Radiographic evaluation of sclerosis of the third carpal bone associated with exercise and the development of lameness in Standardbred racehorses

A proteomics perspective on 2 years of high-intensity training in horses: a pilot study

The human plasma proteome is rather well studied, but not that of other species, including horses. The aims of this study were to (1), explore differences in plasma proteomic profile of young elite harness trotters kept under standardised conditions and subjected to two different training programmes for 2 years and (2) explore changes in proteomic profile over time during the training period. From September at age 1.5 year to March at age 2 years, 16 Standardbred horses were exposed to the same training programme. In March, high-intensity training was introduced and the horses were divided into two training groups (High and Low). Blood samples were collected at rest in December as 1.5-year-olds, July as 2-year-olds, December as 2.5-year-olds and December as 3.5-year-olds. Untargeted proteomics was performed and a hypothesis-generating approach was used in statistical analysis (t-tests). At the age of 2.5 years, the level of serotransferrin was higher in the High group (P = 0.01) and at least at one sampling occasion, proteins associated with fat metabolism, oxidant/antioxidant processes, cardiovascular responses, bone formation and inflammation were lower in High group compared to Low (P < 0.05). Analyses of changes over time revealed that levels of proteins involved in energy metabolism, red cell metabolism, circulation, oxidant/antioxidant activity, bone formation, inflammation, immune modulation and cellular and vascular damage changed (P < 0.05). The results indicate that proteomics analysis of blood plasma could be a viable tool for evaluation of exercise adaptations, performance and for health monitoring, with several potential biomarkers identified in this study.

Comparison of Radiography and Computed Tomography for Evaluation of Third Carpal Bone Fractures in Horses

Radiographs underestimate the extent of bone injury in horses with third carpal bone (C3) fractures (Fx). We aimed to describe bone pathologies identified using computed tomography (CT) and compare the diagnostic value of digital radiography (DR) and CT in horses with C3 Fx. CT images of 15 racehorses with C3 Fx and 10 controls were reviewed (Part 1) then DR and CT images of 26 racehorses (24 Thoroughbred, 2 Standardbred) with C3 Fx (Part 2) were evaluated. Agreement on fracture geometry and concomitant bone lesions was tested between DR and CT using the kappa statistic (Part 2). For agreement analysis, 38 limbs were used (27 Fx carpi from 26 horses and 11 contralateral carpi). Intermodality agreement was good for recognition of displacement, fair for comminution, articular surface bone loss and osseous fragmentation, and poor-slight for recognition of whether the Fx was complete, additional fissures and lucencies. CT provides more detailed information than DR regarding bone pathology and fracture configuration in horses with C3 fracture. Correlation of CT findings with clinical information and outcome needs to be explored; however, the more accurate diagnosis possible with CT is likely valuable when deciding on the most appropriate management and for surgical planning.

Novel computed tomographic analysis demonstrates differences in patterns of bone mineral content between fracture configurations in distal condylar fractures of the third metacarpal/metatarsal bones in 97 Thoroughbred racehorses

OBJECTIVE

To evaluate bone mineral content patterns between fracture configurations using novel CT image analysis.

ANIMALS

CT images from 97 Thoroughbred racehorses with third metacarpal/tarsal condyle fractures provide the case population for analysis.

PROCEDURES

Fractures were grouped by radiographic appearance. Image analysis objectively measured area of highly attenuating pixels (aHAP), areal density of highly attenuating pixels (dHAP) utilizing novel convex hull analysis, and subjective assessment of apparent attenuation intensity ranking (AAIR) for each fracture. Differences between fracture configuration groups were evaluated.

RESULTS

Analysis of dHAP identified lower-density regions of highly attenuating pixels in propagating fractures and higher-density regions of highly attenuating pixels in unicortical fractures (P = .028). Complete and incomplete configurations were almost indistinguishable in dHAP (P = 1.000). The ratio of dHAP between fractured and nonfractured condyles revealed higher density gradients between condyles in unicortical (P = .040) and incomplete (P = .031) fractures than propagating fractures.

