Arthrotomy versus arthroscopy in the treatment of the fragmented medial coronoid process of the ulna (FCP) in 421 dogs

Evaluation of Canine Shoulder Arthroscopy for Anatomical and Safety Considerations

INTRODUCTION

 Arthroscopy is a well-established diagnostic modality for various orthopaedic conditions in veterinary medicine. The aim of this study was to describe the relationship of canine shoulder arthroscopy portals to major muscular, ligamentous, and neurovascular structures for anatomical and safety considerations.

MATERIALS AND METHODS

 Arthroscopic exploration of 20 adult canine cadaver shoulders was performed. Each shoulder region was dissected layer by layer to the level of the joint. Musculotendinous, ligamentous, and cartilaginous lesions were documented. The distance was measured from each portal to neurovascular structures encountered.

RESULTS

 Muscular lesions included the deltoideus, cleidobrachialis, omotransversarius, supraspinatus, infraspinatus, and teres minor muscles. The neurovascular structures identified were the omobrachial vein, the caudal circumflex humeral artery, axillobrachial vein, and branches of the axillary nerve. Lesions to the lateral glenohumeral ligament were noted from the caudal instrument portal and the middle arthroscope portal. Iatrogenic articular cartilage injuries were identified on the caudal humeral head and the glenoid.

CONCLUSION

 This study supports the safety of lateral shoulder arthroscopy in dogs. Most local neurovascular structures are unaffected with traditional scope portal positions. Musculotendinous lesions are unavoidable due to the extensive muscling surrounding the shoulder but are unlikely to cause severe complications postoperatively.

Therapeutic success in fragmented coronoid process disease and other canine medial elbow compartment pathology: a systematic review with meta-analyses

Introduction

The correct treatment of elbow dysplasia is controversial in modern small animal orthopedics. The aim of this study was to compile all relevant literature of the therapy of fragmented coronoid process and other hereditary disorders of the medial elbow compartment and to statistically evaluate the therapeutic results in three meta-analyses.

Methods

The basis for the systematic literature review was a comprehensive database search of Web of Science, PubMed and Medline. Studies on living patients with above mentioned degenerative joint disease were included in the initial literature search. The data from the final studies, selected according to the PRISMA guidelines, was subsequently extracted. Finally, the success of the different therapies was compared and analyzed by three meta-analyses: success rate, mean difference and standardized mean difference.

Results

Fourteen of 494 publications covered by the systematic literature search remained. Their overall truth was: In studies where surgery outcomes was determined by clinical examination and owner questionnaires, it was found that surgical intervention had a significant positive outcome in the presence of fragmented coronoid process and medial compartment disease. Surgical outcomes were also good in three cross-over studies that investigated treatment success using computerized gait analysis. In contrast, comparative studies between surgical and conservative management yielded controversial results. The meta-analysis found no significant difference between medical and surgical therapy.

Discussion

The positive results of studies investigating owner satisfaction and veterinary clinical examination of surgical therapy for medial compartment disease were confirmed by two meta-analyses. However, their study designs were susceptible to observer biases. A third meta-analysis of standardized mean difference differentiating computerized gait analysis results of surgical and conservative management found no evidence of significant superiority of each treatment modality. It however had a limited number of subjects. More comparative studies of high evidence are needed to better understand medial compartment disease and provide the clinician with more accurate diagnostics to separate pathology that should be treated surgically from pathology that can benefit from conservative therapy similarly. Given the invasiveness a more cautious approach might be warranted regarding generally recommending surgery for pathology of the medial elbow compartment.

Review of minimally invasive surgical procedures for assessment and treatment of medial coronoid process disease

OBJECTIVE

To summarize the current peer-reviewed publications on minimally invasive surgery (MIS) for medial coronoid process disease (MCPD) in dogs.

STUDY DESIGN

Invited review.

METHODS

Pubmed, CAB Abstracts and Scopus databases were utilized for literature review (1990-2023).

