EQUINE VETERINARY EDUCATION Equine vet. Educ. (2018) 30 (4) 211-212 doi: 10.1111/eve.12721
Critically Appraised Topic Best imaging modality for femoral trochlear ridge osteochondrosis
A. Talbot* Philip Leverhulme Equine Hospital, University of Liverpool, Neston, Cheshire, UK. *Corresponding author email:
lvxat@liv.ac.uk
Search strategy Summary
Introduction The femoropatellar joint is one of the principle joints of the horse that may be affected by osteochondrosis (McIlwraith 2008). Radiography has been reported to underestimate the incidence and severity of lesions that may subsequently be identified on arthroscopic examination (Steinheimer et al. 1995).
PICO question
In horses with osteochondrosis of the femoral trochlear ridges, how does radiography compare with a combination of radiography and ultrasound for the sensitivity and specificity of lesion diagnosis? • Patient: horses with osteochondrosis of the femoral ridge • Intervention: radiography • Comparison intervention: radiography and ultrasound • Outcome: accuracy in diagnosis of lesion occurrence
TABLE 1: Search results Databases searched Initial search results
PubMed IVIS
Web of Science CAB direct
33 5
21 1
2 0
3 (2 repeated from PubMed)
0
(Equine or horse) AND (stifle or femoral trochlear ridge) AND (OCD or osteochondrosis or developmental orthopaedic disease) AND (radiology or ultrasound or imaging). Performed on 28 April 2016 (Table 1). Inclusion criteria: studies where findings have been verified
using post-mortem or arthroscopic evaluation to confirm imaging findings directly relevant to the PICO question. Exclusion criteria: papers older than 25 years, papers that
did not relate to the PICO question (e.g. prevalence of osteochondrosis or performance outcomes); secondary sources of information (book chapters/review articles).
Summary of the evidence
All three included publications (Steinheimer et al. 1995; Bourzac et al. 2009; Beccati et al. 2013; Tables 2–4) were classified level 4 on the Oxford Centre for Evidence-Based Medicine (OCEBM Levels of Evidence Working Group). The studies included are low on the hierarchy of
Included search results Clinical message
The small number of studies identified support the statement that a combination of ultrasound and radiographic examination does confer a diagnostic advantage in evaluation of horses with osteochondrosis of the femoral
TABLE 2: Steinheimer et al. (1995) Study details Population
Sample size Intervention details Study design Outcome studied
evidence; however, the cases included are relevant to clinical cases of osteochondrosis of the stifle that may be encountered in a referral, mixed-breed population. Further studies in first opinion/sales practice are required in order to be able to relate the findings to other populations of animals.
211
Referral population. Mixed breeds with a range of ages Seventy-two joints of 50 horses
Comparison of radiographic changes with arthroscopic findings in the equine femoropatellar and femorotibial joints Retrospective case series
Lesion detection on radiographs in the femoropatellar and femorotibial joints compared with arthroscopic findings
Main findings (relevant to PICO question) A significant number of radiographically normal femoropatellar joints will have articular changes during arthroscopic examination on the femoral trochlear ridges. A very low number of false positive radiographic studies when compared with arthroscopic examination was also reported
Limitations
A standardised protocol was not stipulated. Results may have been incomplete. All radiographic images were obtained using conventional film/screen combination. This may have led to an underappreciation of lesions that might have been detected using current standards of imaging
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