CLINICAL RELEVANCE

Differences in patterns of bone mineral content were identified between propagating, bicortical (incomplete and complete), and unicortical fractures of third metacarpal/tarsal bone condyles. Computer-assisted geometric measurement of dHAP identified on CT images could help to assess fracture risk in equine athletes. This application may have greater relevance as standing CT screening becomes more available.

Biglycan neo-epitope (BGN262), a novel biomarker for screening early changes in equine osteoarthritic subchondral bone

OBJECTIVE

Native biglycan (BGN), which can undergo proteolytic cleavage in pathological conditions, is well known to be involved in bone formation and mineralization. This study aimed to delineate the specific cleavage fragment, a neo-epitope for BGN (BGN²⁶²), in synovial fluid (SF) from young racehorses in training, osteoarthritic (OA) joints with subchondral bone sclerosis (SCBS), and chip fracture joints.

DESIGN

A custom-made inhibition ELISA was developed to quantify BGN²⁶² in SF. Cohort 1: A longitudinal study comprising 10 racehorses undergoing long-term training. Cohort 2: A cross-sectional study comprising joints from horses (N = 69) with different stages of OA and radiographically classified SCBS. Cohort 3: A cross-sectional study comprising horses (N = 9) with chip fractures. Receiver operating characteristic (ROC) curve analysis was performed (healthy joints vs chip joints) to evaluate BGN²⁶² robustness.

RESULTS

Cohort 1: SF BGN²⁶² levels from racehorses showed a statistical increase during the first 6 months of the training period. Cohort 2: BGN²⁶² levels were significantly higher in the SF from severe SCBS joints. Cohort 3: SF BGN²⁶² levels in chip fracture joints showed a significant increase compared to normal joints. The ROC analysis showed an AUC of 0.957 (95% C.I 0.868-1.046), indicating good separation between the groups.

CONCLUSIONS

The data presented show that BGN²⁶² levels increase in SF in correlation with the initiation of training, severity of SCBS, and presence of chip fractures. This suggests that BGN²⁶² is a potential predictor and a novel biomarker for early changes in subchondral bone (SCB), aiming to prevent catastrophic injuries in racehorses.

A diagnostic pathologist's guide to carpal disease in racehorses

As a pathologist, postmortem examination of the equine carpus can be daunting. The anatomy is complex and oftentimes, small or subtle lesions have significant impact on lameness and secondary lesions such as catastrophic musculoskeletal fractures and other injuries. In performance horses, particularly racehorses, the carpus is a common site of injury and source of lameness. Given the predisposition of racehorses to developing carpal disease, familiarity with clinically relevant anatomy and common developmental, degenerative, traumatic, and inflammatory processes are imperative for thorough postmortem examination. Our aim is (1) to provide a concise summary of clinically relevant anatomy and function that serves as a guide for postmortem evaluation of the equine carpus, and (2) to review common carpal injuries and diseases in actively training, racing, or retired racehorses, including developmental lesions (incomplete ossification, osteochondromata), infectious and inflammatory lesions (septic arthritis and tenosynovitis), and degenerative and traumatic lesions (degenerative and traumatic osteoarthritis, osteochondral fragmentation, and polyostotic catastrophic "breakdown" fractures). Representative gross and histologic images are presented along with corresponding antemortem and postmortem diagnostic images, and a review of current scientific literature pertaining to the pathogenesis of these equine carpal lesions.

Bone volume and regional density of the central tarsal bone detected using computed tomography in a cross-sectional study of adult racing greyhounds

AIMS

To determine whether left-to-right asymmetry of the central tarsal bone (CTB) of racing greyhounds was detectable using computed tomography (CT) in live dogs; to quantify the asymmetry in terms of average bone volume, volumetric bone mineral density (vBMD), and dorsal cortical shape, and to determine if age, gender, bodyweight, number of starts or history of tarsal injury were significant covariates.