RESULTS

More than 60 papers have been published that involve MIS evaluation or treatment of MCPD. Six prospective trials incorporated quantitative gait analysis evaluating outcome following MCPD debridement, of which three included a control group. Whilst case numbers were limited, all studies employing a control group failed to demonstrate superiority of surgery over nonsurgical management. Of three studies employing gait analysis and no control group, all documented some improvement in function compared to pretreatment lameness. Multiple studies document progression of osteoarthritis in dogs following MCPD debridement although this may not be synonymous with worsened function. Subtotal coronoid osteotomy (SCO) is described as an alternative to MCP fragment removal, although the long-term biomechanical consequences are currently unclear and quantitative data on the efficacy of this treatment in isolation for MCPD is awaited.

CONCLUSION

Arthroscopy of the canine elbow joint is a safe means by which to evaluate MCP pathology. Quantitative longitudinal analysis of outcome following minimally invasive surgery for MCPD is required. Correlation with clearly defined subclassification inclusion criteria such as age, incongruity and the precise arthroscopic findings in each case are required to more accurately differentiate any superiority of surgery over nonsurgical management for this disease.

Comparative evaluation of radiographic and computed tomographic findings in dogs with bilateral medial coronoid disease (MCD) presenting with unilateral forelimb lameness

OBJECTIVES

The purpose of this study was to compare the radiographic and computed tomographic (CT) findings of dogs with diagnosed bilateral medial coronoid disease, which showed clinically only unilateral lameness of the forelimbs.

MATERIALS AND METHODS

Medical records, including radiographs and CT images of dogs with diagnosed bilateral MCD showing only a unilateral forelimb lameness clinically were reviewed retrospectively. Depending on the gait of each dog we established two groups to investigate their radiographs and CT data comparatively. Group I: affected non-lame limb. Group II: affected lame limb. Several evaluation systems were used to assess which factors are important for clinical decision making and a patient tailored therapeutic plan.

RESULTS

Data from 84 affected elbow joints (42 dogs) diagnosed with MCD by computed tomography were included. Both the radiological and the CT analysis showed that there are significant differences between Groups I and II. Group I had a lower modified International Elbow Working Group Score (IEWG), the values of the Trochlear notch sclerosis were only slightly deviated, and this group showed less often a dislocation of the fragment compared to group II. Furthermore, the size of the fragment (both the median and the mean value) of the forelimbs from group II was almost twice as big as the one from group I. The following sizes of the fragments were calculated (group I versus (vs.) group II)-median: 0.09 cm2 vs. 0.16 cm2, mean value: 0.112 cm2 vs. 0.202 cm2. It could be shown that a larger fragment is more likely to dislocate than a smaller one.

CLINICAL SIGNIFICANCE

This study provides some evidence towards a better understanding of which diagnostic parameters and findings might be important in clinical decision making. Nevertheless, a "decision tree" for the correct therapy of MCD could not be determined in this study.

Proximal Abduction Ulnar Osteotomy (PAUL): Short- and Long-Term Evaluation in Dogs Presenting Medial Compartment Disease

Simple Summary

Developmental elbow disease is one of the main causes of lameness in the canine species and occurs often in large and giant breed dogs. The most frequent manifestation of this pathology is known as medial compartment disease due to a physiological overload in the medial region of the elbow. It is considered as a complex disease and the treatment is focused on relieving the pain and slowing the progression of osteoarthritis. The Proximal Abduction Ulnar Osteotomy (PAUL) technique is one of the newest techniques whose purpose is the transmission of loads from the medial to the lateral compartment. In this prospective case series, the authors use the combination of elbow arthroscopy and the PAUL technique and report a significant improvement in clinical signs, showing a low major complications rate with a high degree of owner satisfaction.

