From Biovision’s Views Newsletter, Issue 2, May 2015
Vet: David Frisbie, DVM, PhD, MS, DACVS, DACVSMR
Affiliation: CO State University Equine Orthopaedic Research Center
Position: Professor of Equine Surgery
Location: Fort Collins, CO
I specialize in orthopaedic research, intra-articular therapeutics, new methods of cartilage repair, equine lameness, orthopaedic surgery and biologics for the treatment of musculoskeletal injuries with an emphasis on stem cells, gene therapy, and sports medicine. I’ve worked on projects with Chad Devitt since residency, primarily in canine orthopaedics. As Biovision moved into arthroscopy, Chad suggested John Small should get me involved in evaluating and developing potential equine applications for the NeedleView scope.
With Chad’s recommendation, we knew we could probably find applications and develop techniques. I met with John Small, and we came up with a plan to look at NeedleView in the field and see where the technology could make the biggest impact. Then we would conduct research and publish for solid science. The outcome of that research was the standing stifle diagnostic arthroscopy procedure.
Definitive diagnosis of slight to moderate stifle pathology has been limited. 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. The NeedleView scope’s field of view is smaller than that of a standard 4mm arthroscope, but we feel it provides a better exploratory of the stifle joint than we get with a 2.7mm arthroscope.
In our study (“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.), we were able to confirm that the 18-gauge NeedleView arthroscope could be used to perform complete diagnostic examination of the three compartments of the stifle joint in standing horses. Further, we found that in some areas of the joint where space was limited, the small diameter of the scope was an advantage despite the smaller field of view.
I presented the standing stifle diagnostic procedure at the American Association of Equine Practitioners (AAEP) Annual Conference in 2013, in conjunction with Dr. Josh Zacharias of Countryside Large Animal Clinic of Greeley, CO. Combined, we’ve performed the procedure on more than 100 joints. Additionally, my colleagues and I have demonstrated and/or taught the procedure worldwide — two CE courses in Fort Collins (2013 and 2014, with another coming up in September 2015); two at Newmarket Equine Hospital in the United Kingdom; and one each in Germany, Switzerland, and Canada.
We’ve pretty much established what NeedleView can do, and our experience will stand in any arena. I’m now looking at using NeedleView in the navicular bursa and tendon sheaths, following essentially the same plan to prove its efficacy as we did for stifle diagnostics.
Key benefit(s) of NeedleView modality: 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.
For what practitioner/practice is NeedleView best suited? The people who will experience the best ease of use with NeedleView are those who already use arthroscopy and know the anatomy. Surgeons who feel a need to reinvent themselves in a hard economy have had success using it to perform diagnostics and preventive procedures. That said, it should be kept in mind that NeedleView is a diagnostic tool; if a vet sees something with that indicates the animal needs surgery, he or she can refer it out if they are not trained for orthopaedic surgery. Similarly, NeedleView can help with the clinical decision to use a regenerative medicine approach.