Use of compression stress radiography for the detection of partial tears of the canine cranial cruciate ligament

Correlation of spontaneous radiographic cranial tibial translation with complete cranial cruciate ligament rupture and medial meniscal tears in dogs

The primary objective of our study was to determine the prevalence of cranial tibial translation on a single unstressed, standing angle, mediolateral radiograph of the stifle and the accuracy of diagnosing complete cranial cruciate ligament rupture in dogs with this finding using a previously published method. The secondary objective was to determine if there was a higher incidence of meniscal injuries associated with spontaneous radiographic cranial tibial translation as previously proposed. Medical records were reviewed for client owned dogs with cranial cruciate ligament rupture that underwent surgical stabilization with intra-operative evaluation of the stifle joint via arthrotomy between June 2013 to January 2022 and had pre-operative radiographs performed within 60 days prior to surgery. Pre-operative radiographs were evaluated for cranial tibial translation via the previously published method. Three hundred twenty-three dogs met the inclusion criteria for the study. Intra-operative findings and radiographic assessments were evaluated for correlations. Cranial tibial translation on pre-operative standing angle radiographs detected cranial cruciate ligament tears in 24.8% of cases but had a positive predictive value of 97.5% for diagnosing complete cranial cruciate ligament rupture with a specificity of 95.4% and an overall accuracy of 36.8%. Meniscal tears were present in 58.75% of cases with radiographic cranial tibial translation and 41.25% of cases without. There was no significant increase in the incidence of meniscal tears between the two groups. The presence of radiographic cranial tibial translation in dogs on an unstressed, standing angle, mediolateral radiograph of the stifle is diagnostic for cranial cruciate ligament rupture, but cannot be used to determine the presence of a meniscal tear.

Etiopathogenesis of Canine Cruciate Ligament Disease: A Scoping Review

The spontaneous rupture of the cranial cruciate ligament in dogs remains a pathoetiologic puzzle. Despite much progress in research over the past years, the systemic and local mechanisms leading to ligament degeneration and structural failure remain largely obscure. This scoping review focuses on pathogenesis and aims at summarizing and interpreting today's knowledge on causes of canine cruciate ligament rupture, i.e., the multifactorial mechanisms leading to degenerative stifle joint disease with collagen matrix degeneration and structural failures. Thus, the initial view of traumatic ligament rupture, fostered by "wear and tear", has clearly been replaced by a new concept of systemic processes linked to progressive degenerative joint disease and ligament failure; thus, the term "cranial cruciate ligament disease" has been coined and is generally accepted. In addition, cruciate ligament rupture in people shares some similarities with the lesion in dogs; therefore, the review also includes comparative studies. The methods used were based on the PRISMA-ScR model (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews).

The epidemiology of stifle joint disease in an insured Swedish dog population

BACKGROUND

Stifle joint diseases (SJD) are common in dogs and include a variety of diagnoses. The objective of the study was to provide an overview of the epidemiology of SJD in insured dogs.

METHODS

An historical single cohort study of dogs insured in Agria Pet Insurance (2011-2016) in Sweden was performed. Incidence and relative risk (RR) of SJD was calculated for the whole dog population and for subgroups divided by breed, breed group and sex.

RESULTS

The study population included almost 600,000 insured dogs (>1.7 million dog-years). Ninety-three different stifle joint diagnoses were reported in 9624 dogs, and the most common were cruciate ligament rupture and patellar luxation. The incidence of SJD was 55.4 cases per 10,000 dog-years at risk. Bulldog and boerboel had the highest RR of SJD. The breeds that accounted for the highest proportion of all SJD claimed dogs were mixed breed and Labrador retriever. Female dogs had a slightly increased RR compared with male dogs (RR 1.06, p = 0.006). The incidence increased yearly during the observation period.

CONCLUSION

The study demonstrates breed-specific differences in incidence of SJD in dogs, which may be of importance for breeders, dog owners and veterinarians.

Radiographic findings have an association with weight bearing and locomotion in English bulldogs

Background

English bulldogs are known to be prone to skeletal problems, but knowledge is lacking of the effect of these problems on locomotion and function. This study was undertaken to report the conformational, orthopaedic and radiographic findings in a cohort of English bulldogs in Finland and to evaluate how these findings affect weight bearing and locomotion of the dogs. Twenty-eight English bulldogs were prospectively recruited to this cross-sectional study. An orthopaedic examination, measurements of conformation, static and dynamic weight bearing, and radiographic examinations of elbow, hip, stifle joints and spine were done.

