of normal (injury-free) equine superficial digital flexor (SDF) tendons and equine SFD tendons that have pathologic changes with corresponding histologic sections. SAMPLE POPULATION: 4 SDF tendons, 2 of which had various stages of tissue integrity. The 2 ipsilateral tendons were used as points of reference. PROCEDURE: Tendons were mounted in a custom-made device that permitted sequential scanning, transversely and perpendicular to the tendon long axis. At precise steps of 0.5 mm, transverse ultrasonographic images were collected. Subsequently, tendons were fixed and prepared for histologic examination. The following 8 tissue types were discerned: normal young, normal old, necrotic, early granulation, late granulation, early fibrotic, late fibrotic, and scar tissues. In areas of interest, the corresponding ultrasonographic images were selected for gray level statistical analysis. RESULTS: Compared with other tissue types, early-stage granulation tissue was characterized by substantially lower mean gray level and a clearly different histogram. Necrotic tissue had a higher mean gray level, with a virtually normal histogram. In late granulation and early fibrotic tissues, the mean gray level and the histogram could not be discerned from those of normal tendon tissue. The same applied to late fibrotic and scar tissues; mean gray levels were fractionally lower than those of normal tendon tissue with a completely normal histogram. CONCLUSIONS: Although quantification of the transverse ultrasonographic image by use of first-order gray level statistics may be helpful, the method is not sufficiently sensitive to accurately and unequivocally determine the type of tendon tissue. Quantitative analysis should incorporate transverse and longitudinal information.  相似文献   

5.
Ultrasonographic examination is an essential diagnostic tool that complements radiographic examination in the diagnostic work-up of injury to the tuber calcanei area. Using a plantar approach, the superficial digital flexor tendon, gastrocnemius tendon, the bone surfaces of the two lobes of the tuber calcanei and the gastrocnemius bursa and the calcaneal bursa of the superficial digital flexor tendon (if distended) can be accurately assessed. Using a collateral approach, the tenocalcaneal ligaments of the superficial digital flexor tendon and the branches of the calcaneal tendon of the caudal femoral muscles can be imaged. This paper describes the normal anatomy of the tuber calcanei area and presents the complete ultrasonographic procedure and normal ultrasonographic images of this region.  相似文献   

6.
B‐mode ultrasound is an established imaging modality for evaluating canine tendon injury. However, full extent of tendon injury often remains difficult to estimate, as small changes in sonographic appearance are associated with large changes in biomechanical strength. The acoustoelastic strain gauge (ASG) is an ultrasound‐based tissue evaluation technique that relates the change in echo intensity observed during relaxation or stretching of tendons to the tissue's mechanical properties. This technique deduces stiffness gradient (the rate of change of normalized stiffness as a function of tissue strain) by analyzing the ultrasound dynamic images captured from gradually deforming tissue. ASG has been proven to accurately model strain and stiffness within tendons in vitro. To determine the feasibility and repeatability for in vivo ASG measurements of canine tendon function, stiffness gradients for the gastrocnemius tendons of 10 clinically normal dogs were recorded by two nonindependent observers at three sites (musculotendinous junction, mid tendon, and insertion). Average stiffness gradient indices (0.0132, 0.0141, 0.0136) and dispersion values (0.0053, 0.0054, 0.0057) for each site, respectively, were consistent with published mechanical properties for normal canine tendon. Mean differences of the average stiffness gradient index and dispersion value between observers and between limbs for each site were less than 16%. Using interclass coefficients (ICC), intra‐observer (ICC 0.79–0.98) and interobserver (ICC 0.77–0.95) reproducibility was good to excellent. Right and left limb values were symmetric (ICC 0.74–0.92). Findings from this study indicated that ASG is a feasible and repeatable technique for measuring stiffness gradients in canine tendons.  相似文献   

7.
Traumatic rupture of the calcaneal tendon was diagnosed in a 3-year-old female goat. Clinical features included tarsal hyperflexion and diffuse swelling in the area of the calcaneal tendon. Surgical repair consisted of debridement of devitalized tissue and transposition of the tendon of the peroneus longus muscle to bridge the calcaneal tendon defect. Adequate postoperative immobilization followed by gradual introduction of tendon loading allowed a favorable outcome.  相似文献   