METHODS

One trainer supplied 11 male and seven female, unrelated, skeletally mature, actively racing greyhounds, including dogs with a history of tarsal injury diagnosed by the trainer and/or track veterinarian (n=8), and dogs without a history of tarsal injury (n=10). Using CT, standardised parameters of the CTB were measured including volume and average vBMD of the left and right CTB, vBMD of regions within the CTB, and bone shape.

RESULTS

There was no difference in the volumes of the left and right CTB and no association with number of racing starts. Volume of CTB in dogs with a history of tarsal injury was greater than in dogs with no history of injury (p<0.001). Mean vBMD of the right was greater than the left CTB (p=0.004), and was independent of history of injury, gender, bodyweight, and number of starts. Males with a history of injury weighed more than those with no history of injury (p=0.004). The region of greatest difference in vBMD between right and left limbs was the centrodorsomedial aspect of the CTB. Middle plantar ligament enthesiopathies and fractures of tarsal bones other than the central tarsal bone were identified in dogs with and without a history of tarsal injury.

CONCLUSIONS

Significant left-to-right asymmetry of the CTB in racing greyhounds was detected using CT. Contrary to previous suggestions, the asymmetry was not associated with the number of racing starts. We propose that the majority of the adaptive modelling of the CTB occurred rapidly following the onset of counter-clockwise training, with little further modelling throughout the racing career of the dog, however further investigation is warranted.

CLINICAL RELEVANCE

This study described a technique using CT for imaging the CTB in live dogs, which opens the way for a longitudinal study of bone modelling of the CTB in response to training and racing in a counter-clockwise direction.

Statistical analysis of bone mineral density using voxel-based morphometry-an application on proximal sesamoid bones in racehorses

Voxel-based morphometry (VBM) is a computational technique that has been used to analyze statistical differences between groups of MR brain images. This study outlines a new VBM pipeline, designed for determining statistical variation in bone mineral density (BMD). CT images of proximal sesamoid bone (PSB) specimens from the right forelimb of six racehorses that had suffered PSB fractures were compared with six age-matched control specimens. Following segmentation, masked gray-scale images were co-aligned to a statistical template generated with all 12 CT datasets iteratively. Student t-tests were performed voxel-by-voxel on spatially aligned 3D images to reveal significant differences in the spatial variation of bone density between the fracture and control groups. Overall density and densities from the axial and abaxial areas of PSBs were compared between groups. The BMD in abaxial regions of the medial and lateral PSBs of the fracture group were 12.7% (p = 0.044) and 13.5% (p = 0.047) higher, respectively, than controls. The overall mean density of paired PSB and the medial and lateral PSBs separately were higher in the fracture group. The VBM pipeline facilitates detailed comparison of density variation between bone groups at the voxel level.

Clinical findings, diagnosis, prevalence and predisposing factors for lameness localised to the middle carpal joint in young Standardbred racehorses

REASONS FOR PERFORMING STUDY

Lameness related to the middle carpal joint (MCJ) occurs in up to 30% of young Standardbred horses in race training and the incidence increase with radiographic severity of third carpal bone (C3) sclerosis on DPr-DDIO (skyline) view of the carpus. Factors predisposing horses to carpal injury have not been well investigated.

OBJECTIVES

To determine the importance of MCJ lameness as a cause of wastage in young Standardbred racehorses, stage of training at which it occurs and predisposing factors, and to describe clinical findings and diagnosis.

METHODS

Standardbred horses (n = 114) entering their first year of race training were examined at approximately 3-month intervals over 12-18 months. For 87 of the horses, a training diary was available and these horses were trained at 3 different stables, each using a different exercise regime. At each examination, forelimb conformation, MCJ effusion, MCJ lameness and radiographic findings were graded, and training history and reasons for lost training days recorded. Nuclear scintigraphy and exploratory arthroscopy were performed on a limited selection of horses. Results for horses that developed MCJ lameness during the study period were compared statistically with results for horses that did not.

