Recognition of stifle disease appears to be increasing, and estimates put the incidence in some athletic disciplines as high as 40%. While treatment options are expanding, definitive diagnosis of slight to moderate stifle pathology has long been limited, for a number of reasons:
- Traditional diagnostic arthroscopy (using scopes from 2.7mm and up), while it allows for both diagnosis and therapy, requires general anesthesia, rehabilitation time, and significant cost…all of which factor in to difficulty securing owner/trainer buy-in.
- Many practitioners are uncomfortable performing diagnostic anesthesia of the stifle.
- Many lesions (particularly soft tissue lesions) go undetected with radiography.
- Ultrasonography has helped, but use of this modality to examine cruciate ligaments remains difficult because of the orientation and deep anatomic location of these structures.
- CT using contrast arthrography has been used to image the stifle, but limitations exist to its availability and the availability of MRI.
But not since the introduction of the NeedleView 1.2mm arthroscope. With it, standing diagnostic arthroscopy is an outpatient standing procedure that offers:
- Early detection and conclusive diagnosis of joint problems
- Timely intervention
- Shortened rehab and better patient outcomes
- Higher owner/trainer compliance
Standing diagnostic arthroscopy with the NeedleView Arthroscope Suite does have some limitations, however, in that the size of the scope allows for only certain therapeutic interventions, and there is the potential for additional procedures (for example, when standing diagnostic arthroscopy indicates a definitive need for a more invasive surgery).
Capabilities Proven By Both Research And Practice
In a seminal peer-reviewed study1 published in 2014, researchers confirmed:
- The 18-gauge NeedleView arthroscope can be used to perform complete diagnostic examination of the three compartments of the stifle joint in standing horses.
- In areas of the joint where space was limited, the small diameter of the scope was an advantage despite the smaller field of view.
One of the study’s lead authors (David Frisbie, DVM, PhD, MS, DACVS, DACVSMR, Professor of Equine Surgery, Colorado State University, Fort Collins, CO) has successfully used the NeedleView arthroscope to diagnose injuries in more than 100 stifles, including:
- Meniscal tears and lesions
- Cartilage damage
- Cruciate ligament tears and lesions
- Floating joint fragments
- Subchondral bone cysts
Needle arthroscopy can also be used to confirm the presence of a lesion identified by either x-rays or ultrasound and confirm that no additional lesions are present.
Another study2 in 2015 concluded: “When combined, arthroscopy and ultrasound can provide a more global assessment of pathological changes within the equine stifle.”
And it’s not limited to the stifle. Recently-published studies have found novel applications for NeedleView, including:
- Navicular bursa: A 2015 study³ explored direct and transthecal approaches to the navicular bursa using Biovision’s NeedleView scope. Among its conclusions: “Needle endoscopy offers a reliable technique to evaluate the navicular bursa and may complement or replace other diagnostic modalities in horses with lameness localized to the navicular region.”
- Paranasal sinus: A 2018 study4 explored the use of Biovision’s NeedleView camera in conjunction with a 2mm flexible endoscope for standing, conscious evaluation of the paranasal sinus. The conclusion: “Minimally invasive sinoscopy was readily performed without relevant complications in standing horses. A thorough evaluation of most sinus structures was obtained only using the frontal and the rostral maxillary portals.”
- Fetlock: This 2019 prospective clinical study5 described the technique, experience and outcome of standing, consciousarthroscopic removal of dorsal osteochondral fragmentation of the metacarpophalangeal and metatarsophalangeal joint using Biovision’s 1.2-mm NeedleView arthroscope. The conclusion: “All fragments were successfully removed and needle arthroscopy allowed a thorough evaluation of the dorsal aspect of the joint. The technique offers an alternative for standing fetlock arthroscopy for surgeons concerned about equipment damage or portability.”
1 Frisbie DD, Barrett MF, McIlwraith CW, and Ullmer J. Diagnostic stifle joint arthroscopy using a needle arthroscope in standing horses. Vet Surg. 2014 Jan;43(1):12-8. doi: 10.1111/j.1532-950X.2013.12068.x. Epub 2013 Oct 31.
2 Adrian AM, Barrett MF, Werpy NM, et al. A comparison of arthroscopy to ultrasonography for identification of pathology of the equine stifle. Equine Vet J. 2015 Nov 18. doi: 10.1111/evj.12541. [Epub ahead of print]
3 Mahlmann K, Koch C, and Bodo G. Diagnostic endoscopy of the navicular bursa using a needle endoscope by direct or transthecal approach: a comparative cadaver study. Vet Surg. 2015;44:816-824.
4 Pouyet M and Bonilla A. Validation of a 2-mm videoendoscope for the evaluation of the paranasal sinuses with a minimally invasive technique. Vet Surg. 2019;1-11.
5 Bonilla, Alvaro G. Standing Needle Arthroscopy of the Metacarpophalangeal and Metatarsophalangeal Joint for Removal of Dorsal Osteochondral Fragmentation in 21 Horses. Veterinary and Comparative Orthopaedics and Traumatology, 2019, doi:10.1055/s-0039-1688984.
From David Frisbie, DVM, PhD, MS, DACVS, DACVSMR, pioneer of standing stifle needle arthroscopy:
“Because of the NeedleView scope’s small size, we can ‘drive it around’ the stifle and image everything. No other technology gives us that ability. Traditional imaging modalities typically require transporting the animal and then putting it under general anesthesia and handling the subsequent recovery…all of which can be costly and may require significant lead time. The NeedleView Arthroscope Suite is so small and portable, we can perform diagnostic arthroscopy in our trailer at equine events. It truly lets us get an instant answer anywhere. We like that NeedleView gives us a way to diagnose mild to moderate stifle disease earlier in the process, before it has progressed too far to be amenable to treatment.”
One of the pioneers of therapeutic intervention using the NeedleView scope is Shane Miller, DVM, DACVS of Comstock Equine Hospital (Reno, NV), who says:
“I do a lot of stifle diagnostics, primarily because of my practice’s population and caseload. I also use it for exploration in areas like the tendon sheath, coffin, fetlock, and carpus. I even use it for sinuses to see masses, tumors, and fluid. I recently started using the NeedleView on horses that present with septic arthritis. The typical approach is to lay the horse down with general anesthesia and use a standard 4mm arthroscope to lavage or flush the joint. With the NeedleView, I can leave the horse standing and conscious but sedated, I can flush the joint, and I can generally get further into the joint than with a 4mm scope. If I see lots of fibrin deposition, I can put an instrument in from the other side – using the NeedleView to guide me – and pull it out. Whenever I can do an effective procedure without laying a horse down, it’s a win for the animal, the client, and me. When there’s no general anesthesia, there’s typically less morbidity and it’s almost always more cost-effective for the client. I’ve found that clients are more willing to move forward with the procedures – even if they are more expensive – if it means the horse can remain standing and conscious.”
In their own words: Equine Practitioners
- NeedleView Pioneer: David Frisbie, DVM, PhD, MS, DACVS, DACVSMR, Colorado State University Equine Orthopedic Research Center (Fort Collins, CO)
- NeedleView Researcher: Christoph Koch, Dr. Med. Vet., DACVS, DECVS, Swiss Institute of Equine Medicine (Bern, Switzerland)
- NeedleView Researcher: Barrie Grant, DVM, MS, DACVS, MRCVS, Barrie Grant Equine Consultant (Bonsall, CA)