8.
This study was designed to evaluate the normal anatomy of the digital flexor tendon sheath using contrast radiography and diagnostic ultrasound. Iodinated contrast medium was injected into eight cadaver limbs and the limbs immediately frozen. Lateromedial and dorsopalmar/plantar radiographs were made. These limps were then cut transversely and proximal to distal radiographs of each slab were made. This cross sectional contrast methodology allowed the visualization of the relative size and shape of the superficial and deep digital flexor tendons as well as the potential space taken by effusions of the digital flexor tendon sheath.
The second part of the study used twelve live animals with normal digital flexor tendon sheaths. Ultrasonographic measurement of the structures of the digital flexor tendon sheath at each level were compiled. This documented the ability of diagnostic ultrasound to image: 1) the superficial and deep digital flexor tendons, 2) the proximal and distal ring of the manica flexoria , 3) the straight and oblique sesamoidean ligaments, and 4) the mesotendinous attachments to the superficial and deep flexor tendons. Iodinated contrast medium was then injected into the digital flexor tendon sheath and the ultrasonography repeated. These images were compared with those obtained from contrast radiography and prosections of twenty normal limbs. The iodinated contrast medium enhanced sonographic imaging of the structures of the digital tendon sheath, particularly the abaxial borders of the superficial digital flexor tendon branches and the mesotendinous attachments to the superficial and deep digital flexor tendons.  相似文献   

9.
Muttini  A.  Mattioli  M.  Petrizzi  L.  Varasano  V.  Sciarrini  C.  Russo  V.  Mauro  A.  Cocciolone  D.  Turriani  M.  Barboni  B. 《Veterinary research communications》2010,34(1):117-120

An experimental protocol was designed to study the survival and behaviour of an allograft of amniotic epithelial cells (AECs) in an ovine model. The study was conducted on three healthy adult sheep. A core lesion was created in both calcaneal tendons under ultrasound (US) guidance by injecting 400 UI of Type 1A collagenase diluted in 0.6 ml saline. The AECs were obtained from a 60–80-day-old fetus and cultured under standard conditions. After 15 days of collagenase treatment, 2 × 106 AECs stained with a vital membrane fluorescent probe (PHK26) were injected under US guidance in 500 μl saline solution into the lesion of one limb. The contralateral untreated limb was used as a control. Animals were euthanatized 7 (1) and 30 (2) days later. Histological analyses performed on explanted tendons clearly demonstrate that AECs survived for at least 1 month inside the lesion without any adverse reactions. The damaged tissue of the treated tendons showed a high number of reparative cells in active proliferation that were accumulating collagen within the extracellular matrix. In addition, after 1 month, the neo-collagen began to be organized into parallel arrays of fibers oriented along the longitudinal axis of the tendon.

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10.
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11.
OBJECTIVES: To determine whether quantitative analysis of sonographic brightness could be used to detect healing of an induced injury of the superficial digital flexor tendon in horses and whether rate of healing was influenced by equine recombinant growth hormone. ANIMALS: 8 clinically normal Standardbreds. PROCEDURES: A localized injury was created in the left and right superficial digital flexor tendons of each horse by injection of 2,000 units of collagenase. After injury, 4 horses received equine recombinant growth hormone, a possible promoter of tendon healing. Sonographic images (7.5 MHz) of the flexor tendons and ligaments of the metacarpal region were recorded on videotape prior to injury and weekly for 7 weeks after injury. Images were digitized, and sonographic brightness of tendons and ligaments was calculated. RESULTS: Collagenase-induced injury was sonographically similar to naturally occurring injury. After injury, sonographic brightness of the tendon decreased; after 3 weeks, brightness progressively increased, although by 7 weeks brightness had not returned to preinjury value. Equine recombinant growth hormone had no significant effect on the rate of tendon healing, as evaluated sonographically or at necropsy. CONCLUSIONS AND CLINICAL RELEVANCE: As healing developed, alterations in sonographic brightness of injured tendons coincided with real changes in tendon structure. Quantitative sonographic brightness could be used to accurately monitor healing of equine tendon and ligament injuries and investigate the efficacy of various treatment regimens.  相似文献   

12.
Reasons for performing study: The assessment of a normal range for cross‐sectional area (CSA) of tendons in the tarsal region is important in order to use them as reference values in the identification of pathological changes of dimensions. Objectives: To provide normal reference values for the CSA of the tendons of the tarsus of Standardbred trotter horses (STH) by means of ultrasonography. Methods: Transverse echographic images of the tendons were obtained at different levels proximodistally; these images were digitised and CSA values (mean ± s.d.) were obtained for each structure. Results: The largest structure corresponded with the lateral digital flexor/caudal tibial tendon complex at Level 1 and the smallest was the medial digital flexor tendon at Level 4. Almost all tendons showed a slight decreasing in their CSA when crossing the tarsus. Conclusions: The normal CSA values of tendinous structures in the tarsal region of the STH are reported. These data could be used as anatomical references. Potential relevance: The establishment of reference values could serve as a tool to discriminate between normal and abnormal dimensions of tarsal tendons in STH. Other horse breeds should need their own reference values.  相似文献   