Abstract

The aim of the study is to report the results obtained from performing a Proximal Abduction Ulnar Osteotomy (PAUL) technique in a cohort of dogs with medial compartment disease with short- and long-term follow-up, assessing the perception of the owners and describing the long-term complications associated with the technique. This is a clinical prospective study, including dogs diagnosed with medial compartment disease treated with elbow arthroscopy and PAUL between 2013 and 2020. Long-term follow-up data and postoperative complications were registered, and a questionnaire adapted from Fitzpatrick et al. 2009 was collected from owners. Thirty-three elbows in 26 dogs were included. The duration of follow-up ranged from 4 to 61 months (median: 24.76 months). At the end of the study, 73.1% of the owners reported excellent satisfaction and 74.1% of the owners would repeat the surgery in the same circumstances. The owner questionnaire showed a greater capacity to walk and run, without lameness and pain, and climb up and down stairs a year after surgery, being constant at the end of the study. Major postoperative complications were documented in 4/33 elbows (12.12%), including delayed union, implant failure, and osteophytosis of the medial aspect of the coronoid process. In conclusion, elbow arthroscopy and the PAUL technique achieved an evident improvement in the quality of life of patients with great satisfaction for most of the owners.

Mid- to Long-Term Outcome after Arthroscopy and Proximal Abducting Ulnar Osteotomy Versus Arthroscopy Alone in Dogs with Medial Compartment Disease: Thirty Cases

OBJECTIVE

 The aim of this study was to determine owner-assessed mid- to long-term outcome for dogs with medial compartment disease treated arthroscopically with fragment removal with or without proximal abducting ulnar osteotomy (PAUL).

STUDY DESIGN

 This was a retrospective clinical study.

MATERIALS AND METHODS

 Records from 30 dogs with medial compartment disease treated with arthroscopy with or without PAUL were retrospectively reviewed over a 5-year period. Proximal abducting ulnar osteotomy cases were matched to arthroscopy-alone controls based on bodyweight and modified Outerbridge score. Outcome was assessed via owner questionnaire using the Canine Brief Pain Inventory (CBPI), frequency of non-steroidal anti-inflammatory drug (NSAID) administration and owner-assessed overall improvement.

RESULTS

 Canine Brief Pain Inventory score for dogs in the PAUL group was not significantly different from the control group (p = 0.54). Non-steroidal anti-inflammatory drug administration was similar between groups (p = 0.61) and there was no significant difference between modified Outerbridge score and outcome (p = 0.57) over a median of 43 months post-surgically (range: 7-66 months). Canine Brief Pain Inventory and NSAID use were affected by the age of the dog with dogs greater than 3 years of age at the time of surgery having a higher CBPI score and increased NSAID use regardless of the surgery that was performed. Overall, owner-assessed improvement was not different between groups (p = 0.72).

CLINICAL SIGNIFICANCE

 Proximal abducting ulnar osteotomy showed no owner-assessed benefit over arthroscopic medial coronoid fragment removal for dogs with medial compartment disease and modified Outerbridge score of 3 or greater. A prospective, blinded, controlled clinical trial is warranted to determine the appropriate clinical application of the PAUL procedure.

Epidemiology and clinical management of elbow joint disease in dogs under primary veterinary care in the UK

Background

Conditions affecting the elbow joint are a common cause of lameness in dogs. Primary-care veterinary clinical data are now recognised as a valuable research resource. Using data from the VetCompass Programme, this study aimed to report the frequency and risk factors for elbow joint disease in dogs under primary veterinary care in the UK and describe clinical management.