RESULTS

Carpal lameness occurred in 28% of horses and was present in 56% with forelimb lameness. In most cases lameness was mild, bilateral and with little or no MCJ effusion and was attributed to subchondral bone pain associated with radiographic evidence of C3 sclerosis. Carpal lameness was the most common reason for >1 month's rest during the study period. It occurred at any stage of training but, in most cases, some speed training had begun. Of the variables studied, poor forelimb conformation and more intense speed training were predisposing factors.

CONCLUSIONS AND POTENTIAL RELEVANCE

The information gained should assist in making recommendations regarding training young Standardbreds to reduce the incidence of MCJ lameness. However, further investigations to determine the optimal training regime are warranted.

Effects of exercise vs experimental osteoarthritis on imaging outcomes

OBJECTIVE

To identify changes in imaging outcomes in a controlled model of osteoarthritis (OA) vs exercise.

METHOD

Sixteen 2-year-old horses were randomly assigned to an exercise control (n=8) or an exercise OA (n=8) group. All horses had middle carpal joints arthroscopically explored and an osteochondral fragment was induced in one middle carpal joint of the OA group. All horses were treadmill exercised for the duration of the study (91 days). Clinical, radiographic, nuclear scintigraphic, computed tomographic and magnetic resonance imaging (MRI) examinations were performed and outcomes of these were compared between groups. Imaging results were correlated to clinical, biomarker and gross pathologic results.

RESULTS

The OA group had significant increases in clinical outcomes and most imaging parameters. Specifically, the OA group showed significant increases in radiographic lysis and nuclear scintigraphic uptake. There was very little change in subchondral bone density, but a significant change in subchondral bone edema. Radiographic lysis, radial carpal bone edema and nuclear scintigraphy were strongly correlated with clinical changes and radial carpal bone edema was strongly correlated with changes in Type I and Type II collagen found in the synovial fluid.

CONCLUSIONS

OA induced significant changes in imaging parameters beyond the adaptation seen with exercise. Bone edema detected with MRI was closely correlated with collagen biomarkers detected in the synovial fluid.

Outcome of lag-screw treatment of incomplete fractures of the frontal plane of the radial facet of the third carpal bone in horses

AIM

To describe outcomes for horses diagnosed with incomplete, non-displaced fractures of the frontal plane of the radial facet (INFR) of the third carpal bone (C3) treated by placement of a lag screw across the fracture under arthroscopic guidance.

METHODS

Horses (n=13) diagnosed with INFR and treated between December 1999 and January 2005 using a lag screw placed over the fracture were studied. For each case, five horses matched for sire, age and sex which were not known to have INFR were sought for comparison. Racing performance data were collected from a commercial online database. The racing performance of cases pre- and post-operatively, and of cases and matched horses in the post-operative period was compared.

RESULTS

Sixteen INFR were found in the 13 horses. Radiographic evidence of healed fracture lines 2-4 months after surgery was seen in 11/16 (69%) fractures; 11/13 (85%) cases raced again after a median recovery period of 292 (range 149-681) days. Treatment was considered successful in 9/13 (69%) cases, which were still in training or had been retired for reasons other than lameness localised to the middle carpal joint at the end of the study period. Just 6/13 (46%) cases had raced prior to injury. The racing ability pre- and post-operatively of five cases was compared, three (60%) of which performed better post-operatively than they had before. There was no significant difference in racing longevity or ability post-operatively between patients and matched (control) horses.

CONCLUSIONS

Post-operatively, there was little difference in the racing performance between horses diagnosed with INFR which had a lag screw placed across the fracture line and horses matched for sire, age and sex which were not known to have INFR.

CLINICAL RELEVANCE

Horses which were diagnosed with INFR of C3 and had a lag screw placed across the fracture had a good prognosis for future racing performance.