Outcome after Tibial Plateau Levelling Osteotomy and Modified Maquet Procedure in Dogs with Cranial Cruciate Ligament Rupture

Effect of tibial plateau angle < 5° on ground reaction forces in dogs treated with tibial plateau leveling osteotomy for cranial cruciate ligament rupture up to 6 months postoperatively

Tibial plateau leveling osteotomy (TPLO) has been commonly performed in dogs with cranial cruciate ligament disease (CCLD) since the introduction by Slocum and Slocum (1993). To reduce cranial tibial thrust the TPLO technique aims for a postoperative tibial plateau angle (TPA) of 5-6.5°. In recent years studies have shown that a postoperative TPA below 5° could be beneficial regarding stifle stability or meniscal load. Dogs with CCLD that were treated with TPLO, were examined preoperatively, six weeks, three and six months postoperatively with gait analysis and grouped according to their postoperative TPA. The aims of study was (1) to evaluate if dogs with a postoperative TPA below 5° would have a faster limb function recovery up to six months postoperatively as measured objectively with ground reaction forces (GRFs) and (2) to determine whether the postoperative TPA correlates with the outcome measurements. Dogs with TPA <5° showed no faster limb function recovery postoperatively up to six months as measured with peak vertical force (PVF) or vertical impulse (VI) (p > 0.05). No correlation for the postoperative TPA <5° on GRFs was demonstrated. But the postoperative TPA showed a significant correlation with the symmetry indices of PVF (SIPVF) and VI (SIVI) for all dogs (>5° and <5° TPA together), indicating that with lower postoperative TPA dogs had a more symmetrical gait in hindlimbs SIPVF (r = 0.144, p < 0.05) and SIVI (r = 0.189, p < 0.01). The study indicates that a lower postoperative TPA could be beneficial regarding hindlimb symmetry indices of GRFs.

Effect of intra-articular platelet-rich plasma or hyaluronic acid on limb function recovery in dogs with TPLO for cranial cruciate ligament rupture: a randomised controlled trial

OBJECTIVES

This study aimed to investigate the recovery of limb function following a single intra-articular injection of platelet-rich plasma or hyaluronic acid in dogs with cranial cruciate ligament rupture treated with tibial plateau levelling osteotomy compared to dogs receiving no injection intraoperatively.

MATERIALS AND METHODS

Sixty-two dogs with cranial cruciate ligament rupture, body weights of 20 to 40 kg, and no other orthopaedic conditions were enrolled in this prospective, randomised, double-blind, controlled study at the small animal clinic at LMU Munich. All dogs underwent tibial plateau levelling osteotomy. Based on random allocation, they received either a single intra-articular injection of platelet-rich plasma, hyaluronic acid or no injection intraoperatively. Gait analysis, clinical examinations, radiography of the stifle joint for osteoarthritis progression and two validated owner questionnaires were compared among groups at three timepoints postoperatively (6 weeks, 3 and 6 months). Limb function was primarily assessed by measuring the ground reaction forces.

RESULTS

At all times postoperatively, no differences were observed among groups regarding clinical examinations, osteoarthritis score values, ground reaction forces or owner questionnaires. All dogs showed significant improvement in limb function clinically, in all ground reaction forces and in the validated questionnaires. Osteoarthritis progressed minimally during rechecks in all dogs regardless of the additional injection or not.

CLINICAL SIGNIFICANCE

All dogs treated with tibial plateau levelling osteotomy for cranial cruciate ligament rupture showed improvements in limb function. No additive effect on faster recovery was demonstrated with the additional intra-articular injection of platelet-rich plasma or hyaluronic acid. Addition of platelet-rich plasma/hyaluronic acid injections during tibial plateau levelling osteotomy is unnecessary considering the lack of benefit observed up to 6 months postoperatively.

