Reprinted in IVIS with the permission of the AAEP Close window to return to IVIS. Fig 1 Normal ultrasonographic appearance of the medial meniscus This sagittal image was taken at the level of the medial. collateral ligament MCL fibers can be seen superficial to the meniscus Note the triangular shape of the meniscus and the. homogeneously echogenic appearance The normal meniscus fills the joint space between the femoral condyle and the tibial plateau. joint were clipped with a No 50 blade The skin were not performed on five horses because of the. was washed with soap and water and ultrasound severity of lameness All cases demonstrated pal. coupling gel was applied Horses were lightly se pable effusion of the stifle joint. dated with detomidine HClc 0 004 0 008 mg kg Ultrasonographic parameters used to evaluate the. IV The scanning technique used was similar to meniscus included shape echogenicity and posi. that described in previous reports 7 8 10 The 7 5 or tion The normal ultrasonographic appearance of. 10 MHz linear transducer was used to evaluate the the medial and lateral meniscus is shown in Figures. middle medial and lateral patellar ligaments me 1 and 2 respectively All affected menisci demon. dial and lateral collateral ligaments and medial and strated a flattened and or irregular shape Four. lateral menisci as well as the femoropatellar and teen menisci demonstrated a mottled echogenicity. medial and lateral femorotibial joint capsules The 12 of these had anechoic defects One meniscus. 6 0 MHz curvilinear transducer was used to evalu was diffusely hypoechoic Abaxial bulging or pro. ate the cranial aspect of the stifle with the limb held lapse was seen in 13 menisci Figures 3 5 show. in the flexed position This allowed visualization of abnormal ultrasonographic findings Effusion and. the cranial horn of the menisci cranial meniscal synovitis of the associated femorotibial joint was. ligaments and cranial cruciate ligament,seen in 12 horses Femoropatellar effusion and sy. 3 Results novitis was seen in nine horses Other ultrasono. graphic findings included seven cases of medial,One hundred and nine stifles were evaluated ultra. sonographically in 77 horses Fifteen meniscal in collateral ligament desmitis Six were mild to. juries were diagnosed in 14 horses The medial moderate and one was severe Seven horses dem. meniscus was affected in eight horses and the lat onstrated patellar ligament injuries Six were. eral meniscus was affected in five horses Both me mild to moderate and appeared chronic in na. nisci were affected in one horse ture One horse had ruptured patellar ligaments. The mean age of affected horses was 9 4 yr range associated with a comminuted patellar fracture. 7 mo to 20 yr Quarter Horses were over repre Eleven cases demonstrated ultrasonographic evi. sented compared with the UCD VMTH hospital dence of periarticular osteophyte formation. population Lameness was evaluated according to Stifle radiographs taken of all horses revealed sec. the AAEP grading scale 1 5 The degree of lame ondary degenerative joint disease DJD in 11 of 14. ness at presentation ranged from grade 3 5 5 with horses Ten of 11 horses demonstrated uniaxial. a mean lameness grade of 4 5 Duration of lameness DJD which was associated with the side of meniscal. before presentation was 4 days to 10 mo Upper injury One horse with biaxial meniscal injury. limb flexion tests were positive in six cases Three demonstrated biaxial degenerative changes De. horses resisted upper limb flexion Flexion tests generative joint disease was not present in three. 250 2002 Vol 48 AAEP PROCEEDINGS, Proceedings of the Annual Convention of the AAEP 2002. Reprinted in IVIS with the permission of the AAEP Close window to return to IVIS. Fig 2 Normal ultrasonographic appearance of the lateral meniscus This sagittal image was obtained between the peroneus tertius. tendon and the lateral collateral ligament The normal lateral meniscus also demonstrates a homogeneous echogenicity and a. triangular shape, Fig 3 Abnormal medial meniscus These sagittal images were obtained from a 6 yr old Standardbred racehorse with grade 5 5. right hind lameness The left image demonstrates a large central hypoechoic defect arrow The right image demonstrates a large. central anechoic defect arrowhead Both images depict an irregular shape with bulging of the meniscus. horses that had clinical signs of less than 2 wk confirmed Four horses have been followed