Results

From 455,069 dogs under veterinary care, the one-year period prevalence for elbow joint disease diagnosis was 0.56% (95% CI: 0.53-0.60). Of 616 incident cases, the most common specific variants of elbow joint disease were osteoarthritis (n = 468, 75.97%), elbow dysplasia (190, 30.84%) and traumatic (41, 6.66%). The most common signs described by the owners were lameness (n = 466, 75.65%), difficulty exercising (123, 19.97%) and pain (86, 13.96%). The most common findings recorded on veterinary examination were pain (n = 283, 45.94%), lameness (278, 45.13%) and reduced range of movement (243, 39.45%). Common medications used included non-steroidal anti-inflammatory drugs (n = 544, 88.31%), tramadol (121, 19.64%) and disease modifying agents (118, 19.16%). Of 109 deaths involving euthanasia with information available from the 616 incident cases, elbow joint disease contributed to the decision to euthanase in 45 (41.28%) dogs.Five breeds showed increased odds of elbow joint disease compared with crossbred dogs: Rottweiler (OR: 6.16, 95% CI 3.89-9.75), Labrador Retriever (OR: 5.94, 95% CI 4.65-7.60), German Shepherd Dog (OR: 4.13, 95% CI 2.88-5.93), Golden Retriever (OR: 3.11, 95% CI 1.93-5.00) and English Springer Spaniel (OR: 2.00, 95% CI 1.26-3.18). Additional risk factors included having an adult bodyweight that was equal or higher than their breed/sex mean, advancing age, being male, being neutered, being insured and larger bodyweight.

Conclusions

Elbow joint disease is a relatively common diagnosis in dogs and has a high welfare impact as evidenced by the high proportion of cases recorded with pain, lameness and analgesic therapy. There are strong breed predispositions, in particular for large breed dogs. These findings present a clear case for improved breeding programmes to reduce the burden of elbow joint disease.

Erosion of the medial compartment of the canine elbow: occurrence, diagnosis and currently available treatment options

Erosion of the medial compartment of the elbow joint refers to full thickness cartilage loss with exposure of the subchondral bone (modified Outerbridge grades 4–5) of the medial part of the humeral condyle (MHC) and the corresponding ulnar contact area. This finding may appear in the absence of an osteochondral fragment or a cartilage flap, or in combination with fragmentation of the medial coronoid process (MCP) or osteochondritis dissecans (OCD) of the MHC. With regard to the prognosis, it is important to diagnose these severe erosions. Imaging of cartilage lesions by means of radiography, ultrasonography, computed tomography or magnetic resonance imaging is challenging in dogs. In contrast, direct arthroscopic inspection provides detailed information about the cartilage.

The treatment of these severe erosions is difficult because of the limited regenerative capacity of cartilage and presumed mechanical or physical triggering factors. Several conservative and surgical treatment methods have been proposed to treat elbows with severe cartilage defects. However, due to irreversible loss of cartilage, the prognosis in these cases remains guarded.

A retrospective study of the short-term complication rate following 750 elective elbow arthroscopies

Arthroscopy is the gold standard for articular surface examination and is commonly advocated for diagnosing and treating cases of canine elbow dysplasia. Arthroscopy is generally regarded as a low-risk procedure, however there is a paucity of information in the small animal veterinary literature regarding the associated complication rates. In a retrospective study spanning a ten year period, 750 elective elbow arthroscopies were evaluated. Complications necessitating repeat surgery were defined as major, and were documented in 4.8% of dogs. Minor perioperative complications occurred in 17.1% dogs. The failure of arthroscopic treatment necessitating unplanned conversion to arthrotomy was the most frequently encountered complication in this category, having been reported in five percent of dogs. Minor postoperative complications occurred in 10.7% dogs; these included a worsened postoperative lameness (5.5%), severe pain (2.8%), severe swelling (2%), infection (0.2%), and neurapraxia (0.2%). A total of 204 dogs returned for a postoperative re-examination and in seven percent, lameness was more severe than that noted preoperatively. The results of the study show that the major complication rate associated with elective elbow arthroscopy is low, but that the minor peri- and postoperative complication rate is concerning. These findings will assist veterinarians in their preoperative discussions with owners to ensure the achievement of informed consent.

Traumatic fracture of the medial coronoid process in 24 dogs

OBJECTIVE

To describe traumatic fracture of the medial coronoid process in dogs as a clinically distinct disease unrelated to congenital elbow dysplasia.

METHODS

Clinical records of dogs with acute, traumatic, unilateral lameness attributable to medial coronoid process disease were reviewed retrospectively. Clinical interpretation included findings on physical examination, orthopaedic examination, and subjective gait analysis. Radiographs of the affected and contralateral elbows were obtained and reviewed for pathology. Arthroscopy of the elbow joints was performed by one of three surgeons and findings were compared to preoperative diagnostics. Postoperative follow-up was continued for 16 weeks.