Objective and owner-reported outcomes after modified cranial closing wedge ostectomy: a case series

Immediate and longer-term outcomes of a cranial closing wedge ostectomy variant for management of canine cranial cruciate ligament disease were assessed in this single-center retrospective consecutive study. Records and radiographs were retrieved and assessed by three independent observers to evaluate tibial plateau angle, anatomical-mechanical axis angle, tibial tuberosity distalization, and mechanical axis length before and after surgery. Kinetic gait analysis and owner questionnaires were used to assess clinical outcomes. Seventeen stifles from fifteen dogs were evaluated radiographically. Mean error from target tibial plateau angle was 0.4 degrees. Anatomical-mechanical axis angles reduced from mean 2.9 degrees preoperatively to mean - 0.9 degrees postoperatively. Tibial tuberosity distalization was mean 5.0% of mechanical axis length, and mean reduction in mechanical axis length was 0.1%. Increased tibial plateau angles were noted in 8/17 stifles, with a mean of 9.6 degrees at short-term follow-up. Major complications were observed in 9/17 stifles. Long term follow-up (mean 832 days) was obtained with gait analysis in 8/15 dogs and with questionnaire in 11/15. Most dogs (9/11) were weakly to moderately affected by osteoarthritis symptoms. All values for peak vertical force and vertical impulse normalized to body weight exceeded local lower reference limits for normal dogs, indicating acceptable limb use. Satisfactory immediate and long-term clinical outcomes appear to be possible with this technique, but the high incidence of shorter-term complications may caution against the technique or the fixation and management described here.

Evaluation of the Effects of an Undenatured Collagen Type-2-Based Nutraceutical (ARTHROSHINE® HA²) on Recovery Time after TPLO in Dogs: A Prospective, Randomized Study with Objective Gait Analysis as the Primary Outcome Measure

This randomized, prospective clinical trial investigates the impact of a novel undenatured collagen type 2 (T2NDC)-based nutraceutical, ARTHROSHINE® HA² (AS), on postoperative rehabilitation following Tibial Plateau Leveling Osteotomy (TPLO) in 50 dogs with unilateral cranial cruciate ligament rupture (CCLR). The patients were randomly allocated to either group A, receiving AS once daily for 24 weeks post-TPLO surgery, or group B, without any supplementation. Frequency matching was applied to enhance group comparability. Assessment of outcomes included computerized gait analysis and a validated owner questionnaire. AS supplementation was well received, without any reported side effect. Consistently, patients in group A exhibited significantly higher peak vertical force values during all follow-up assessments. By the 12-week mark, gait analysis indicated a return to a physiological gait pattern in group A, while group B achieved this normalization only by the 24-week point. The administration of AS post-TPLO surgery demonstrates promise in enhancing limb function, leading to faster restoration of a physiological gait pattern. The inclusion of AS, a T2NDC-based nutraceutical, in the post-TPLO rehabilitation protocol may contribute to improved limb function and an expedited recovery, potentially facilitating a quicker return to normalcy. It is noteworthy that subjective owner perceptions did not differ between the two groups.

Long-term outcome in dogs with cranial cruciate ligament disease evaluated using the canine orthopaedic index

BACKGROUND

Cranial cruciate ligament disease (CCLD) is common in dogs, but studies on the long-term treatment outcome are scarce.

METHODS

The long-term outcome in a cohort of 71 dogs with CCLD treated with tibial plateau levelling osteotomy (TPLO, n = 18), tibial tuberosity advancement (TTA, n = 23) or lateral fabellotibial suture (LFS, n = 30) was evaluated using the canine orthopaedic index.

RESULTS

The risk of stiffness and lameness was increased in dogs treated with TPLO (stiffness: incidence rate ratio [IRR] 1.33, p = 0.015; lameness: IRR 1.34, p = 0.020) or TTA (stiffness: IRR 1.26, p = 0.035; lameness: IRR 1.31, p = 0.026) when compared to LFS at a median follow-up time of 4.6 years.

LIMITATIONS

No follow-up veterinary examination was performed. Data were collected from only two university animal hospitals, and thus, a referral bias towards more complicated cases is possible, which may limit the generalisability of the results.

CONCLUSION

Clinicians can use the results to inform dog owners about the expected long-term outcome in dogs with CCLD.

Determination of Isometric Points in the Stifle of a Dog Using a 3D Model

OBJECTIVE

 The aim of this study was to develop a three-dimensional (3D) model to identify the isometric component of the cranial cruciate ligament (CCL) in dogs.

METHODS

 A static 3D model of the specimen was generated from a computed tomography scan of the stifle of a dog and a kinematic model was generated from data collected, every 5 degrees from full extension (131 degrees) through 80 degrees of stifle flexion, from four sensors attached to the tibia. Kinematic data were superimposed on the static model by aligning the points of interest, which were defined for both models. This allowed the tibia to rotate and translate relative to the femur based on the kinematic data. The contours of the distal femur and proximal tibia were converted into point clouds and the distance between each point in the femoral point cloud and all the points in the tibial point cloud were measured at each of the 15 positions. The difference between the maximum and minimum distances for each pair of points was calculated, and when it was less than 0.2 mm, points were illustrated as two red dots connected by a line at their locations on the femur and tibia.

