Clinical outcomes after common calcanean tendon rupture repair in dogs with a loop-suture tenorrhaphy technique and autogenous leukoreduced platelet-rich plasma

Hybrid, transarticular external fixation with platelet-rich plasma injection as a treatment for partial calcaneal tendon disruption in dogs without primary tenorrhaphy

OBJECTIVE

To report the use of a hybrid, transarticular external skeletal fixator and platelet-rich plasma injection without primary tenorrhaphy for management of partial calcanean tendon disruption in dogs.

STUDY DESIGN

Multi-institutional retrospective study.

ANIMALS

A total of 11 client-owned dogs.

METHODS

Medical records from two referral centers from 2019 to 2022 were reviewed for inclusion in the study. Dogs diagnosed with partial, non-traumatic calcanean tendon disruption treated with hybrid, transarticular external skeletal fixation and platelet-rich plasma injection were included in the study. Cases that did not include complete postoperative follow-up over 8-12 weeks and owner-reported outcomes at >6 months were excluded from the study. Dogs with traumatic laceration or those in which a primary tenorrhaphy was performed were also excluded.

RESULTS

A total of 11 (n = 11) dogs met the inclusion criteria. Median follow-up time was 18.5 months (6 months-34 months). Mean time of fixation was 9 weeks (6 weeks-12 weeks). Five dogs returned to full, pain-free function (5/11 = 45%). Five dogs had an acceptable return to function (5/11 = 45%). One dog had an unacceptable outcome (1/11 = 9%). Pin tract complications occurred in five dogs (5/11 = 45%) and resolved with medical intervention.

CONCLUSION

The results of this study suggest that temporary tibiotarsal immobilization with a hybrid, transarticular external skeletal fixator and platelet-rich plasma injection without primary tenorrhaphy can lead to a successful outcome in dogs with partial calcanean tendon disruption.

CLINICAL SIGNIFICANCE

Temporary hybrid, transarticular external skeletal fixation and platelet-rich plasma injection without primary tenorrhaphy may play a role in the management of partial calcanean tendon disruption in dogs.

Case report: Nonsimultaneous bilateral triceps tendon rupture and surgical repair in a healthy dog

A 7-year-old female spayed Australian shepherd dog was presented for an acute onset of inability to stand. On physical examination, the dog was unable to support weight on the thoracic limbs. On neurological examination, the thoracic limbs had absent hopping and paw placement and reduced withdrawal reflexes bilaterally. The remainder of the neurological examination was normal. The anatomic lesion localized to the C6-T2 spinal nerve roots, spinal nerves, or the named nerves of the thoracic limb, bilaterally. A lesion affecting the ventral gray column of the C6 through T2 spinal cord segments was considered less likely. In an effort to exclude an orthopedic disorder from consideration, radiographs of the shoulders, elbows, and manus were normal. Magnetic resonance imaging of the cervical and cranial thoracic vertebral column was normal. Analysis of synovial fluid from the carpi, elbows, and shoulders were normal. Ultrasonography of the triceps muscle and tendon of insertion revealed bilateral, acute-subacute tears of the tendon at insertion of the triceps muscles, bilaterally. Magnetic resonance imaging of both elbows revealed complete avulsion of the triceps tendons bilaterally. Surgical repair of both tendons was performed using the Arthrex FiberLoop system combined with autologous conditioned plasma soaked in a collagen sponge. Postoperatively, external coaptation was provided using Spica splints for 6 weeks followed by the use of soft padded orthotic braces for an additional 6 weeks. Concurrently, a front support wheelchair was used for 10 weeks postoperative. By 10 weeks postoperative, the dog was able to ambulate without support. To the authors' knowledge, this is the first report of bilateral triceps tendon avulsion in a dog. Tendon avulsion occurred without a known history of trauma or predisposing metabolic abnormalities. Magnetic resonance imaging provided excellent anatomical detail that aided in surgical repair.

Non-invasive methods to assess muscle function in dogs: A scoping review

Skeletal muscle function can be affected by multiple disorders in dogs of which cranial cruciate ligament rupture or disease (CCLD) is one of the most common. Despite the significance of this condition only sparse research exists regarding assessment of muscle function in dogs. This scoping review aimed to identify the non-invasive methods for canine muscle function assessments that have been reported in the literature in the past 10 years. A systematic literature search was conducted 1st March 2022 across six databases. After screening, 139 studies were considered eligible for inclusion. Among the included studies, 18 different muscle function assessment categories were identified, and the most frequently reported disease state was CCLD. We included an attempt to elucidate the clinical applicability of the 18 reported methods, as experts were asked to subjectively assess the methods for their clinical relevance as well as their practical applicability in dogs with CCLD.