RESULTS

Twenty-four dogs were included in this study. All dogs in this study were free of radiographic evidence of medial coronoid pathology. All dogs were diagnosed with a single, large, displaced or non-displaced fracture of the medial coronoid process, with no other joint pathology. Dogs generally had an excellent short-term outcome following arthroscopic treatment of the fractured medial coronoid process.

CLINICAL SIGNIFICANCE

Traumatic fracture of the medial coronoid process should be considered a clinical disease distinct from dysplasia-related fragmentation and should be considered as a differential diagnosis in dogs that are presented with the complaint of acute unilateral elbow discomfort or lameness, especially after concussive activities involving the forelimb. .

Fragmentation of the Medial Coronoid Process in Toy and Small Breed Dogs: 13 Elbows (2000-2012)

Fragmentation of the medial coronoid process (FCP) is an uncommon cause of thoracic limb lameness in toy and small breed dogs. Arthroscopic findings and treatment remains poorly described. The objective of this study was to describe the arthroscopic findings and short-term outcome following arthroscopic treatment in toy and small breed dogs with FCP. Medical records were retrospectively reviewed. Arthroscopic findings were available from 13 elbows (12 dogs). Outcome data ≥4 wk postoperatively were available for nine elbows. Owner satisfaction scores were available for 10 elbows. Common preoperative findings included lameness, elbow pain, and imaging abnormalities consistent with FCP. Displaced FCP was the most common FCP lesion identified. Cartilage lesions at the medial coronoid process were identified in 92.3% of elbows (n = 12), with a median Outerbridge score of 4 (range 1-5). Concurrent cartilage lesions of the medial humeral condyle were identified in 76.9% of elbows (n = 10). Seven of nine elbows had full or acceptable function postoperatively. Median owner outcome satisfaction was 91% (range 10-100). FCP should be considered a cause of thoracic limb lameness in toy and small breed dogs. Arthroscopy can be safely and effectively used to diagnose and treat FCP in these breeds.

Arthroscopic, Computed Tomography, and Radiographic Findings in 25 Dogs With Lameness After Arthroscopic Treatment of Medial Coronoid Disease

OBJECTIVE

To describe the radiographic, computed tomography (CT), and arthroscopic findings in the elbow of dogs admitted for elbow lameness after previous arthroscopic treatment of medial coronoid disease (MCD).

STUDY DESIGN

Retrospective case series.

ANIMALS

Client-owned dogs (n = 25) admitted for elbow lameness after arthroscopic treatment.

METHODS

Clinical records (2005-2009), including radiographs, CT images, and arthroscopic findings, from the first and second presentation of dogs diagnosed with medial coronoid disease were searched and reviewed.

RESULTS

Twenty-nine joints were included in this study. The mean age at first treatment was 2.2 years. Second presentation was at a mean of 2.7 years later and progressive osteoarthritis and cartilage damage was noticed in all joints. Arthroscopic findings included a calcified body in 11/29 joints (38%), multiple small calcified bodies in 1/29 joint (3%), loose scar tissue in 12/29 joints (42%), and immobile scar tissue in 2/29 joints (7%). Three of 29 joints (10%) did not have any calcified body or loose scar tissue found but had erosion of the medial compartment as the only pathology diagnosed in the coronoid region. Characteristics of flexor enthesopathy were identified in 9/29 joints (31%).

CONCLUSION

Arthroscopic treatment of MCD, even with limited cartilage lesions, may not resolve lameness in some dogs. Calcified bodies or loose scar tissue near the medial coronoid process are a frequent followup finding in these joints.

Focal humero-ulnar impingement following subtotal coronoid ostectomy in six dogs with fragmented medial coronoid process

OBJECTIVE

To report acute eburnation of joint cartilage at the humeral trochlea following subtotal coronoid ostectomy (SCO) in a clinical case series of six elbows.