Results

The English bulldogs carried a mean of 67.3% and 62.1% of their body weight in front limbs while standing and trotting, respectively. Front and hind limb lameness was seen in 20.8% (5/24) and 12.5% (3/24) of dogs, respectively. At orthopaedic examination, abnormal palpation findings (i.e. pain response, crepitation, swelling or subjectively decreased range of motion) were observed in a median of one joint (range 0–5) in each dog. Medial patellar luxation was diagnosed in 33.0% (8/24) of the evaluated dogs. At radiographic examination, elbow dysplasia was diagnosed in 48.2% (27/56) of elbow joints and severe hip dysplasia in 55.4% (31/56) of hip joints. The grade of elbow dysplasia was negatively associated with the ratio of static weight bearing between the front and hind limbs (slope estimate − 1.46, 95% CI − 2.75 to − 0.16, P = 0.03) and in dynamic weight bearing the ratio of total pressure index between the front and hind limbs (slope estimate − 0.088, 95% CI − 0.164 to 0.025, P = 0.03). The severity of hip dysplasia or hip osteoarthritis was not associated with the amount of static or dynamic weight bearing, but all except one dog were diagnosed with Fédération Cynologique Internationale grade C, D or E hips (dysplastic). In the spine, 78.6% (22/28) of the dogs had at least one malformed vertebra.

Conclusions

Orthopaedic diseases and abnormal radiographic findings were common in the English bulldogs studied. The static weight bearing of the dogs was heavily distributed to the front limbs. With increasing severity of elbow dysplasia, the static and dynamic weight bearing shifted from dysplastic elbows to hind limbs.

Correlation between orthopaedic and radiographic examination findings and arthroscopic ligament fibre damage in dogs with cruciate ligament rupture

OBJECTIVE

The objective is to study the correlations between physical examination and stifle radiography findings and severity of arthroscopic cranial cruciate ligament (CrCL) fibre damage in dogs with cruciate rupture (CR).

DESIGN

Design Prospective clinical study.

METHODS

Twenty-nine client-owned dogs with CR underwent physical examination, stifle radiography and arthroscopy, and the findings were recorded. Initial examination was repeated after sedation and after general anaesthesia. The Spearman rank correlations of examination variables with diagnostic imaging were examined.

RESULTS

Overall, cranial tibial translation assessed by the tibial compression test in extension showed correlation with arthroscopic CrCL fibre damage (P < 0.05). Correlations between severity of cranial drawer laxity and arthroscopic CrCL fibre damage were not significant. Under general anaesthesia, stifle laxity tests were positively correlated with lameness severity grade (S_R  ≥ 0.41, P < 0.05). Meniscal damage was correlated with pain on the internal rotation of the tibia (S_R = 0.42, P < 0.05) and severity of radiographic osteophytosis (S_R = 0.53, P = 0.01).

CONCLUSION

Detection and estimation of severity of cranial tibial translation enable the diagnosis of CR and also the inference of the severity of CrCL fibre rupture, particularly with the tibial compression test in extension. Severity of joint laxity is best assessed under general anaesthesia. Such knowledge should reduce the risk of misdiagnosis and may enhance early diagnosis and treatment of dogs with CR over time.

Extended long-term radiographic and functional comparison of tibial plateau leveling osteotomy vs tibial tuberosity advancement for cranial cruciate ligament rupture in the dog

OBJECTIVE

To report extended long-term outcomes of dogs with cranial cruciate ligament rupture treated by tibial plateau leveling osteotomy (TPLO) or tibial tuberosity advancement (TTA).

STUDY DESIGN

Retrospective clinical cohort study.

ANIMALS

Client-owned dogs with ≥3 years follow-up (118 dogs, 166 stifles).

METHODS

Records from June 2012 to May 2015 were reviewed. Follow-up examination and radiography were performed in dogs meeting the inclusion criteria. Measures of outcomes included a radiographic osteoarthritis score (preoperative, 8 weeks postoperative, and ≥3 years postoperative), the Canine Brief Pain Inventory, and the Canine Orthopedic Index.

