Systematic review of the prevalence, risk factors, diagnosis and management of meniscal injury in dogs: Part 1. [corrected]

Postoperative tibial plateau angle changes and their influence on ground reaction forces 6 months after TPLO: a prospective study

Objectives

The objectives of the study were to investigate the association between change in postoperative (post-op) tibial plateau angle (TPA) in dogs and cranial cruciate ligament disease (CCLD) after tibial plateau leveling osteotomy (TPLO) during 6 months on the post-op outcome.

Methods

The inclusion criteria included 60 dogs with CCLD treated with TPLO fulfilled. TPA measurements were taken immediately post-op and 6 months post-op by three observers, and change in TPA was calculated. The outcome was evaluated using lameness score, owner questionnaire, and gait analysis performed preoperatively and 6 months post-op.

Results

The mean change in TPA was 0.22 ± 0.75°. The interobserver reliability for TPA measurements was excellent. No differences in TPA measurements between observers were found (p = 0.07-0.105). No association between the change in TPA and outcome was found. The multivariate linear regression model for the symmetry index of peak vertical force (SIPVF) 6 months post-op was significant (R 2 = 0.210; p = 0.031), and the TPA at 6 months post-op was the only significant factor (ß = 0.459; 95% CI: 0.41-1.44; p < 0.001), indicating that a lower TPA 6 months post-op results in lower SIPVF values.

Conclusion

The study indicated that lower TPAs 6 months post-op lead to a more symmetrical gait in hindlimbs 6 months post-op. No other significant factor between post-op changes in TPA and outcome after TPLO was found. Our results showed little post-op TPA change up to 6 months. This indicates that change in TPA is not present as reported.

Diagnosis of medial meniscal lesions in the canine stifle using multidetector computed tomographic positive-contrast arthrography

OBJECTIVE

To assess diagnostic value and clinical utility of multidetector computed tomographic positive contrast arthrography (CTA) for meniscal lesions in dogs.

STUDY DESIGN

Prospective case series.

STUDY POPULATION

Client-owned dogs (n = 55) with cranial cruciate ligament injuries.

METHODS

Sedated dogs underwent CTA using a 16-slice scanner, and subsequently received mini-medial arthrotomy for meniscal assessment. Scans were anonymized, randomized, and reviewed twice for meniscal lesions by three independent observers with varying experience. Results were compared with surgical findings. Reproducibility and repeatability were assessed with kappa statistics, intraobserver changes in diagnosis by McNemar's test, and interobserver differences using Cochran's Q test. Test performance was calculated using sensitivity, specificity, proportion correctly identified, and positive and negative predictive values and likelihood ratios.

RESULTS

Analysis was based on 52 scans from 44 dogs. Sensitivity for identifying meniscal lesions was 0.62-1.00 and specificity was 0.70-0.96. Intraobserver agreement was 0.50-0.78, and interobserver agreement was 0.47-0.83. There was a significant change between readings one and two for the least experienced observers (p < .05). The sum of sensitivity and specificity exceeded 1.5 for both readings and all observers.

CONCLUSION

Diagnostic performance was suitable for identifying meniscal lesions. An effect of experience and learning was seen in this study.

Associations between meniscal tears and various degrees of osteoarthritis among dogs undergoing TPLO for cranial cruciate ligament rupture

OBJECTIVE

The aim of this study was to evaluate the association between meniscal lesions and severity of osteoarthritis (OA) among dogs that underwent Tibial Plateau Leveling Osteotomy (TPLO) for stabilization of cranial cruciate ligament rupture (CrCLR) at the University of Tennessee in 2011-2017.

RESULTS

There were a total of 252 meniscal tears. Factors associated with diagnosis of medial meniscal tears (MMT) in dogs were severe OA in comparison to no OA (3.8 OR, 2.0-8.0 95% CI, 0.001 p-value), sporting and mixed breed group compared to other breed (3.6 OR, 1.7-7.6 95% CI, 0.004 p-value; 3.2 OR, 1.6-6.6 95% CI, 0.019 p-value, respectively), increasing age (1.1 OR, 1.0-1.2 95% CI, 0.018 p-value), complete CrCLR compared to partial (3.3 OR, 2.1-5.0 95% CI, < 0.001 p-value), and arthrotomy compared to arthroscopy (2.2 OR, 1.4-3.1 95% CI, 0.002 p-value). The factors that did not have significance in predicting MMT were weight, sex, lameness period, and side affected.