RESULTS

 A total of 3,681 pairs of isometric points were identified and were located at the origin and insertion of the CCL and on the lateral aspect of the stifle.

CONCLUSION

 Isometric areas are present at the origin and insertion of the CCL and lateral aspect of the stifle. Better understanding of these locations may lead to refinements in techniques to replace the ruptured CCL.

Meniscal Load and Load Distribution in the Canine Stifle after Modified Tibial Tuberosity Advancement with 9 mm and 12 mm Cranialization of the Tibial Tuberosity in Different Standing Angles

OBJECTIVES

 The aim of this study was to investigate the kinetic and kinematic changes in the stifle after a modified tibial tuberosity advancement (TTA) with 9 and 12 mm cranialization of the tibial tuberosity in different standing angles.

STUDY DESIGN

 Biomechanical ex vivo study using seven unpaired canine cadaver hindlimbs. Sham TTA surgery was performed. Motion sensors were fixed to the tibia and the femur for kinematic data acquisition. Pressure mapping sensors were placed between femur and both menisci. Thirty percent body weight was applied to the limbs with the stifle in 135 or 145 degrees of extension. Each knee was tested in 135 degrees with intact cranial cruciate ligament (CCL) and deficient CCL with 12 mm cranialization of the tibial tuberosity in 135 and 145 degrees of extension. The last two tests were repeated with 9 mm.

RESULTS

 Transection of the CCL altered kinematics and kinetics. Tibial tuberosity advancement with 12 mm cranialization sufficiently restored stifle kinematics in 135 and 145 degrees but 9 mm TTA failed to do so in 135 degrees. The same effects were seen for internal rotation of the tibia. After TTA, a significant reduction in the force acting on both menisci was detected.

CONCLUSION

 Tibial tuberosity advancement could restore stifle kinematics and meniscal kinetics after transection of the CCL ex vivo in the present study. Tibial tuberosity advancement reduced the contact force ratio on both menisci significantly. No changes of peak pressure and peak pressure location occurred following TTA under any of the tested experimental settings. Increased stifle extension (145 degrees) might lead to more stability, contradictory to biomechanical theory.

Center of pressure and ground reaction forces in Labrador and Golden Retrievers with and without hip dysplasia at 4, 8, and 12 months of age

Canine hip dysplasia (CHD) is a common orthopedic disease. Owing to the importance of CHD in affected dogs, both clinically and for their use in breeding or work, increasing attention is being given to early diagnosis. Therefore, early clinical and radiological examination of young animals is increasingly in demand, whereas common CHD screening according to the Fédération Cynologique Internationale (FCI) is usually performed at the age of 12 months or even older in Europe. One way to objectively evaluate gait pattern is to measure the ground reaction forces (GRFs) and center of pressure (COP). In this study, we used a pressure plate to evaluate the GRF and COP parameters for 32 Labrador Retrievers and 17 Golden Retrievers at 4, 8, and 12 months of age. The dogs also underwent radiological examination of the hip joints following the FCI rules at the age of at least 12 months, which were grouped as sound (FCI grade A or B) and diseased (FCI grade C or worse). The results revealed significantly higher COP values in both breeds in the diseased limb groups at any measurement point during walking, with the most pronounced results obtained at 8 months of age. Furthermore, COP values during walking were significantly higher at 4 months than at 8 and 12 months in both the sound and diseased limb groups, indicating an increased stability of the gait pattern. Except for COP-Speed, the values of all COP parameters were higher during walking than during trotting at 4 months of age (i.e., COP-Speed was higher when trotting), indicating that the 4-beat gait in walk is more difficult to control for puppies than the 2-beat gait in trot. Overall, our results support the early evaluation of CHD in growing animals using non-invasive methods.