RESULTS

Ninety-four dogs treated with TPLO (133 stifles) and 24 dogs treated with TTA (33 stifles) met the inclusion criteria. All dogs underwent meniscal release or partial medial meniscectomy. Osteoarthritis score progressed more after TTA (P = .003) and in dogs with bilateral surgery (P = .022). Long-term outcomes that were better after TPLO compared with TTA included average pain in the last 7 days (P = .007), interference with walking (P = .010), morning stiffness (P = .004), jumping (P = .003) and climbing (P = .040), limping during mild activities (P = .001), and overall quality of life (P = .045).

CONCLUSION

Osteoarthritis progressed more after TTA and in dogs with bilateral stifle surgery. Dogs treated with TPLO subjectively seemed to have less pain and fewer mobility issues.

CLINICAL SIGNIFICANCE

Tibial plateau leveling osteotomy provides a better long-term radiographic and functional outcome than TTA.

Long-term functional outcome after surgical repair of cranial cruciate ligament disease in dogs

Background

Cranial cruciate ligament (CCL) rupture is a very common cause of pelvic limb lameness in dogs. Few studies, using objective and validated outcome evaluation methods, have been published to evaluate long-term (>1 year) outcome after CCL repair. A group of 47 dogs with CCL rupture treated with intracapsular, extracapsular, and osteotomy techniques, and 21 healthy control dogs were enrolled in this study. To evaluate long-term surgical outcome, at a minimum of 1.5 years after unilateral CCL surgery, force plate, orthopedic, radiographic, and physiotherapeutic examinations, including evaluation of active range of motion (AROM), symmetry of thrust from the ground, symmetry of muscle mass, and static weight bearing (SWB) of pelvic limbs, and goniometry of the stifle and tarsal joints, were done.

Results

At a mean of 2.8 ± 0.9 years after surgery, no significant differences were found in average ground reaction forces or SWB between the surgically treated and control dog limbs, when dogs with no other orthopedic findings were included (n = 21). However, in surgically treated limbs, approximately 30% of the dogs had decreased static or dynamic weight bearing when symmetry of weight bearing was evaluated, 40-50% of dogs showed limitations of AROM in sitting position, and two-thirds of dogs had weakness in thrust from the ground. The stifle joint extension angles were lower (P <0.001) and flexion angles higher (P <0.001) in surgically treated than in contralateral joints, when dogs with no contralateral stifle problems were included (n = 33). In dogs treated using the intracapsular technique, the distribution percentage per limb of peak vertical force (DPVF) in surgically treated limbs was significantly lower than in dogs treated with osteotomy techniques (P =0.044).

Conclusions

The average long-term dynamic and static weight bearing of the surgically treated limbs returned to the level of healthy limbs. However, extension and flexion angles of the surgically treated stifles remained inferior to healthy joints, and impairment of AROM and weakness in thrust from the ground in the surgically treated limbs were frequently present. Ground reaction forces may be inadequate as a sole method for assessing functional outcome after cranial cruciate ligament repair.

Retrospective analysis of complications and outcomes in Boxers and Staffordshire Bull Terriers undergoing cranial cruciate ligament surgery

OBJECTIVE

The aim of this study was to determine whether Boxers and Staffordshire Bull Terriers (SBT) have a higher incidence of complications or a worse outcome after cranial cruciate ligament (CCL) surgery compared with control breeds.

DESIGN

The design was a retrospective cohort study with data reviewed from medical records and outcome assessed by owner questionnaire.

RESULTS

The cohort included 210 canine stifles comprising 33 Boxers, 47 SBTs and 130 controls. For Boxers, the overall complication rate (39.4%), major complication rate (30.3%) and revision surgery rates (18.2%) were significantly higher than those of the control groups (14.6%, 10.8% and 4.6%, respectively). Overall, SBTs were no more likely to suffer complications or repeat surgery than the control group. Considering only lateral fabello-tibial suture (LFS) stabilisation, both Boxers (32.0%) and SBTs (23.3%) had higher complication rates than the control group (6.3%). There were no significant differences in outcome among the Boxer, SBT and control groups; median follow-up time was 2 years (range 0.5-7 years).

