Equine Study: Arthroscopic Fix for Talar Ridge Fractures Yields Excellent Recovery

Arthroscopic Removal of Traumatic Fractures of the Proximal Medial Trochlear Ridge of the Talus: A Retrospective Analysis of 18 Horses

Anna Drahonovska, Henry D. O’Neill

Background

Trauma to the proximal medial trochlear ridge (PMTR) of the talus in horses can cause osteochondral fragmentation, leading to joint effusion and synovial sepsis. These fractures are difficult to diagnose on standard radiographs due to superimposition by the tibial cochlea. Flexed radiographic projections or ultrasonography may improve detection, but little is known about long-term outcomes after surgical fragment removal. This study evaluated the diagnostic utility of flexed imaging and the prognosis following arthroscopic removal of traumatic PMTR fragments.

Methods

A retrospective review of 18 horses admitted with traumatic puncture wounds to the medial tarsus and concurrent tarsocrural sepsis between 2004 and 2020 was conducted. Horses with confirmed PMTR fragmentation were included. Diagnostic imaging (standard, flexed, and oblique radiographs; ultrasonography) was analyzed, and intraoperative findings were documented. Arthroscopic fragment removal was performed, often with hyperflexion for visualization. Postoperative follow-up was obtained via racing records and owner questionnaires, with a minimum of six months.

Results

Standard radiographs (n=15) frequently failed to detect PMTR fragments, while flexed projections, especially the novel Flexed Pl30Pr45Lat-DoDiM oblique view, identified lesions in most cases (n=8/8). All horses had synovial sepsis. Arthroscopic removal of fragments was performed in 15 horses at first surgery and in 3 during subsequent procedures due to persistent sepsis. Sixteen horses had follow-up data: 15 returned to full athletic activity, while one was retired due to unresolved lameness. Horses requiring multiple surgeries still achieved good outcomes, including return to racing or polo.

Limitations

This was a retrospective study with a small sample size. Diagnostic imaging was not standardized across cases, and some lesions were only detected intraoperatively. The study could not determine how often undiagnosed PMTR fractures occur in the wider horse population.

Conclusions

Flexed radiographic projections, particularly the novel Flexed Pl30Pr45Lat-DoDiM oblique view, are essential for diagnosing PMTR fractures in horses with medial tarsal trauma. Arthroscopic removal of traumatic PMTR fragments, although technically challenging, resulted in excellent prognoses, with most horses returning to previous athletic levels. Failure to identify and remove fragments led to persistent synovial sepsis.

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