MATERIAL AND METHODS

Six dogs (median BW 27.1 kg; median age 7.5 months) with fragmented medial coronoid process (FCP) and varying degree of radio-ulnar incongruence (RUI) (mean 2 mm) were treated with SCO using an arthroscopic burr. Second look arthroscopy 4-12 weeks later was performed either because of recurrent or persistent lameness in three dogs. In the others, second-look arthroscopy was scheduled prospectively because of RUI, which was thought to be a risk factor for the observed humero-ulnar impingement.

RESULTS

All six elbows had a 1-2 mm wide line of focal full-thickness cartilage loss along the edge of the SCO, while the opposing trochlea had diffuse cartilage damage of Outerbridge grade III-IV, indicating focal humero-ulnar impingement. None of the elbows showed repeated FCP.

CONCLUSION

In some cases SCO might lead to focal humero-ulnar impingement along the osteotomy line.

CLINICAL SIGNIFICANCE

Whether this relays to variations in respect the amount of resected bone (too much vs. too less) or concomitant joint pathologies like RUI or joint instability remains unknown and warrants further studies.

Short- and long-term outcomes after arthroscopic treatment of young large breed dogs with medial compartment disease of the elbow

OBJECTIVES

To report short- and long-term outcomes after arthroscopic treatment in young large breed dogs affected by medial coronoid process disease (MCPD) and identify variables affecting outcome.

STUDY DESIGN

Prospective observational case series.

ANIMALS

Large breed dogs <3 years old (n = 15; 23 elbows).

METHODS

MCPD was confirmed by radiography, computed tomography, and arthroscopy. Dogs were treated by arthroscopy. Variables recorded at time of treatment included radioulnar incongruity (RUI) and degree of cartilage erosion. Variables recorded before, 6 weeks, and ≥23 months after surgery included radiographic score for osteoarthritis, trochlear notch sclerosis, muscle circumference, range of motion (ROM), and the load distribution of vertical ground reaction forces between thoracic and pelvic limbs.

RESULTS

A greater load distribution to the pelvic limbs was identified preoperatively in dogs with RUI than in dogs with congruent elbows. Load distribution was not significantly improved at 6 weeks compared with preoperatively. Muscle circumference and vertical impulse distributions were improved at long-term evaluation despite an increased osteoarthritis score. This improvement was more obvious in dogs with RUI or a high degree of cartilage erosion at initial presentation.

CONCLUSION

Some evidence of improvement in long-term function was found in dogs with MCPD after arthroscopic treatment. RUI and cartilage erosion at the time of diagnosis were associated with more lameness preoperatively but did not affect the final gait assessment or osteoarthritis score in this small cohort.

Ex vivo contact mechanics and three-dimensional alignment of normal dog elbows after proximal ulnar rotational osteotomy

OBJECTIVE

To evaluate the effect of proximal ulnar rotational osteotomy (PURO) on the contact mechanics and 3-dimensional (3D) alignment of cadaveric normal dog elbows.

STUDY DESIGN

Ex vivo biomechanical study.

ANIMALS

Unpaired thoracic limbs from 12 dogs (mean ± SD weight, 26 ± 4 kg).

METHODS

PURO consisted of a transverse osteotomy with 30° external rotation of the proximal segment. With the limb under 200 N axial load, contact area (CA), mean contact pressure (CP) and peak contact pressure (PCP) were measured using digital pressure sensors in the medial and lateral compartments and 3D static elbow poses were obtained, before and after PURO. Each specimen was tested at 115°, 135°, and 155° elbow flexion, with the antebrachium in neutral rotation, in 28° supination, and in 16° pronation. Repeated measures ANOVAs with post-hoc Bonferroni (P ≤ .05) were performed.