Case report: Flexor carpi ulnaris tendinopathy in a lure-coursing dog treated with three platelet-rich plasma and platelet lysate injections

In the present case report a 7-year-old male Whippet competing in lure-coursing presented with third-degree recurrent lameness of the right forelimb, pain on palpation of the caudal aspect of the carpus and swelling of the forearm proximally to the accessory carpal bone. Clinical, radiographic, and ultrasonographic evaluation diagnosed a flexor carpi ulnaris (FCU) chronic tendinopathy unresponsive to previously attempted conservative treatments such as oral non-steroidal anti-inflammatory drugs (NSAIDs) administration along with padded palmar splint application and rest. The dog was subjected to one injection of autologous platelet-rich plasma (PRP) obtained using a double centrifugation tube method, followed by two platelet lysate (PL) injections. Treatment was administered at three-week intervals. The healing process was assessed through clinical and ultrasonographic imaging (US) on the day of the first injection (T0), and at week three (T1), six (T2), twelve (T3), fifty-two (T4), and one-hundred-and-four (T5). Fiber alignment score (FAS) and echogenicity score (ES) were developed by modifying a previously published US assessment scale. At T1, ES, and FAS improvement was detected, and at T2, further improvements in ES and FAS were observed. Ultrasonographic results were clinically consistent with the improvement in lameness: lameness grade 3/4 was detected at T0 and grade 2/4 at T1. A lameness grade of 1/4 was detected at T2, and grade 0/4 was observed at T3, T4, and T5. Moreover, at T5, the dog returned to competition, and no history of re-injury was reported. Our results suggest that the treatment of FCU tendinopathy in lure-coursing dogs with a combination of consecutive injections of autologous PRP and PL could be feasible. Additionally, no adverse reactions were observed.

Retrospective multicentre evaluation of common calcaneal tendon injuries in 66 cats. Part 2: treatment, complications and outcomes

OBJECTIVES

The aims of the second part of this retrospective multicentre study were to describe the surgical techniques used in the treatment of common calcaneal tendon (CCT) injuries, and evaluate the short- and long-term outcomes and complications.

METHODS

The medical records of five different small animal referral centres and veterinary teaching hospitals between 2010 and 2020 were reviewed. Surgical vs conservative treatment was evaluated. Treatment type, type of postoperative immobilisation, and short- and long-term outcomes and complications were recorded. Minor complications were defined as not requiring surgical intervention. Long-term outcome was evaluated by an owner questionnaire.

RESULTS

Sixty-six cats met the inclusion criteria. Mean time to surgery was 9.6 days (range 0-185). Most cats (83.3%) were treated surgically. Regardless of treatment modality, all limbs were immobilised for a mean time of 48.2 days (range 2-98). For 63 cats that had the temporary tarsal joint immobilisation technique recorded, a transarticular external skeletal fixator (ESF; 57.1%) or a calcaneotibial screw (33.3%) were used most commonly. The method of immobilisation had a notable, although non-significant, influence on the occurrence of short-term complications, with most complications being reported for the transarticular ESF group. The total short-term complication rate was 41.3%, the minor complication rate was 33.3% and the major complication rate was 7.9%, with pin tract infections being the most commonly occurring minor complication. Three cats (6%) had a total of four major complications over the long term. Most cats (86%) were free of lameness at the long-term evaluation, with an overall successful clinical long-term outcome of 84.9%, according to the owner questionnaire. Cats with traumatic injuries and injuries treated surgically had higher questionnaire scores than those with atraumatic injuries and those treated conservatively.

CONCLUSIONS AND RELEVANCE

Outcome was generally good in cats with CCT injury, irrespective of the type of treatment. Complications included a high proportion of minor complications associated with the technique of tarsal joint immobilisation. ESF frames were more commonly involved in complications than other techniques. Surgically treated cats had a slightly better long-term outcomes.

The effects of orthobiologics in the treatment of tendon pathologies: a systematic review of preclinical evidence

Purpose

The aim of this systematic review is to explore the current available knowledge about tendon disorders and orthobiologics derived by preclinical experiments to evaluate their role and efficacy in the different stages and conditions related to the tendon healing processes.

Methods

The systematic review was performed according to the PRISMA guidelines. Different electronic databases (MEDLINE, Web of Science, EMBASE) were searched for studies investigating orthobiologics (PRP and cell-based products from adipose tissue or bone marrow) in animal models or veterinary clinical trials for tendon pathologies (complete/partial tendon ruptures, rotator cuff tears, tendinopathy, enthesis-related injuries). Data regarding the specific product used, the treatment site/pathology, the host and the model were collected. The results were classified into the following categories: histological, biomechanical, molecular and imaging.