CONCLUSIONS

The overall complication rate for Boxers undergoing CCL surgery was higher compared with other breeds of dog. When surgical techniques were analysed separately, the LFS was associated with a higher complication rate in Boxers and SBTs. Further investigation into breed-specific surgical techniques is indicated.

Ranking of physiotherapeutic evaluation methods as outcome measures of stifle functionality in dogs

Background

Various physiotherapeutic evaluation methods are used to assess the functionality of dogs with stifle problems. Neither validity nor sensitivity of these methods has been investigated. This study aimed to determine the most valid and sensitive physiotherapeutic evaluation methods for assessing functional capacity in hind limbs of dogs with stifle problems and to serve as a basis for developing an indexed test for these dogs. A group of 43 dogs with unilateral surgically treated cranial cruciate ligament deficiency and osteoarthritic findings was used to test different physiotherapeutic evaluation methods. Twenty-one healthy dogs served as the control group and were used to determine normal variation in static weight bearing and range of motion.

The protocol consisted of 14 different evaluation methods: visual evaluation of lameness, visual evaluation of diagonal movement, visual evaluation of functional active range of motion and difference in thrust of hind limbs via functional tests (sit-to-move and lie-to-move), movement in stairs, evaluation of hind limb muscle atrophy, manual evaluation of hind limb static weight bearing, quantitative measurement of static weight bearing of hind limbs with bathroom scales, and passive range of motion of hind limb stifle (flexion and extension) and tarsal (flexion and extension) joints using a universal goniometer. The results were compared with those from an orthopaedic examination, force plate analysis, radiographic evaluation, and a conclusive assessment. Congruity of the methods was assessed with a combination of three statistical approaches (Fisher’s exact test and two differently calculated proportions of agreeing observations), and the components were ranked from best to worst. Sensitivities of all of the physiotherapeutic evaluation methods against each standard were calculated.

Results

Evaluation of asymmetry in a sitting and lying position, assessment of muscle atrophy, manual and measured static weight bearing, and measurement of stifle passive range of motion were the most valid and sensitive physiotherapeutic evaluation methods.

Conclusions

Ranking of the various physiotherapeutic evaluation methods was accomplished. Several of these methods can be considered valid and sensitive when examining the functionality of dogs with stifle problems.

Use of bathroom scales in measuring asymmetry of hindlimb static weight bearing in dogs with osteoarthritis

OBJECTIVE

The study assessed the use and reliability of bathroom scales as an objective measurement tool, and setting a normal variance of static weight bearing between hindlimbs.

METHODS

Two groups of dogs were tested: a healthy control group (n = 21) and a group (n = 43) of dogs with confirmed osteoarthritis in at least one stifle joint, with or without hip joint osteoarthritis. Static weight bearing was evaluated manually and measured with two bathroom scales. An orthopaedic examination was done and dynamic weight bearing was measured using a force platform. Radiographs were taken to confirm the presence of osteoarthritis, and dogs were divided into groups of severe and non-severe osteo- arthritic changes. Reliability by repeatability was tested using analysis of variance, and the congruity between static weight bearing and other evaluation methods with Kappa statistics and proportion of agreement.

RESULTS

The difference between the hindlimbs proportional to the body weight in control dogs was 3.3% (± 2.7%). The repeatability of measuring static weight bearing in the hindlimbs of osteoarthritic dogs with bathroom scales was 81% with osteoarthritic limbs, and 70% for unaffected limbs. The sensitivity of static weight bearing measurements using bathroom scales was 39% and specificity 85%.

CLINICAL SIGNIFICANCE

Bathroom scales are a reliable, simple, and cost-effective objective method for measuring static weight bearing and can be used as an outcome measure when rehabilitating dogs with osteoarthritic changes in the hindlimbs.

Radiographic quantitative assessment of cranial tibial subluxation before and after tibial plateau leveling osteotomy in dogs

OBJECTIVE

To determine the influence of stifle joint flexion angle, cranial cruciate ligament (CrCL) integrity, tibial plateau leveling osteotomy (TPLO), and cranial tibial subluxation on the distance between the location of the origin and insertion of the CrCL (CrCL(d)) in dogs.

