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Monitoring of the repair process of surgically created lesions in equine superficial digital flexor tendons by use of computerized ultrasonography

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  • 1 Departments of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, 3508 TD Utrecht, The Netherlands; the Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Erasmus MC University Medical Hospital, 3000 DR Rotterdam, The Netherlands
  • | 2 Leiden Institute for Advanced Computer Science, Leiden University, 2333 CA Leiden, The Netherlands
  • | 3 Departments of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, 3508 TD Utrecht
  • | 4 Laboratory of Pathology, Isala Klinieken, 8000 GM Zwolle, The Netherlands
  • | 5 Departments of Equine Sciences, Biochemistry, Cell Biology and Histology, Faculty of Veterinary Medicine, Utrecht University, 3508 TD Utrecht
  • | 6 Departments of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, 3508 TD Utrecht

Abstract

Objective—To evaluate quantitative ultrasonography for objective monitoring of the healing process and prognostication of repair quality in equine superficial digital flexor (SDF) tendons.

Animals—6 horses with standardized surgical lesions in SDF tendons of both forelimbs.

Procedures—Healing was monitored for 20 weeks after surgery by use of computerized ultrasonography. Pixels were categorized as C (intact fasciculi), B (incomplete fasciculi), E (accumulations of cells and fibrils), or N (homogenous fluid or cells). Four scars with the best quality of repair (repair group) and 4 scars with the lowest quality (inferior repair group) were identified histologically. Ratios for C, B, E, and N in both groups were compared.

Results—During 4 weeks after surgery, lesions increased 2- to 4-fold in length and 10-fold in volume. Until week 3 or 4, structure-related C and B ratios decreased sharply, whereas E and N ratios increased. After week 4, C and B ratios increased with gradually decreasing E and N ratios. At week 12, C and B ratios were equivalent. After week 12, C ratio increased slowly, but B ratio more rapidly. At week 20, C ratio remained constant, B ratio was substantially increased, and E and N ratios decreased. Values for the inferior repair group were most aberrant from normal. Ratios for C differed significantly between repair and inferior repair groups at weeks 16 and 18 and for B beginning at 14 weeks.

Conclusions and Clinical Relevance—Computerized ultrasonography provided an excellent tool for objective monitoring of healing tendons in horses and reliable prognostication of repair quality.

Abstract

Objective—To evaluate quantitative ultrasonography for objective monitoring of the healing process and prognostication of repair quality in equine superficial digital flexor (SDF) tendons.

Animals—6 horses with standardized surgical lesions in SDF tendons of both forelimbs.

Procedures—Healing was monitored for 20 weeks after surgery by use of computerized ultrasonography. Pixels were categorized as C (intact fasciculi), B (incomplete fasciculi), E (accumulations of cells and fibrils), or N (homogenous fluid or cells). Four scars with the best quality of repair (repair group) and 4 scars with the lowest quality (inferior repair group) were identified histologically. Ratios for C, B, E, and N in both groups were compared.

Results—During 4 weeks after surgery, lesions increased 2- to 4-fold in length and 10-fold in volume. Until week 3 or 4, structure-related C and B ratios decreased sharply, whereas E and N ratios increased. After week 4, C and B ratios increased with gradually decreasing E and N ratios. At week 12, C and B ratios were equivalent. After week 12, C ratio increased slowly, but B ratio more rapidly. At week 20, C ratio remained constant, B ratio was substantially increased, and E and N ratios decreased. Values for the inferior repair group were most aberrant from normal. Ratios for C differed significantly between repair and inferior repair groups at weeks 16 and 18 and for B beginning at 14 weeks.

Conclusions and Clinical Relevance—Computerized ultrasonography provided an excellent tool for objective monitoring of healing tendons in horses and reliable prognostication of repair quality.

Contributor Notes

Dr. Cherdchutham's present address is Department of Veterinary Surgery, Faculty of Veterinary Medicine, Kasetsart University, 10900 Bangkok, Thailand.

Address correspondence to Dr. van Schie.