RESULTS

PURO caused significant changes, mostly at 135° elbow flexion and neutral antebrachial rotation, characterized by decreased CP (10%) and PCP (10%) in the medial compartment, and increased CP (27%) and PCP (23%) in the lateral compartment. The apex of the medial coronoid process translated 3.4 mm caudally, 1.7 mm abaxially, and rotated 1.8° externally relative to the radial head. Humeroradial varus angulation reduced by 6.7°.

CONCLUSIONS

In limited poses, PURO displaces the medial coronoid process caudally and abaxially and shifts contact pressures towards the lateral elbow compartment by decreasing varus angulation.

Anatomical study of fibrous structures of the medial aspect of the canine elbow joint

Forces exerted by fibrous structures on the medial aspect of the canine elbow joint have been reported to be involved in elbow pathology. The purpose of this paper is to assess the relationships of the ligamentous and muscular structures of this region of the canine elbow joint, and how they relate to the medial coronoid process. Six cadavers of adult German shepherd cross-breed dogs were used in this study to make intra-articular and vascular injections of this region. Some joints were dissected and some were frozen to saw sagittal or dorsal cryosections to assess the relationships of the myotendinous structures. The brachialis muscle tendon passed through the division of the bicipital tendon of insertion which formed a fibrous tendon sheath that was reinforced by the oblique ligament. The biceps' brachii's main insertion is the radial tuberosity where it inserts along with the cranial branch of the oblique ligament and the cranial branch of the medial collateral ligament. Rotational and compression forces exerted by the insertion of the biceps brachii-brachialis tendon complex onto the ulna might influence medial coronoid disease. Therefore, sectioning these tendons could be considered as a treatment for medial coronoid disease.

Arthroscopic treatment of fragmented coronoid process with severe elbow incongruity. Long-term follow-up in eight Bernese Mountain Dogs

The purpose of this study was to investigate the long-term treatment results of fragmented coronoid process (FCP) in joints with a radio-ulnar step greater than 3 mm. Treatment of these patients only consisted of fragment removal, without correction of the incongruity. The eight Bernese Mountain Dogs (11 joints) included in this study showed obvious clinical signs of elbow disease and were diagnosed with severe elbow incongruity and concomitant FCP in the time period from 1999-2003. At that time, elbow radiography, computed tomography, and arthroscopy were performed. The mean follow-up period was 5.6 years. The follow-up consisted of a telephone questionnaire combined with a clinical and radiographic re-evaluation at our clinic. The questionnaire revealed that all dogs were either free of lameness or only lame following heavy exercise. One dog sporadically required medication after heavy exercise. The owner satisfaction rate was 100%. The clinical re-evaluation did not reveal any signs of pain or lameness in all cases. Range-of- motion was decreased in nine of the 11 elbows. Radiographs revealed an increase in severity of osteoarthritis in every case.In this case series, arthroscopic fragment removal without treatment of incongruity was demonstrated to be a valuable treatment option and may provide a satisfactory long-term outcome.

Occurrence of Radiologically Detectable “Kissing” Lesion in Dog Elbows in Dependence on the Type of Fragmentation of the Processus Coronoideus Medialis and on Sex

The aim of the study was to find the frequency of radiologically detectable “kissing” lesion in individual variants of fragmented processus coronoideus medialis (FCP) and its occurrence in relation to sex. The radiographs of elbow joints (n = 135) of dogs (n = 77) in which a fragmented processus coronoideus medialis ulnae was detected arthroscopically (n = 109) or arthrotomically (n = 26) were evaluated. Significantly higher occurrence of radiologically detectable “kissing” lesion was found in elbows with non-dislocated and dislocated fragment (p< 0.01). Significantly lower occurrence of radiologically detectable “kissing” lesion was found in elbows with chondromalacia of processus coronoideus medialis (PCM) (p< 0.01). We found no significant difference (p > 0.05) between the occurrence of a “kissing” lesion in males and females with FCP. The occurrence of the “kissing” lesion extending to the subchondral bone was not affected by sex. The results of our study suggest the possibility of identifying elbow joints with completely fragmented FCP on the basis of occurrence of a radiologically detectable “kissing” lesion.

