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TABLE 3: Bourzac et al. (2009) Study details Population
Sample size
Intervention details Study design
Outcome studied
Referral population of a variety of breeds and age of horses diagnosed with osteochondrosis dissecans in the equine femoropatellar joint Thirty-two joints of 21 horses
Comparison of radiographic, ultrasonographic and arthroscopic findings Retrospective case series
Sensitivity and specificity of radiography and ultrasound for detection of osteochondrosis detected at arthroscopy
Main findings (relevant to PICO question) Radiographic sensitivity was reported to be 80–100% for lateral trochlear ridge (LTR) lesions and 33–100 for medial trochlear ridge (MTR) depending on the site involved. For ultrasound, sensitivity for LTR was 100% and for MTR was 33–100%. Specificity for both imaging modalities for both trochlear ridges was 100%, except for the distal third of the MTR where ultrasound specificity was 94%
Limitations
The study lacked a standardised prospective imaging protocol. One only radiographic reviewer was employed. There is no mention of repeatability studies of image grading. The use of conventional or computed radiography films may have resulted in differences in image quality in some horses. Arthroscopy or necroscopy was only performed on a total of 18/32 joints, significantly reducing the numbers of joints included in calculations of sensitivity or specificity of lesions detection
TABLE 4: Beccati et al. (2013) Study details Population
Sample size
Intervention details Study design
Outcome studied
Referral population mixed breeds and ages 36 joints of 22 horses
Comparison of radiographic, ultrasonographic and arthroscopic findings Prospective case series
Sensitivity and specificity of radiography and ultrasound for detection of osteochondrosis detected at arthroscopy
Main findings (relevant to PICO question) Agreement between observers for grading and detecting lesions using radiography and ultrasound varied from moderate to excellent. Diagnostic sensitivity for radiography was 84–88% and for ultrasonography 100%. Specificity for radiography was 89–100% and for ultrasonography was 60–82%. The authors concluded that findings supported ultrasound as a preferred method for predicting presence and severity of osteochondrosis lesions of the femoral trochlear ridge
Limitations Small numbers of horses, mixed breeds and ages of horses
trochlear ridge over radiographic study alone. Further prospective studies of a larger number of horses are required to answer the question more clearly. The clinical implications of this review are that it is likely to change the practice of those who do not routinely include ultrasound evaluation of the femoropatellar joint when osteochondrosis of the trochlear ridges is suspected. This evidence will reinforce my current clinical practice to
always include an ultrasound examination of the stifle when osteochondrosis is suspected.
References
Beccati, F., Chalmers, H.J., Dante, S., Lotto, E. and Pepe, M. (2013) Diagnostic sensitivity and interobserver agreement of radiography
and ultrasonography for detecting trochlear ridge osteochondrosis lesions in the equine stifle. Vet. Radiol. Ultrasound. 54, 176-184.
Bourzac, C., Alexander, K., Rossier, Y. and Laverty, S. (2009) Comparison of radiography and ultrasonography for the diagnosis of osteochondritis dissecans in the equine femoropatellar joint. Equine Vet. J. 41, 685-692.
McIlwraith, C.W. (2008) What the equine practitioner needs to know about the biochemical manipulation of equine joint disease. In: Proceedings of the 10th International Congress of World Equine Veterinary Association, Moscow, Russia. pp 188-196. Available at:
www.ivis.org.
Steinheimer, D.N., McIlwraith, C.W., Park, R.D. and Steyn, P.F. (1995) Comparison of radiographic subchondral bone changes with arthroscopic findings in the equine femoropatellar and femorotibial joints: a retrospective study of 72 joints (50 horses). Vet. Radiol. 36, 478-484.
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