Effect of center of angulation of rotation-based leveling osteotomy on ex vivo stifle joint stability following cranial cruciate ligament transection and medial meniscal release with and without a hamstring load

Objective

To evaluate the effect of center of rotation of angulation (CORA)‐based leveling osteotomy (CBLO) and hamstring load on stifle stability following cranial cruciate ligament transection (CCLx) and medial meniscal release (MMR).

Study design

Ex vivo experimental study.

Sample population

Cadaver hind limb preparations (n = 7).

Methods

After instrumentation, constant quadriceps and gastrocnemius loads with an optional hamstring load in a 3:1:0.6 ratio were applied, and stifles were extended from fully flexed using an electrical motor during fluoroscopic recording. The recording process was repeated after each of CCLx, MMR and CBLO and the extracted landmark coordinates were used for calculation of cranial tibial translation (CTT) and patellar ligament angle (PTA).

Results

Mean initial tibial plateau angle was 28.1°: post‐CBLO the mean was 9.7°. Cranial tibial translation developed from 50° and 75° with CCLx and MMR respectively (p < .04, < .02) without hamstring loading. Hamstring loading mitigated CTT due to CCLx and delayed CTT until 120° for MMR (P < .02) in this model. CBLO prevented CTT, except at 140° without hamstring loading (P = .01). Similar results were seen for PTA, but CBLO curves were parallel to and lower than intact values at all tested angles (P < .04), consistent with induced effective joint flexion.

Conclusion

CBLO to a target tibial plateau angle of 10° largely eliminated CTT induced by CCLx and MMR. Hamstring loads of 20% quadriceps load improved stifle stability in this model.

Impact

Stifle stability following CBLO appears to be multifactorial and depends on meniscal integrity, joint angle, and hamstring strength.

Effects of Oral Hyaluronic Acid Administration in Dogs Following Tibial Tuberosity Advancement Surgery for Cranial Cruciate Ligament Injury

Hyaluronic acid (HA) intraarticular injection is used in the management of osteoarthritis in veterinary medicine. However, HA oral administration is less common given the scarce currently available scientific evidence. This study was aimed at evaluating the effects of oral HA administration on synovial fluid concentrations of several selected biomarkers in dogs with cranial cruciate ligament (CCL) injury operated on using the tibial tuberosity advancement (TTA) technique. Fifty-five dogs were included in this prospective, randomized, double-blind, clinical study; they were randomly assigned to receive either a placebo (group A; n = 25) or HA (group B; n = 30) orally for 10 weeks. Synovial fluid samples were obtained before surgery, and at 10 weeks postoperatively to measure concentrations of HA, haptoglobin, nitric oxide, and paraoxonase-1. After 10 weeks, group HA showed a significant increase in HA concentration (p = 0.0016) and a significant decrease in PON-1 concentration (p = 0.011) compared to baseline. In conclusion, post-op oral HA administration in canine patients with CCL injury leads to improvements in osteoarthritis biomarkers, namely higher synovial fluid HA concentrations and reduced synovial fluid paraoxonase-1 concentrations. These findings support the bioavailability of orally-administered HA and its usefulness in improving biomarkers of osteoarthritis.

Articular cartilage lesions associated with complete lateral meniscal tears in the dog

OBJECTIVE

To describe articular cartilage (AC) lesions associated with complete lateral meniscal tears in dogs.

STUDY DESIGN

Observational series.

ANIMALS

Seventeen dogs with arthroscopic evidence of a complete lateral meniscal tear and associated AC lesions.

METHODS

Medical records of dogs with arthroscopic evidence of complete lateral meniscal tear and associated AC lesions between March 2006 and December 2017 were examined for arthroscopic findings.

RESULTS

The cranial cruciate ligament (CrCL) was intact in 11 of 17 dogs, partially ruptured but competent in 4 of 17 dogs, and completely ruptured in 2 of 17 dogs. All dogs had grossly normal caudal cruciate ligament, medial meniscus, and AC of the medial compartment. In each dog, a complete radial tear of the caudal body of the lateral meniscus was associated with degenerative osteoarthritis (OA) of the lateral compartment of the stifle. The Outerbridge score of the lateral tibial condyle and lateral femoral condyle was 5 of 5 in 15 dogs, 3 of 5 in 1 dog, and 4 of 5 in 1 dog.

CONCLUSION

Dogs with complete tears of the lateral meniscus developed degenerative OA of the lateral compartment of the stifle leading to AC loss and clinical dysfunction.

CLINICAL SIGNIFICANCE

Complete lateral meniscal tears may occur as isolated injuries in dogs with a functional CrCL.