Vergleichende Langzeitergebnisse zwischen Tibial Plateau Leveling Osteotomy und Modified Maquet Procedure nach Ruptur des vorderen Kreuzbandes beim Hund

Gegenstand und Ziel Ziel dieser Studie ist es, die Modified Maquet Procedure (MMP) mit der Tibial Plateau Leveling Osteotomy (TPLO) anhand von Langzeitkontrollen über ein Jahr (∅ 3,15 Jahre) mittels klinischer Untersuchung, röntgenologischer Beurteilung der Arthroseprogression und Ganganalyse durch Laufbanduntersuchung zu vergleichen. Zusätzliches Ziel ist es, den Einfluss der Erfahrung der Chirurgen bei der TPLO-Technik zu überprüfen.

Material und Methoden Bei dieser klinischen Studie wurden 67 Kniegelenke von 50 Hunden verschiedener Rassen zwischen 20 und 40 Kilogramm Körpergewicht einbezogen, die mittels TPLO beziehungsweise MMP (n = 19) nach Ruptur des vorderen Kreuzbandes operiert wurden. Die TPLO-Gruppe unterteilte sich in eine Gruppe, welche von 2 erfahrenen Chirurgen (TPLO1, n = 25) operiert wurde und eine zweite Gruppe, die von mehreren Chirurgen unterschiedlicher Erfahrung (TPLO2, n = 23) versorgt wurden. Die Hunde wurden nach mindestens über einem Jahr (3,15 ± 1,21 Jahre) postoperativ orthopädisch, röntgenologisch und ganganalytisch uni- und bilateral getrennt untersucht. Zusätzlich wurden die Daten der Ganganalyse mit einer orthopädisch gesunden Kontrollgruppe verglichen.

Ergebnisse Bei der orthopädischen Untersuchung wurden keine signifikanten und klinisch relevanten Unterschiede zwischen den 3 Gruppen festgestellt.

Die Arthroseprogression zeigte in allen 3 OP-Gruppen ähnliche Werte, wobei die der TPLO2-Gruppe durchschnittlich pro Jahr gerechnet signifikant etwas geringer war als die der TPLO1- und der MMP-Gruppe.

Die ganganalytische Untersuchung im Schritt konnte vor allem im Vergleich mit der gesunden Kontrollgruppe signifikante Unterschiede bei bilateralen Rupturen für die Peak Vertical Force und den Vertical Impulse zeigen. Die Standphasendauer wies keine signifikanten Unterschiede auf. Im Trab konnten keine signifikanten Unterschiede zwischen den 3 OP-Gruppen festgestellt werden.

Schlussfolgerung Beide Operationstechniken erzielten in den 3 Gruppen bei den Langzeitkontrollen gute klinische, radiologische und ganganalytische Ergebnisse auch im Vergleich mit einer gesunden Kontrollgruppe.

Klinische Relevanz Die MMP kann als schnell durchführbare Alternative zur etablierten TPLO mit ebenfalls guten Ergebnissen beim Hund angesehen werden. Die Erfahrung des Chirurgen scheint keinen Einfluss auf das Ergebnis zu haben.

Surgical treatment of cranial cruciate ligament disease in dogs using Tibial Plateau Leveling Osteotomy or Tibial Tuberosity Advancement-A systematic review with a meta-analytic approach

Tibial Plateau Leveling Osteotomy (TPLO) or Tibial Tuberosity Advancement (TTA) are commonly used surgical techniques for correction of cranial cruciate ligament (CCL) rupture in dogs. This systematic review aims to investigate whether one technique is superior to the other. Seventy-two studies on surgical management of CCL rupture have been identified and evaluated in regard of subjective and objective gait analysis criteria, development of osteoarthritis (OA), thigh circumference measurements, goniometry, joint stability, pain and complication rates. Almost half (47.2 %) of the studies were considered of low quality of evidence, leading to high heterogeneity in quality among studies; this posed a major limitation for an evidence-based systematic review of both surgical techniques. Out of 72 studies, there were only eleven blinded randomized clinical trials, of which five were rated with a low overall risk of bias. However, both techniques were considered to be successful management options. Subjective and objective gait analysis revealed no lameness at long-term evaluation for the majority of the patients. However, it appeared that TTA lead to better OA scores up to 6 months postoperatively, while TPLO had a lower rate of surgical site infections. In summary, no method can be clearly preferred, as most of the study evaluated were subpar. Studies with a high level of evidence are therefore urgently needed for such a common surgical procedure.