Techniques of application and initial clinical experience with sliding humeral osteotomy for treatment of medial compartment disease of the canine elbow

OBJECTIVE

To determine medium-term clinical efficacy of sliding humeral osteotomy (SHO) for treatment of lameness and elbow pain associated with clinically diagnosed elbow disease featuring cartilage eburnation of the medial elbow compartment (medial compartment disease--MCD).

STUDY DESIGN

Case series.

ANIMALS

Dogs (n=49) with severe or persistent lameness attributable to MCD.

METHODS

Signalment, lameness history, and preoperative imaging findings were recorded. A custom, locking, stepped SHO plate was applied to the medial aspect of the humerus, stabilizing a mid-diaphyseal transverse osteotomy, medially translating the distal segment relative to the proximal segment. Three variants of technique of application were used and outcomes compared between respective patient groups. Outcome measures included lameness scoring, anatomic measures, VAS scoring of elbow pain, and owner assessment of function. Measures recorded preoperatively, 12, and 26 weeks postoperatively were compared.

RESULTS

Of 59 limbs that had SHO, 39 had preoperative focal treatment of the diseased medial aspect of the coronoid process. Mean +/- SD dog age was 45.5 +/- 37.48 months and body weight ranged from 13.6 to 46.7 kg. Mean preoperative duration of lameness was 14.7 +/- 18.50 months. Lameness improved for all limbs by 26 weeks, and resolved in 21/32 limbs. Significant improvements in postoperative elbow pain scores and most owner assessments of function were observed. Incidence of major complications requiring surgical intervention was 17.2%, 22.2%, and 4.8% for each of the 3 technique variants described. Histologic examination of 2 elbows at >12 months revealed fibrocartilage cover of medial aspect of humeral condyle.

CONCLUSIONS

Canine SHO with or without focal treatment of the diseased medial aspect of the coronoid process ameliorates lameness and pain associated with MCD at medium-term follow-up. Application technique is critical to minimizing morbidity.

CLINICAL RELEVANCE

SHO is appropriate for clinical management of pain and lameness in select cases of canine MCD.

Radiographic, Computed Tomographic, and Arthroscopic Evaluation of Experimental Radio-Ulnar Incongruence in the Dog

OBJECTIVE

To compare the diagnostic value of arthroscopy, computed tomography (CT), and radiography for evaluation of radio-ulnar incongruence (RUI).

STUDY DESIGN

Experimental evaluation of induced progressive RUI.

SAMPLE POPULATION

Cadaveric Labrador forelimbs (n=11).

METHODS

The radius was shortened by 1, 2, and 3 mm with a surgical model of RUI. RUI was scored on radiographs, CT (2 radiologists), and arthroscopy (2 surgeons) before and after each modification. The sensitivity and specificity of each modality were compared. The effects of arthroscope and elbow position on arthroscopy observations were evaluated. Agreement between surgeons, radiologists, and each imaging technique and the known status of the elbow was calculated.

RESULTS

Complete arthroscopic sessions had an averaged sensitivity of 94% and specificity of 81.9%. The ability to detect mild incongruity (1 mm step) was greater at the incisure than other locations (P<.001). The average sensitivity and specificity of radiography were 99.3% and 42.4%, and for CT were 85.05% and 45.8%, respectively. The average agreement between imaging techniques and the known status of the elbows was greater with complete arthroscopic sessions (89.75%) than radiography (70.1%) and CT (76.85%). Inter-investigator agreement was greater between surgeons scoring arthroscopic examinations (88.6%) than radiologists scoring CT studies (43.9%).

CONCLUSIONS

Evaluation of arthroscopic images allows sensitive and reproducible detection of experimental RUI, especially at the incisure. Arthroscopic evaluation of experimental RUI reached a higher diagnostic value than radiographs and CT images, because of its specificity and reproducibility.

CLINICAL RELEVANCE

The diagnostic value and reproducibility of arthroscopy may compare favorably with those of CT when evaluating RUI in dogs with elbow disease.