Gottlieb R, Whitcomb M B, Vaughan B, Galuppo L D, Spriet M
William R Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, USA.
Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, USA.
Equine Vet J. 2016 May;48(3):299-306. doi: 10.1111/evj.12444. Epub 2015 May 29.
Ultrasound is widely used in horses with stifle lameness, yet limited information is available regarding the appearance of normal and injured lateral patellar ligaments (LPL).
To map the normal ultrasonographic appearance of the LPL. To describe the clinical and ultrasonographic features of LPL injuries.
Descriptive study of healthy horses and retrospective case series.
Twelve horses without stifle lameness underwent ultrasonographic examination of bilateral LPLs and ultrasonographic features were recorded. Eighteen horses with LPL injury were identified from 1999 to 2011.
The normal LPL changes in appearance from origin to insertion. It shows ill-defined margins at the patella, becomes flattened and bilobed over the lateral trochlear ridge, is oval-triangular shaped with variable echogenicity and fibre pattern distal to the LTR, and becomes tapered with striations at the tibial insertion. LPL injury was identified in 18 horses of multiple breeds and uses. All injuries were acute, and 12 had wounds. Eleven horses were severely lame (grade 4-5/5). Ultrasonographic lesions were severe in 78% of cases. The mid to insertional portion of the LPL was most often affected. Radiography showed fractures of the tibial tuberosity (n = 6), patella (n = 4) and lateral trochlear ridge (n = 1). Fractures involved LPL attachments in 9 horses. Five were treated for osteomyelitis and one for synovial sepsis. Recheck ultrasound in 4 horses showed minimal to no change in the appearance of LPL injuries. Nine horses returned to riding, one continued as a broodmare, 2 were retired, one became a broodmare, 2 were lost to follow-up and 3 were subjected to euthanasia owing to concurrent injuries.
Normal variations in shape, echogenicity and fibre pattern of the LPL are important considerations to prevent false positive diagnoses during ultrasonography. LPL injuries were often severe and associated with craniolateral stifle trauma. Prognosis varied from good to guarded in horses without additional severe injuries.
超声在患有 stifle 跛行的马匹中广泛应用，但关于正常和损伤的外侧髌韧带（LPL）的表现的信息有限。
描绘 LPL 的正常超声表现。描述 LPL 损伤的临床和超声特征。
对健康马匹的描述性研究和回顾性病例系列。
对 12 匹无 stifle 跛行的马匹进行双侧 LPL 的超声检查并记录超声特征。从 1999 年至 2011 年确定了 18 匹患有 LPL 损伤的马匹。
正常 LPL 从起点到止点外观会发生变化。它在髌骨处边缘不清晰，在外侧滑车嵴上方变扁平且呈双叶状，在 LTR 远端呈椭圆形三角形，回声性和纤维模式各异，在胫骨止点处变细并带有条纹。在多个品种和用途的 18 匹马中发现了 LPL 损伤。所有损伤均为急性，12 匹马有伤口。11 匹马严重跛行（4 - 5/5 级）。78%的病例超声病变严重。LPL 的中至止点部分最常受累。放射学检查显示胫骨结节骨折（n = 6）、髌骨骨折（n = 4）和外侧滑车嵴骨折（n = 1）。9 匹马的骨折累及 LPL 附着处。5 匹马接受了骨髓炎治疗，1 匹马接受了滑膜败血症治疗。4 匹马复查超声显示 LPL 损伤外观变化极小或无变化。9 匹马恢复骑行，1 匹继续作为繁殖母马，2 匹退役，1 匹成为繁殖母马，2 匹失访，3 匹因并发损伤而实施安乐死。
LPL 在形状、回声性和纤维模式方面的正常变异是超声检查时防止假阳性诊断的重要考虑因素。LPL 损伤通常较为严重，并与颅外侧 stifle 创伤相关。在没有其他严重损伤的马匹中，预后从良好到谨慎不等。