Tibial Tuberosity Advancement Techniques (TTAT): A Systematic Review

(1) Background: Several surgical techniques were described for the treatment of cranial cruciate ligament rupture in dogs. This report aims to critically review the available literature focused on preoperative planning, surgical procedure, follow-up, and complications of cranial cruciate ligament rupture treated by tibial tuberosity advancement techniques; (2) Methods: three bibliographic databases: PubMed, Google Scholar, and Scopus were used for a board search of TTAT (canine OR dog). Five GRADE recommendations according to Grading of Recommendations Assessment, Development and Evaluation and Joanna Briggs Institute Critical Appraisal Checklists were applied to the studies included. Data regarding preoperative planning (a measure of advancement), meniscal disease (meniscectomy, meniscal release, and late meniscal tears), and postoperative patellar tendon angle were recorded. Time frame, outcome, and complications were classified according to Cook’s guidelines; (3) Results: from 471 reports yielded, only 30 met the inclusion criteria. The common tangent method was the most commonly reported measurement technique for preoperative planning. The 40.21% of stifles presented meniscal tears at surgery, while 4.28% suffered late meniscal tears. In short-, mid-and long-term follow-ups examined showed a full/acceptable function was shown in >90% of cases. Among all new generation techniques, minor complications were reported in 33.5% of cases and major complications in 10.67%; (4) Conclusions: Compared to traditional TTA, new generation TTAT resulted effective in the treatment of cranial cruciate ligament failure, showing a lower rate of late meniscal injury but a higher rate of minor complications.

Changes in Ground Reaction Forces and Center of Pressure Parameters of Paws When Wearing Dog Boots in Dogs

Dog boots are commonly used as protective footwear against snow, ice, hot sand, road salt, and paw injury. Only a few studies exist in veterinary medicine that capture the impact of dog boot replacements, such as bandages, on ground reaction forces (GRF) in dogs. To our knowledge, no studies have investigated the effect of dog boots on the center of pressure (COP) in dogs. This study investigated changes in the GRF of the whole limb and selected COP parameters of the paws while wearing dog boots in five Labrador Retrievers. After habituation, data were collected by walking and trotting dogs over a pressure platform without boots (control measurement) and under five different test conditions (wearing boots on all limbs, boots on both front limbs, boots on both hind limbs, one boot on the left front limb, and one boot on the right hind limb). The most prominent change was detectable when one boot was worn on the left front limb, with a decrease of peak vertical force (PFz%) in the left front limb at trot which led to a significant difference between both front limbs and a significant increase of PFz (%) in the right hind limb. Additionally, in both tempi, the vertical impulse (IFz%) showed significant differences between the front limbs; in trot, there was also an increase in the right front limb compared with the control. Furthermore, some significant changes in COP parameters were detected; for instance, all test conditions showed a significant increase in COP area (%) at the right front limb during walking compared to the control. Therefore, our results show that wearing the tested dog boots in different constellations seems to have an impact on GRF and some COP parameters.

Relationship between Ground Reaction Forces and Morpho- Metric Measures in Two Different Canine Phenotypes Using Regression Analysis

Simple summary

The force plate gait analysis is considered the gold standard for the objective assessment of limb function in dogs. Force plate analysis has been employed in several studies using a cohort of healthy dogs as a control group. However, these studies do not consider the subject variability within the same breed. Moreover, the lack of a rigorous analysis of morphometric variabilities in the same breed makes these evaluations poorly reliable. This prospective study aims to investigate the relationship between the ground reaction forces obtained by the force plate gait analysis and the morphometric measures in two different domestic dogs’ morphotypes. Our results highlighted how the ground reaction forces are influenced by morphometric measures not so much as a single contribution, but through the interaction between them. Indeed, the interaction between body weight, withers height, and velocity significantly influenced ground reaction forces with a greater unit increase for mesomorphs. Statistical models used in the available literature only partially explain the influence of morphometric measures on ground reaction forces, and the comparison between dogs should be made not referring to the breeds but the canine morphotype.

