Ultrasound: a valid method for detecting scar-tissue in the equine superficial digital flexor tendon?
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1 Ultrasound: a valid method for detecting scar-tissue in the equine superficial digital flexor tendon? Alice Chatham BSc (Hons) Equine Science & Kirsty McDonald MSc
2 16/09/2018 Content Introduction Why do tendons fail? What is the consequence of injury? The structure of scar-tissue Link to welfare Objectives Materials and Methods Results Discussion The future?
3 16/09/2018 Introduction Superficial Digital Flexor Tendonitis is very common 46% of all limb injuries in racing are tendon and ligament (Williams et al., % of tendon injuries are to the SDFT (Ely et al., 2004, 2009) 24% subclinical prevalence (Avella et al., 2009) High rate of reinjury
4 16/09/2018 Why do tendons fail? SDFT functions as elastic energy store for energyefficient locomotion % strain at gallop (Stephens et al., 1989) Tendon operating close to its functional limit Low tolerance (in vitro rupture %) (Wilson, 1991) Cause of injury Repetitive strain cumulative fatigue damage Preceding tendon degeneration with superimposed sudden over-extension
5 16/09/2018 What is the consequence of injury? Tendon predominantly heals post injury with fibrosis (collagen type III) A tendon suffering from fibrosis is likely to significantly interfere with normal function (Goodship et al., 1994) Transitional zone injury (Crevier- Denoix et al., 1997) Re-injury is common (Marr et al., 1993)
6 The structure of scar-tissue Scanning EM NORMAL Tendon Two ultrasound images - a normal transverse image (left) and an off-incidence image of the same level (right) (Smith, 2010). Scanning EM SCARRED tendon 16/09/2018 6
7 Links to welfare Wastage in TB industry Injury management Breeding Potentially preventable? Career longevity
8 16/09/2018 Objectives 1. To determine whether scar tissue in the SDFT is visible on off-incidence, transverse and longitudinal ultrasonography 2. To find the anatomical level of largest incidence of scar-tissue on ultrasound, gross and histological examination 3. To determine whether scar-tissue synthesis occurs bilaterally 4. To conclude whether of not off-incidence, transverse ultrasonography is a accurate method for assessing the degree of scar-tissue in the equine SDFT through a comparison to gross and histological findings.
9 Materials and Methods 10 pairs of TB cadaver forelimbs with a mean age of 8.1 years (s.d. ± 3.87) Ultrasonographic, gross and histological evaluation Scar-tissue scale 1-5 Mean and statistical analysis 16/09/2018
10 Results Table 1: The anatomical level of largest mean scar-tissue value in the SDFT Ultrasound view Forelimb Level of largest US mean scartissue value Level of largest MP mean scartissue value Level of largest H mean scartissue value Transverse Longitudinal Left 1A 1B, 3B 1A Right 1A, 1B, 3A 1A, 3A 3A Left 2B, 3A 1A, 1B 1A Right 3A 1A 1A US: ultrasound; MP: macrophotograph; H: histology 16/09/2018
11 Table 2: The percentage of identical mean scar-tissue values in the left and right forelimbs using different methods of examination Ultrasound View Method of examination Amount of identical scale values (%) Mean percentage of identical values (%) Longitudinal Transverse US 3/6 = 50.0 MP 3/5 = 60.0 H 3/5 = 60.0 US 3/6 = 50.0 MP 1/6 = 16.7 H 1/5 = US: ultrasound; MP: macrophotograph; H: histology 16/09/2018
12 Wilcoxon s Matched Pairs statistical test calculations: Palmar Areas of fibrosis/ scar-tissue o Ultrasound vs. Macrophotograph Medial Lateral o Ultrasound vs. Histology Dorsal o Macrophotograph vs. Histology All results statistically non-significant (p>0.05) 16/09/2018
13 Discussion Anatomical level of highest prevalence of injury = mid metacarpal region (Smith and Webbon, 1994; Patterson-Kane and Firth, 2009) Bilateral similarity (Birch et al., 2008) Presence of pathology Extent of pathology (Parkin et al., 2006) Relationship between ultrasonographic, gross and histological evaluation (Marr et al., 1993) Is off-incidence, transverse ultrasonography an accurate method of assessing scar-tissue in the SDFT? 16/09/2018
14 The future? Further research Clinical use Prophylactic methodology Improving welfare
15 16/09/2018 Any Questions?
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