Results

A large pool of preclinical studies on tendon disorders have been found on platelet-rich plasma (PRP), while data about stromal vascular fraction (SVF) and bone marrow concentrate (BMAC) are still limited and frequently focused on expanded cells, rather than orthobiologics prepared at the point of care.

The effect of PRP is related to an acceleration of the healing process, without improvements in the final structure and properties of repaired tendon. Cell-based products have been reported to produce more durable results, but the level of evidence is currently insufficient to draw clear indications.

Conclusions

The preclinical results about orthobiologics applications to tendon pathologies would support the rationale of their clinical use and encourage the performance of clinical trials aimed to confirm these data in human subjects.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40634-022-00468-w.

Use of Autologous Leucocyte- and Platelet-Rich Plasma (L-PRP) in the Treatment of Aural Hematoma in Dogs

Leukocyte- and platelet-rich plasma (L-PRP) can accelerate the healing process by providing increased concentrations of platelet-derived growth factors. The objective of this study was to evaluate the clinical effect of L-PRP in the treatment of canine aural hematomas associated with otitis externa. Twenty mL of citrated whole blood was collected from each of the 17 dogs included and autologous L-PRP was produced. The aural hematoma was drained and 0.5–1 mL of L-PRP was injected. The dogs were examined weekly until 7 days after complete clinical healing. A final clinical follow-up was performed 6 weeks after the first treatment with L-PRP. If there was recurrence of the aural hematoma at the first follow-up, the treatment was repeated. In total, 2/17 cases were lost after the first follow-up. In 5/17 dogs, a short-term recurrence occurred. In 12/15 cases, complete clinical resolution was achieved with a single L-PRP application (Group A1) and in 3/15 with two treatments (Group A2). The mean time to complete clinical resolution was 16 ± 8.7 days (A1) and 23.3 ± 4 days (A2), respectively. No side effects were reported. The in situ administration of autologous L-PRP resulted in a complete resolution of the aural hematoma in all dogs that completed the clinical trial.

Prospective Evaluation of a Citrate-Based Biomaterial Wedge for a Modified Maquet Procedure in the Treatment of Cranial Cruciate Ligament Rupture in Dogs

OBJECTIVE

 The aim of this study was to describe short- and mid-term outcomes, complications, implant bioabsorption and owner satisfaction for a modified Maquet procedure (MMP) in which a novel bioabsorbable citrate-based implant is used as the wedge component to treat cranial cruciate ligament rupture in client-owned dogs.

STUDY DESIGN

 Prospective clinical study of dogs (n = 13) undergoing MMP (n = 15). Intraoperative complications, postoperative complications, clinical follow-up using a 5-point lameness score and radiographs at 8 weeks and 6 months postoperatively were obtained. Mid-term outcome was assessed via physical examination, radiographs, canine orthopaedic index and owner satisfaction questionnaires.

RESULTS

 No catastrophic complications occurred. Major complications occurred in 3/15 stifles. All were surgical site infections and one case required implant removal. Minor complications occurred in 9/15 stifles. Non-displaced cortical hinge fractures were the most common minor complication, and these occurred intraoperatively (4/15) or postoperatively (2/15). Three dogs achieved full function, eight dogs acceptable function and the outcome was unacceptable in two dogs. Most owners were satisfied with the procedure (11/13). Complete implant bioabsorption was not confirmed on mid-term radiographs.

CONCLUSION

 The described MMP with a citrate-based implant can produce satisfactory mid-term results. However, the long-term outcome of this procedure must be evaluated and technical modifications need to be implemented prior to larger-scale use of this implant.

Rheological Properties and Growth Factors Content of Platelet-Rich Plasma: Relevance in Veterinary Biomedical Treatments

Platelet-rich plasma (PRP) is a nontransfusional hemocomponent, considered as a powerful concentrate of growth factors (GFs) therapeutically used to stimulate tissue regeneration. The use of autologous PRP, as the patient’s own biological material, for therapeutic purposes represents a safe and effective alternative to conventional treatments in both human and veterinary medicine. The aim of this study was the characterization of canine PRP from rheological and biological points of view. Thus, a characterization of the viscoelastic properties of the PRP systems was performed in order to clarify the influence of different calcium concentrations, in the presence of autologous thrombin-rich solution, on the PRP gels’ mechanical properties, from which the applicability of these systems in biomedical treatments is strongly dependent. Then, an evaluation of the content of GFs in PRP, activated or not with thrombin, and stored at different temperatures (37 °C and −20 °C) was performed over time, outlining, for the first time, the importance of the effect of physiological temperature (37 °C) on the production of GFs. A clinical case study conducted in a dog with a complete rupture of the common calcaneal tendon (Achilles tendon) confirmed the relevance of this hemocomponent in the daily veterinary clinical activity and the potential translational value for human health.