Abstract

Force plate analysis assesses gait symmetry and limb loading. However, as previously described, individual and breed variability (body size and conformation) is related to breeding, body conformation, and size. This prospective study aimed to evaluate the influence of morphometric measures on the speed (V), peak of vertical force (PVF), vertical impulse (VI), and stance time (ST) in healthy dolichomorph and mesomorph dogs and their combined effect on and interactions with V, PVF, VI, and ST in the same morphological types. Fifty dogs were enrolled in the current study, and specific morphometric measurements were recorded for each dog. A force platform was used to record the ground reaction forces (GFRs), including PVF and VI. Multiple linear regression models were used for the study purposes. According to our results, GFRs are influenced by morphometric measures (body weight, withers height, and speed) not so much as a single contribution, but by the interaction between them. It is not possible to compare GFRs in dogs that do not belong to the same breed. However, the subjective variabilities make this comparison difficult and poorly reliable. According to the author, the comparison should be made between canine morphological types rather than breeds.

Outcome after Modified Maquet Procedure in dogs with unilateral cranial cruciate ligament rupture: Evaluation of recovery limb function by use of force plate gait analysis

Introduction

Cranial cruciate ligament failure is one of the principal causes of canine lameness. Several surgical procedures were proposed to achieve joint stabilisation; among these, the Modified Maquet Procedure involves using a titanium foam wedge to achieve and maintain the tibial tuberosity advancement. The force-plate analysis provides to objectively assess normal and abnormal gait and the outcome of different surgical techniques. The study evaluates the outcome of limbs that underwent Modified Maquet Procedure using land-force plate analysis comparing the operated limb with its healthy contralateral one as a control.

Materials and methods

Thirty-five dogs with unilateral cranial cruciate ligament rupture were evaluated. Outcome after surgery was assessed by orthopaedic and radiographic evaluations and force plate gait analysis performed before surgery, at 15, 30 and 90 days after surgery. For objective comparison of ground reaction forces, data of operated limb were compared to contralateral limb on each time control and Symmetry Index at 90 days was determined. Healing radiographic signs, minor and major complication were reported.

Results

A significant improvement in ground reaction forces was reached in all the treated limbs between set time intervals. The median percentage increase in ground reaction forces was constant from 15 to 90 days, with a Symmetry Index >9 in 54.2% of patients suggesting a normal gait symmetry. A complete bone healing was noticed at 90 days follow-up radiographic assessment. We experienced three major (8.5%) and one minor (2.8%) complications.

Conclusions

To the Authors’ knowledge, this is the first study in the veterinary literature that assessed outcomes of dogs undergoing Modified Maquet Procedure for the treatment of cranial cruciate ligament rupture using force plate gait analysis and healthy contralateral limb as a control group. Our results confirm that Modified Maquet Procedure is an effective method to stabilise the stifle joint.

Clinical efficacy of Curcuvet and Boswellic acid combined with conventional nutraceutical product: An aid to canine osteoarthritis

Introduction

Osteoarthritis is a progressive degenerative joint disease which is high prevalent in dogs. In the late stage of the disease, it determines chronic neuropathic pain which leads to reduced quality-of-life in affected patients. To date it has not yet been identified a specific treatment, but it has been proved that nutraceutical and dietary supplements may play an important role in controlling inflammation and pain. The aim of this study was to evaluate, by the use of force plate gait analysis, the clinical efficacy of Boswellia and Curcuvet® combined with conventional nutraceutical therapy compared with conventional nutraceutical alone in dogs affected by osteoarthritis.

Materials and methods

Twenty client-owned dogs, over 12 months old and 20 kg of body-weight, with a confirmed diagnosis of Osteoarthritis, were included in this randomized, double-blinded study. The dogs were randomly divided into two groups: the first group (A) received a conventional nutraceutical (consisted in a preparation of glucosamine, chondroitin sulfate, fish-oil containing 80% of omega 3-fatty acid, vitamin C and E, saccharomyces Cerevisiae) with a combination of acid boswellic and Curcuvet®, while the second group (B) received a conventional nutraceutical. All the enrolled dogs underwent a washout period before starting the treatment with nutraceuticals products which were the only admitted treatment over the study period. A full orthopaedic and neurologic examination, and force plate gait analysis were performed before starting the treatment, at 45, 90, and 60 days post-treatment. Ground reaction forces were recorded and analyzed.

Results

Twenty dogs were enrolled in the study. In both groups there was an increasing values of ground reaction forces. These results might indicate that both nutraceutical products determined a better condition in terms of pain feeling but that effect is much more visible after 60 days from the end of the administration in treated group.

Discussion

In conclusion Curcuvet in combination with Boswellic acid could be considered a valid aid in a multimodal treatment for canine osteoarthritis.