for. duration 2 21 mo at the UCD VMTH One case was sound. at 15 mo after diagnosis Two horses have im, 4 Outcome proved 1 2 lameness grades and one horse wors. Necropsy was performed in three horses and con ened 1 lameness grade Ultrasonographic re. firmed meniscal injury Two horses underwent di evaluation of these horses revealed an unchanged. agnostic arthroscopy and meniscal injury was appearance of the injured menisci Radiographic. AAEP PROCEEDINGS Vol 48 2002 251, Proceedings of the Annual Convention of the AAEP 2002. Reprinted in IVIS with the permission of the AAEP Close window to return to IVIS. Fig 4 Abnormal medial meniscus This image depicts a flattened irregularly shaped and extruded meniscus in a 13 yr old Quarter. Horse gymkhana horse that had acute onset grade 4 5 left hind lameness 16 months before Note the increased distance between the. meniscus and the cortical surfaces of the femoral condyle and tibial plateau This image is unchanged from previous exams. Fig 5 Abnormal lateral meniscus This image was obtained from a 4 yr old Paint stallion with persistent grade 3 5 left hind. lameness 15 months after initial diagnosis Note the slightly flattened appearance of the meniscus with a large central hypoechoic. area The meniscus does not demonstrate an extruded or bulging appearance in this view. re evaluation demonstrated stable to mild progres been followed through telephone communication. sion of degenerative joint disease Of the remain One horse has remained lame and was retired to. ing five cases one case was recently diagnosed and pasture and one horse returned to use as a cutting. has not returned for recheck Two horses have horse Two horses were lost to follow up. 252 2002 Vol 48 AAEP PROCEEDINGS, Proceedings of the Annual Convention of the AAEP 2002. Reprinted in IVIS with the permission of the AAEP Close window to return to IVIS. 5 Discussion stifle joint should be considered suspicious for me. The results of this study demonstrate the value of niscal injury However the absence of radio. ultrasound in the diagnosis of meniscal injuries in graphic changes should not rule out meniscal injury. horses In those cases in which a definitive diag in those horses presenting in the acute phase of. nostic procedure was performed e g necropsy or injury. arthroscopy meniscal injury was confirmed in five of Where stifle arthroscopy is available ultrasound. five cases The incidence of meniscal injury in 14 of should be used in combination with or as a screen. 109 stifles evaluated ultrasonographically is similar ing process before arthroscopy In all cases in this. to previous work reported by Denoix et al 13 Our study the extent of injury would have been under. incidence is also similar to that reported by Walms estimated with arthroscopy alone Ultrasound al. ley based on arthroscopic diagnosis of meniscal lows visualization of a greater percentage of the. injuries 15 meniscus than arthroscopy Only the cranial horn. Ultrasonographic evaluation of the stifle joint can of the meniscus is visible arthroscopically Ultra. be performed with basic ultrasound equipment sound allows visualization of the cranial horn of the. available to the equine practitioner Sagittal im meniscus as well as the meniscal body to the level of. ages of the medial meniscus are relatively easy to collateral ligaments. The use of ultrasound does have some limitations, obtain with standard tendon or rectal linear trans. It is possible that minor meniscal injuries may not. ducers by placing the transducer between the me,be appreciated In addition injuries to the caudal. dial patellar ligament and medial collateral,portion of the meniscus may be underrepresented. ligament Sagittal images of the lateral meniscus,Ultrasonographic imaging of the caudal aspect of. are obtained in a similar fashion however a curvi,the meniscus has been described 8 This technique. linear or sector transducer may provide greater ac. is not used at the UCD VMTH because of the diffi, cess because of the increased overlying muscle mass culty in obtaining diagnostic images as a result of. of the lateral aspect of the stifle joint The ultra significant overlying muscle mass in the caudal sti. sonographic parameters of shape echogenicity and fle region. position used in this study to characterize meniscal In summary meniscal injuries should be sus. injury are similar to those used in previous work pected in horses with severe acute or chronic onset. and