13.
OBJECTIVE: To evaluate effectiveness of computerized discrimination between structure-related and non-structure-related echoes in ultrasonographic images for quantitative evaluation of tendon structural integrity in horses. SAMPLE POPULATION: 4 superficial digital flexor tendons (2 damaged tendons, 2 normal tendons). PROCEDURE: Transverse ultrasonographic images that precisely matched histologic sections were obtained in fixed steps along the long axis of each tendon. Distribution, intensity, and delineation of structure-related echoes, quantitatively expressed as the correlation ratio and steadiness ratio , were compared with histologic findings in tissue that was normal or had necrosis, early granulation, late granulation, early fibrosis, or inferior repair. RESULTS: In normal tendon, the even distribution of structure-related echoes with high intensity and sharp delineation yielded high correlation ratio and steadiness ratio. In areas of necrosis, collapsed endotendon septa yielded solid but blurred structure-related echoes (high correlation ration and low steadiness ratio). In early granulation tissue, complete lack of organization caused zero values for both ratios. In late granulation tissue, reorganization and swollen endotendon septa yielded poorly delineated structure-related echoes (high correlation ratio, low steadiness ratio). In early fibrosis, rearrangement of bundles resulted in normal correlation ration and slightly low steadiness ratio. In inferior repair, the almost complete lack of structural reorganization resulted in heterogeneous poorly delineated low-intensity echoes (low correlation ratio and steadiness ratio). CONCLUSIONS AND CLINICAL RELEVANCE: The combination of correlation ratio and steadiness ratio accurately reflects histopathologic findings, making computerized correlation of ultrasonographic images an efficient tool for quantitative evaluation of tendon structural integrity.  相似文献   

14.
OBJECTIVE: To analyze the tendon of the deep digital flexor (TDDF) muscle of the forelimb in horses by use of a contrast radiographic agent (gadopentate dimeglumine [Gd-DTPA/Dimeg]) and magnetic resonance imaging (MRI) and to determine the concentration of water protons in the tendons by use of MRI. SAMPLE POPULATION: 8 TDDF harvested from the forelimbs of 6 horse cadavers. PROCEDURE: Examinations were performed on the same portion of each tendon. Tendons were examined by use of two techniques: MRI before and after treatment with Gd-DTPA/Dimeg as well as scanning electron microscopy. RESULTS: Tendons did not have detectable signal intensity on MRI before treatment with Gd-DTPA/Dimeg; however, intravascular injection of Gd-DTPA/Dimeg allowed evaluation of the internal structure of the tendons Scanning electron microscopy images correlated well with images obtained by use of MRI before and after administration of Gd-DTPA/Dimeg. Localized spectra revealed the concentration of water protons in the TDDF. CONCLUSIONS AND CLINICAL RELEVANCE: The techniques used in this study provided information about internal organization of the TDDF in horses. Analysis of results revealed that the best technique involved vascular injection of contrast medium. Results of MRI correlated well with results for scanning electron microscopy. After administration of Gd-DTPA/Dimeg, MRI provided additional information about tendon morphologic characteristics. This technique may be of value for examination of tendons in lame horses.  相似文献   

15.
A series of experimental tendon biopsies is described. Three biopsies were taken from the lateral digital extensor tendon (LDET) and three from the superficial flexor tendon (SFT). The LDET biopsies resulted in little discomfort whereas the SFT biopsies led to temporary lameness. The tendons were examined histologically up to 99 days after the biopsies were removed. In all of the tendons the defect filled with granulation tissue which subsequently became organised as a longitudinally orientated collagenous scar tissue. In this small series of biopsies the histological effects of the biopsy persisted longer in the SFT than in the LDET. It is concluded that tendon biopsy cannot be advocated for safe routine use in the horse.  相似文献   

16.
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17.
Objective —To describe endoscopic approaches to the calcaneal bursa and clinical findings in 2 horses with calcaneal bursitis.
Study Design —Cadaver evaluations and retrospective case reports.
Animals —12 cadavers and 2 adult horses.
Methods —Cadaver specimens of the calcaneal bursa were evaluated with a rigid arthroscope and gross dissection to determine the endoscopic appearance of anatomic structures located within the bursa. The site(s) for placement of the arthroscope and instrument(s) was determined based on cadaver dissection and endoscopic examination.
Results —Placement of the arthroscope 1 cm dorsal to the superficial digital flexor tendon (SDFT) and 1 cm distal to the medial or lateral aspect of the SDFT retinaculum allowed consistent examination of the tuber calcis, proximal aspect of the long plantar ligament, calcaneal tendon of the gastrocnemius muscle inserting on the tuber calcis, SDFT and the proximal and distal extent of the bursa. Lesions observed and treated with use of endoscopy included local bone necrosis of the proximoplantar aspect of the tuber calcis and damage of the origin of the long plantar ligament in one horse. Mild disruption of the superficial digital flexor tendon and long plantar ligament were observed and debrided in another horse.
Conclusions —Endoscopic exploration of the calcaneal bursa is clinically feasible to treat infectious and noninfectious bursitis and to help identify the cause(s) of undiagnosed bursitis or lameness associated with the calcaneus, superficial digital flexor tendon, tendon of the gastrocnemius muscle, and the long plantar ligament.
Clinical Relevance —An endoscopic approach to the calcaneal bursa is recommended whenever possible to decrease complications associated with surgery in this region and improve the diagnosis of infectious and non-infectious calcaneal bursitis.  相似文献   

