2022 AAEP Convention Bonus Coverage: Treating Medial Femoral Condyle Subchondral Cystic Lesions

San Antonio, Texas, USA cityscape at the River Walk.

Huh, Who’d Have Thought?

Part Five: “Outside the Box” Edition 

In this final installment of “Who’d Have Thought 2022,” I present four San Antonio-specific examples of how go-getters thought outside the box to solve various problems. 

Remembering the Alamo by Proxy

The Alamo, as we discussed in part 1 of this series, home of the 1836 Texan Revolution, is a major tourist draw in San Antonio. Historians have put forth great effort in maintaining the church and long house, various canons, a wall of history, and more. Because there might be various reasons why you cannot visit the Alamo IRL (in real life), you can view a miniature 63-square-foot replica of the Alamo made from 50,000 Legos. This plastic masterpiece is a creative way to save people from walking the 100 meters to reach the actual Alamo (due to inclement weather perhaps?). Note in this picture the proximity of the actual Alamo’s reflection through the doorway of the Crockett Building where the Lego structure resides.

Protecting Property in Public

What’s the best way to beautify the neighborhood, celebrate the season, and keep personal property safe from theft and damage? This fool-proof barrier should do the trick! 

Giving the San Fernando Cathedral Purpose

I stumbled across a Van Gogh-style immersive experience in the Main Plaza at the heart of San Antonio. It’s a light show called The Saga projected onto the San Fernando Cathedral. The show portrays the discovery, settlement, and development of San Antonio. Enjoyable and worthwhile, yes, but perhaps a rather peculiar solution to the problem, “Hey, what should we do with the oldest continuously operating cathedral in the United States?” 

Successfully Treating Medial Femoral Condyle Subchondral Cystic Lesions 

At the 2022 AAEP Convention, María Isabel Calero, DVM, from Alamo Pintado Equine Medical Center in California presented a practical solution to a common problem in equine medicine: transcondylar lag screw placement for treating medial femoral condyle subchondral cysts (MFC SCLs). Clearly a more pressing problem than the examples provided above but one that still requires thinking outside the box. 

Calero and colleagues relayed in their proceedings abstract that SCLs occur in 1.7-3.6% of Thoroughbreds and 10-13.6% of Quarter Horses. Transcondylar lag screws are already being used clinically. However, long-term data are not available to fully assess efficacy or make clinical recommendations. Further, no head-to-head comparisons between other techniques exist, such as exercise restriction, synovial and intralesional steroid injections, arthrotomy with cyst debridement, and arthroscopic cyst enucleation. 

Calero et al. retrospectively reviewed data from 58 Quarter Horses (but 69 stifles, as some horses were affected bilaterally). They were aged 1-7 years with MFC SCLs treated with lag screws through the center of the lesion. 

Study Outcome

A successful outcome was horses returning to their previous level of activity level, performing at the intended use, or horses not performing but sound on recheck examinations. The treatment was successful in 46 out of 58 horses and 57 out of 69 stifles. 

There was a successful outcome in 100% of horses 5 years of age or older. 

“This shows that even older horses diagnosed with MFC SCLs have a chance for successful outcome,” said Calero. 

The study followed horses from less than one year to seven years. It reported very good long-term outcomes. For example, the treatment was 100% successful in the six horses in the 5-year follow-up, according to the study authors. 

“Even horses with higher grades (on a scale of 1-5) had successful outcomes,” relayed Calero. 

She added, “For the 10 horses with follow-up radiographs, a 47% mean reduction in cyst size and a minimum reduction of 22% was observed. This shows that cyst size reduction is achievable using this technique.”

A Last-Minute Lameness Study at the 2022 AAEP Annual Convention 

I felt inspired by the quality and quantity of the continuing education provided by the AAEP. So, I decided to conduct my own impromptu study at the 2022 convention. It was a prospective observational study of approximately 3,000 equine practitioners and paraprofessionals. The study graded lameness according to the AAEP Lameness Scale from 0-5. 

The key finding was that an overwhelming 65.5% of the general population was lame.

Results identified at least 5 cases of grade 5 lameness and approximately 1,568 grade 1 lameness cases. I primarily observed these cases circling the coffee stations. Although not the most prevalent, a substantial percentage of the observed lamenesses were grades 2, 3, and 4 (n=398). That includes 125 that were grade 4.

Limitations of the study were: it was conducted by a single observer over the course of only five days; subjects were not examined at gaits other than the walk; flexion tests were not performed; and diagnostic analgesia was considered unethical in this setting. All subjects were lost to follow up. 

As Lori Bidwell, DVM, pointed out in her presentation Performance Horse Pain Management, “Horses should not be in pain. Our job should be to avoid horses from getting hurt. If we do see occupational soreness, we need to manage it. I don’t call it pain management. I call it performance management.”

Addressing Occupational Soreness in Equine Veterinarians at the 2022 AAEP Convention

The take-home message of this unpublished study is that equine veterinarians need to address their own occupational soreness. We’ve seen the toll that chronic pain has on horses. We need to advocate for our own physical and mental health to avoid the same outcome. The AAEP Wellness site has valuable resources on physical and mental health. These resources can help us achieve and maintain healthier lifestyles for longer, more productive careers and personal lives.  

Another great way to gently soothe sore muscles and provide time for practicing mindfulness is yoga. This year’s AAEP Wellness program was sparse, reportedly due to lack of interest. Help Bring Yoga Back in 2023 by contacting the AAEP today!

Brought to you by ADM Cellarator Advantage

Demands of exercise are a stressor for the performance horse. Heavy work can overwhelm the body’s natural ability to deal with oxidative stress, which can damage muscle proteins, lipids and DNA, release pro-inflammatory cytokines leading to muscle pain, and damage the mitochondrial membrane decreasing energy production. Cellarator Advantage RECOVERY+ by ADM Animal Nutrition™ was designed to help the performance horse combat the stress of exercise. To learn more, go to go.adm.com/recovery and come visit with the ADM experts at AAEP, booth #17095.

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