are felt to be reliable indicators of meniscal hind limb lameness and prominent stifle effusion. injury 9 12 Uniaxial degenerative changes seen radiographi. Ultrasonographic findings can be used to deter cally should also be considered suspicious for menis. mine treatment plans and prognosis In our study cal injury Ultrasonographic evaluation of the. only one horse has been able to return to his prein stifle joint should be performed in such cases to rule. jury exercise level Five of 14 horses have re out meniscal or other soft tissue injury. mained lame The one horse determined to be, sound at UCD VMTH recheck 15 mo postinjury has This study was supported by the Center for. not returned to his preinjury exercise level and has Equine Health School of Veterinary Medicine Uni. been retired to pasture Three horses were eutha versity of California Davis. nized because of severity of lameness at presenta, tion grade 5 5 and poor prognosis based on References and Footnotes. ultrasonographic and radiographic findings Ante 1 O Brien TR Radiology of the equine stifle in 19th Proceed. ings Am Assoc Equine Pract 1973 271 287, mortem diagnosis of meniscal injury played an im 2 Nickels FA Sande R Radiographic and arthroscopic find. portant role for prognostication in these cases and ings in the equine stifle J Am Vet Med Assoc 1982 181 918. assisted their owners and treating clinicians in mak 924. ing an informed decision 3 Jeffcott LB Kold SE Radiographic examination of the. equine stifle Equine Vet J 1982 14 25 30, Our study revealed the consistent radiographic 4 Jeffcott LB Kold SE Stifle lameness in the horse a sur. finding of uniaxial degenerative joint disease in 11 of vey of 86 referred cases Equine Vet J 1982 14 31 39. 14 horses The uniaxial degenerative changes were 5 Harrison LJ Edwards GB Radiographic investigation of. associated with the side of meniscal injury in all the equine stifle Equine Vet Edu 1995 7 161 168. horses The three horses without radiographic ev 6 Walmsley JP Vertical tears of the cranial horn of the me. niscus and its cranial ligament in the equine femorotibial. idence of degenerative joint disease presented to the joint 7 cases and their treatment by arthroscopic sur. UCD VMTH 4 14 days after injury Sufficient gery Equine Vet J 1995 27 20 25. time had not elapsed for degenerative changes to 7 Penninck DG Nyland TG O Brien TR et al Ultrasonogra. occur in these horses secondary to the instability phy of the equine stifle Vet Radiol 1990 31 293 298. 8 Cauvin ERJ Munroe GA Boyd JS et al Ultrasonographic. created by the meniscal injury Two of these horses examination of the femorotibial articulation in horses im. were euthanized shortly after presentation and aging of the cranial and caudal aspects Equine Vet J 1996. therefore radiographic re evaluation did not take 28 285 296. place The third horse developed mild degenera 9 Denoix JM Agrege FA Ultrasonographic examination of. joints in horses in 47th Proceedings Am Assoc Equine. tive joint disease on repeat radiographs taken 3 mo Pract 2001 366 375. after diagnosis Based on these findings the pres 10 Denoix JM Ultrasonographic examination in the diagnosis. ence of uniaxial degenerative joint disease of the of joint disease In McIlwraith W Trotter G eds Joint. AAEP PROCEEDINGS Vol 48 2002 253, Proceedings of the Annual Convention of the AAEP 2002. Reprinted in IVIS with the permission of the AAEP Close window to return to IVIS. Disease in the Horse Philadelphia W B Saunders 1996 14 Dik KJ Refresher article ultrasonography of the equine. 165 202 stifle Equine Vet Edu 1995 7 154 160, 11 Reef VB Musculoskeletal ultrasonography In Reef VB 15 Walmsley JP Cruciate meniscal and meniscal ligamental. ed Equine Diagnostic Ultrasound Philadelphia W B injuries In Robinson NE ed Current Therapy in Equine. Saunders 1998 160 164 Medicine 4 Philadelphia W B Saunders 1997 84 88. 12 Denoix JM Joints and miscellaneous tendons In Ran. tanen NW McKinnon AO eds Equine Diagnostic Ultra,sound Baltimore Williams Wilkins 1998 500 511. 13 Denoix JM Crevier N Perrot P et al Ultrasound exami Universal Ultrasound Bedford Hills NY 10507. nation of the femorotibial joint in the horse in 40th Proceed GE Medical Systems Milwaukee WI 53219. ings Am Assoc Equine Pract 1994 57 58 Dormoseden Orion Corporation Espoo Finland. 254 2002 Vol 48 AAEP PROCEEDINGS, Proceedings of the Annual Convention of the AAEP 2002.
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