18.
Using real-time ultrasound imaging, the normal anatomy of the soft tissues of the palmar aspect of the equine forelimb was examined. Sections of frozen specimens were prepared which correlated well with the ultrasound images. The superficial and deep digital flexor tendons, tendon sheaths, inferior check ligament (accessory ligament of the deep digital flexor tendon), suspensory ligament, contours of the apices of the proximal sesamoids and the intersesamoidean ligament, were identified.  相似文献   

19.
OBJECTIVE: To develop a method to discriminate between structure-related echoes and echoes resulting from interference, as observed in transverse ultrasonographic images of equine superficial digital flexor (SDF) tendons. SAMPLE POPULATION: 2 normal (injury-free) SDF tendons obtained from a 3-year-old Thoroughbred and a 9-year-old Dutch Warmblood horse. PROCEDURE: Tendons were mounted in a custom-made device that permitted exact transverse and perpendicular sequential scanning with precise steps of 0.5 mm along the long axis of the tendon. Photographs of transverse tendon sections at the exact scanning locations were obtained. Propagation, reflection, and refraction artifacts were quantified, and an image rectification procedure was developed, allowing exact matching of each photograph with the corresponding ultrasonographic image. A correlation routine was developed that departed from this transverse ultrasonographic image (position 0); this routine added information from images collected at precise distances of 0.5 and 1 mm on both sides of the actual scan location (positions -2, -1, +1, +2). RESULTS: By use of the correlation routine, echoes that remained steady over all 5 images were enhanced and resolved, and constantly changing echoes were multiplicatively reduced and faded. This correlated image could be projected over the rectified photograph, and the resolved echoes matched perfectly with the endotendon septa surrounding fibers and fasciculi. CONCLUSIONS AND CLINICAL RELEVANCE: The correlation routine permits exclusive resolution of structure-related echoes, as echoes resulting from interference are faded. The technique described can produce images that depict only the essential structure-related information. In this way, the clinical assessment of tendon integrity is greatly facilitated.  相似文献   

20.
The purpose of this study was to describe the normal magnetic resonance (MR) imaging characteristics of the palmar structures of the equine podotrochlear apparatus by means of retrospective evaluation of MR imaging studies of 16 cadaver limbs. The articular aspect of the distal sesamoid bone was not evaluated in this study. Equine digits were imaged with a human knee radiofrequency coil in a 1.5 T magnetic field, using spin echo (SE) T1-weighted, turbo spin echo proton density (TSE PD)-weighted with and without fat saturation (FS), and FS TSE T2-weighted sequences. The limbs were dissected after imaging to validate the absence of gross abnormalities of the flexor aspect of the distal sesamoid bone, of the deep digital flexor tendon, and the distal impar sesamoidean ligament. Seven deep digital flexor tendons were subjected to histologic examination to exclude any microscopic tendon pathology. The anatomic structures of the podotrochlear apparatus were easily identified on MR images. Compact bone of the flexor cortex of the distal sesamoid bone had low intensity signal on all sequences. In 11 digits an increased signal was seen within the thickness of the sagittal eminence of the flexor cortex in SE T1-weighted images and in TSE PD-weighted images without FS. Trabecular bone had a granular appearance and high signal in SE T1-weighted sequences and TSE images without FS. The deep digital flexor tendon had low signal on FS T2-weighted images, while on short echo time sequences (T1- and PD-weighted sequences), the tendon signal varied depending on the relative orientation between its fibers and the static magnetic field. Seven tendons had stippled appearance due to small intratendonous foci of slightly increased signal on transverse T1-weighted images. MR imaging provides a thorough evaluation of the anatomical structure of the podotrochlear apparatus: A good knowledge of the MR imaging appearance and anatomy and an awareness of potential pitfalls will improve diagnostic specificity for the detection of pathologic changes.  相似文献   

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