Arthroscopic approach and intra-articular anatomy of the equine atlanto-occipital joint

TY - JOUR

T1 - Arthroscopic approach and intra-articular anatomy of the equine atlanto-occipital joint

AU - Wright, Linda

AU - Puchalski, Sarah M.

AU - Lindegaard, Casper

PY - 2018/8

Y1 - 2018/8

N2 - Objective: To develop arthroscopic approaches to the atlanto-occipital (A-O) and describe associated arthroscopic anatomy. Study design: Experimental ex vivo study and clinical case report. Animals: Ten equine cadaver joints and 1 clinical case. Methods: CT arthrograms of 8 A-O joints were performed to determine the placement of an arthroscopic portal. Arthroscopy was performed via dorsal and/or ventral approaches (dorsal or ventral to the longissimus capitis tendon) in 10 cadaveric A-O joints and the A-O joint of a 2-week-old foal with septic arthritis. Accessible cartilage was debrided in 3 cadaver joints. Accessibility and risks were assessed by review of arthroscopic images, postoperative necropsy, and computed tomography (CT). Results: Dorsal and ventral outpouchings of the A-O joint were identified with CT. Arthroscopy of the dorsal pouch provided access to 50% of the dorsocranial occipital condyle and 15% of the dorsocranial atlas articular surfaces. Joint distension caused displacement of the dura. Dura perforation occurred with a blind dorsal approach in 2 of 5 joints. Dura perforation did not occur after ultrasonography-guided approaches. Arthroscopic debridement of septic arthritis and osteomyelitis was successful in 1 clinical case. Conclusion: Approaches to the A-O joint were determined from CT examinations. The cranial aspect of the dorsal pouch of the A-O joint was accessed via arthroscopic triangulation in all horses of this study. Ultrasound-guided joint access prevented perforation of vital structures, including the spinal canal. Clinical significance: Advanced imaging improves the diagnosis of A-O joint pathology. Descriptions of arthroscopic anatomy and accessibility provide important information for surgical intervention.

AB - Objective: To develop arthroscopic approaches to the atlanto-occipital (A-O) and describe associated arthroscopic anatomy. Study design: Experimental ex vivo study and clinical case report. Animals: Ten equine cadaver joints and 1 clinical case. Methods: CT arthrograms of 8 A-O joints were performed to determine the placement of an arthroscopic portal. Arthroscopy was performed via dorsal and/or ventral approaches (dorsal or ventral to the longissimus capitis tendon) in 10 cadaveric A-O joints and the A-O joint of a 2-week-old foal with septic arthritis. Accessible cartilage was debrided in 3 cadaver joints. Accessibility and risks were assessed by review of arthroscopic images, postoperative necropsy, and computed tomography (CT). Results: Dorsal and ventral outpouchings of the A-O joint were identified with CT. Arthroscopy of the dorsal pouch provided access to 50% of the dorsocranial occipital condyle and 15% of the dorsocranial atlas articular surfaces. Joint distension caused displacement of the dura. Dura perforation occurred with a blind dorsal approach in 2 of 5 joints. Dura perforation did not occur after ultrasonography-guided approaches. Arthroscopic debridement of septic arthritis and osteomyelitis was successful in 1 clinical case. Conclusion: Approaches to the A-O joint were determined from CT examinations. The cranial aspect of the dorsal pouch of the A-O joint was accessed via arthroscopic triangulation in all horses of this study. Ultrasound-guided joint access prevented perforation of vital structures, including the spinal canal. Clinical significance: Advanced imaging improves the diagnosis of A-O joint pathology. Descriptions of arthroscopic anatomy and accessibility provide important information for surgical intervention.

U2 - 10.1111/vsu.12932

DO - 10.1111/vsu.12932

M3 - Journal article

C2 - 30004116

AN - SCOPUS:85050953574

SN - 0161-3499

VL - 47

SP - 756

EP - 767

JO - Veterinary Surgery

JF - Veterinary Surgery

IS - 6

ER -