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

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

Veterinary Surgery 47(6): 756-767

To develop arthroscopic approaches to the atlanto-occipital (A-O) and describe associated arthroscopic anatomy. Experimental ex vivo study and clinical case report. Ten equine cadaver joints and 1 clinical case. 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). 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. 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. Advanced imaging improves the diagnosis of A-O joint pathology. Descriptions of arthroscopic anatomy and accessibility provide important information for surgical intervention.

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Accession: 049979036

Download citation: RISBibTeXText

PMID: 30004116

DOI: 10.1111/vsu.12932

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