SAMPLES

4 pairs of pelvic limbs from adult dog cadavers weighing 23 to 34 kg. Procedures-Mediolateral projection radiographs of each stifle joint were obtained with the joint flexed at 90°, 105°, 120°, 135°, and 150°. Radiopaque markers were then placed at the sites of origin and insertion of the CrCL. Afterward, radiography was repeated in the same manner, before and after CrCL transection, with and without TPLO. Following CrCL transection, radiographs were obtained before and after inducing overt cranial tibial subluxation. Interobserver variation in measuring the CrCL(d) without fiduciary markers was assessed. The effect of CrCL integrity, cranial tibial subluxation, flexion angle, and TPLO on CrCL(d) was also determined.

RESULTS

Interobserver agreement was strong, with an intraclass correlation coefficient of 0.859. The CrCL(d) was significantly shorter (< 1 mm) at 90° of flexion; otherwise, flexion angle had no effect on CrCL(d). Cranial tibial subluxation caused a 25% to 40% increase in CrCL(d). No effect of TPLO on CrCL(d) was found, regardless of CrCL integrity, forced stifle joint subluxation, or flexion angle.

CONCLUSIONS AND CLINICAL RELEVANCE

Overt cranial tibial subluxation in CrCL-deficient stifle joints can be detected on mediolateral projection radiographs by comparing CrCL(d) on neutral and stressed joint radiographs at joint angles between 105° and 150°, regardless of whether a TPLO has been performed.

Diagnostic imaging of the canine stifle: a review

The stifle joint, a common location for lameness in dogs, is a complex arrangement of osseous, articular, fibrocartilaginous, and ligamentous structures. The small size of its component structures, restricted joint space, and its intricate composition make successful diagnostic imaging a challenge. Different tissue types and their superimposition limit successful diagnostic imaging with a single modality. Most modalities exploit the complexity of tissue types found in the canine stifle joint. Improved understanding of the principles of each imaging modality and the properties of the tissues being examined will enhance successful diagnostic imaging.

Evaluation of anticollagen type I antibody titers in synovial fluid of both stifle joints and the left shoulder joint of dogs with unilateral cranial cruciate disease

OBJECTIVE

To evaluate anticollagen type I antibodies in synovial fluid of the affected stifle joint, the contralateral stifle joint, and the left shoulder joint of dogs with unilateral cranial cruciate ligament (CrCL) rupture during an extended period of 12 to 18 months.

ANIMALS

13 client-owned dogs with CrCL rupture and 2 sham-operated dogs.

PROCEDURES

All dogs were examined and arthrocentesis of all 3 joints was performed every 6 months after surgery. Synovial fluid samples were tested for anticollagen type I antibodies by use of an ELISA.

RESULTS

Dogs with partial CrCL rupture had higher antibody titers than dogs with complete rupture. Six of 13 dogs ruptured the contralateral CrCL during the study, whereby higher antibody titers were found for the stifle joints than for the shoulder joint. Seronegative dogs or dogs with extremely low antibody titers and 2 dogs with high antibody titers did not sustain a CrCL rupture in the contralateral stifle joint.

CONCLUSIONS AND CLINICAL RELEVANCE

In most dogs that had a CrCL rupture of the contralateral stifle joint, a distinct antibody titer gradient toward the stifle joints was detected, suggesting that there was a local inflammatory process in these joints. However, only a small number of sham-operated dogs were used to calculate the cutoff values used to determine the anticollagen type I antibody titers in these patients. Synovial fluid antibodies against collagen type I alone do not initiate CrCL rupture because not all dogs with high antibody titers sustained a CrCL rupture in the contralateral stifle joint.

Caudal proximal tibial deformity and cranial cruciate ligament rupture in small-breed dogs

Eight dogs presented with chronic hindlimb lameness associated with cranial cruciate ligament rupture. Seven were small terriers. A caudal deformity of the proximal tibial shaft, originating at the proximal tibial physis, and an excessive caudal slope of the tibial plateau were present bilaterally in all dogs. The deformity was thought to be responsible for the cranial cruciate ligament failure and poor response to conservative management. Tibial plateau angles were in excess of 26 degrees in all dogs. The lameness was bilateral in three dogs. There was complete cranial cruciate ligament rupture in seven stifles and partial rupture in four. There were no meniscal injuries. Surgical correction resulted in a significant improvement (P<0.0001) in all dogs, with a mean follow-up of 12 months (range three to 24 months). There were no complications.