Caudal cruciate ligament disease in three Basset Hounds

CASE DESCRIPTION

3 adult Basset Hounds were referred for evaluation of chronic, unilateral, pelvic limb lameness with no history of trauma.

CLINICAL FINDINGS

On examination, all dogs had mild lameness of the affected limb; signs of pain were evident during manipulation of the stifle joint in the affected limb, along with effusion of that joint. No stifle joint instability was palpable. Radiographs were available for review for 2 of the 3 dogs. Effusion was confirmed radiographically, but severity of degenerative joint disease varied. Central intercondylar notch width ratios for the 2 dogs were 0.16 and 0.17, and tibial plateau angles were -10° and 15°; relative tibial tuberosity width was 1.1 for both dogs. Exploratory arthroscopy revealed moderate degeneration of the caudal cruciate ligament in all 3 dogs; the cranial cruciate ligaments were grossly normal.

TREATMENT AND OUTCOME

Corrective osteotomy to increase the tibial plateau angle was performed in 1 dog, and the lameness resolved by 2 months after surgery. The 2 other dogs were managed without additional surgery. One dog was persistently lame. The other dog reportedly had normal limb function 2.5 years after undergoing exploratory arthroscopy.

CLINICAL RELEVANCE

Morphological characteristics of the tibia in Basset Hounds may predispose to abnormal stresses on the caudal cruciate ligament. Isolated degeneration of the caudal cruciate ligament should be considered as a differential diagnosis for Basset Hounds with lameness originating from the stifle joint. Without direct inspection of the joint, caudal cruciate ligament disease could be confused for cranial cruciate ligament injury.

Ex vivo mechanical properties of a 2.5-mm bone anchor for treatment of cranial cruciate ligament rupture in toy breed dogs

OBJECTIVE

To determine the mechanical pull-out properties of a 2.5-mm bone anchor implanted in ex vivo femurs of toy breed dogs and to determine whether there is a difference between knotted and knotless configurations.

STUDY DESIGN

Experimental study.

SAMPLE POPULATION

Eight paired harvested femurs.

METHODS

Femurs were assigned to knotted or knotless configuration. Equal numbers of right and left femurs were tested. The caudolateral femoral condyle at the distal pole of the lateral fabella (F2 site) was drilled. The assigned configuration with braided suture combined with the bone anchor was implanted into the F2 site. Each configuration was positioned into a mechanical testing machine to measure yield load, load at 3-mm displacement, ultimate load, stiffness, and mode of failure at the beginning of the canine standing phase angle (150°).

RESULTS

Mean ultimate load was 100.14 and 88.69 N (P = .798), mean yield load was 59.72 and 55.85 N (P = .708), load at 3-mm displacement was 46.72 and 43.33 N (P = .656), and stiffness was calculated to be 43.06 and 47.09 N/mm (P = .548) for knotted and knotless configurations, respectively. Mode of failure occurred primarily by anchor pull-out.

CONCLUSION

The bone anchor withstood deformation at the estimated forces applied on the native cranial cruciate ligament (CCL) of toy breed dogs in both configurations.

CLINICAL SIGNIFICANCE

This bone anchor may constitute a useful alternative for stabilization of the CCL deficient stifle in toy breed dogs. However, before it can be recommended for widespread use in dogs, closely monitored clinical trials must be conducted to assess outcome and complications associated with this implant.

Relationship between objective and subjective assessment of limb function in normal dogs with an experimentally induced lameness

OBJECTIVE

To evaluate the relationship between previously used subjective and objective measures of limb function in normal dogs that had an induced lameness.

STUDY DESIGN

Prospective, blinded, and induced animal model trial.

ANIMALS

Normal, adult, and mixed-breed dogs (n=24) weighing 25-35 kg.

METHODS

Force platform gait analysis was collected in all dogs before and after induction of lameness. All gait trials were videotaped; 60 video trials were evaluated by 3 surgeons with practice limited to small animal orthopedics and 3 first year veterinary students in an effort to establish the relationship between subjective and objective measures of lameness. Evaluators were unaware of the force platform data.

RESULTS

Concordance coefficients were low for all observers and were similar between students and surgeons. These values were further decreased when normal and non-weight bearing trials were removed. Agreement with the force platform data was low even when observers only had to be within +/-10% of the ground reaction forces. When repeat trials were evaluated surgeons had a much higher repeatability compared with students.

CONCLUSIONS

Subjective evaluation of the lameness in this study varied greatly between observers and agreed poorly with objective measures of limb function.

CLINICAL RELEVANCE

Subjective evaluation of gait should be interpreted cautiously as an outcome measure whether performed from a single or from multiple observers.

Microchemical and surface evaluation of canine tibial plateau leveling osteotomy plates

OBJECTIVE

To determine the microchemical and surface composition of tibial plateau leveling osteotomy (TPLO) plates before and after explantation.

SAMPLE POPULATION

7 TPLO plates surgically removed from host dogs 6 to 54 months after implantation; 2 raw unpolished-and-unpassivated 316L TPLO plates; and 2 heat-treated, polished-and-passivated, and cleaned 316L TPLO plates.

PROCEDURES

Samples were removed by use of standard techniques to ensure the plate surface was not damaged. Sample pieces were dissolved and analyzed by inductively coupled plasma-mass spectrometry (ICP-MS) to determine bulk elemental composition. Other sample pieces were investigated by use of scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), and x-ray photoelectron spectroscopy (XPS) for determination of sample morphology, near-surface elemental composition, and surface elemental composition, respectively. To investigate the possibility of corrosion in situ, some samples were chemically corroded and analyzed.

RESULTS

ICP-MS confirmed that elemental composition of samples was consistent with 316L stainless steel. The SEM and EDS analyses revealed trace amounts of polishing materials and a nonuniform carbonaceous biofilm on < 1% of the surface area of samples removed from the host dogs. The XPS analysis indicated an increase in the chromium-to-iron ratio on passivated surfaces, with no difference between passivated samples before implantation and after explantation.

CONCLUSIONS AND CLINICAL RELEVANCE

Composition of the TPLO plates was consistent with 316L stainless steel. No chemical or topographic changes were detected in TPLO plates that had been implanted in dogs for up to 54 months. A small amount of biofilm was evident on the surface of 2 plates.

Arthroscopic treatment of osteochondritis dissecans of the shoulder in 126 dogs

Osteochondritis dissecans of the shoulder joint was treated by arthroscopy in 126 dogs. Twenty-four dogs had bilateral surgery, making a total of 150 joints treated. The OCD flaps were removed in small pieces through the cannula or in a single piece through a stab incision. The lameness resolved completely within seven-60 days following arthroscopy in 137 out of 150 affected limbs. Within a subset of 47 dogs with unilateral OCD, it was found that lesions located on the caudo-medial region of the humeral head had a better functional outcome than those lesions located in the caudo-central region of the humeral head.

Effect of tibial plateau leveling on stability of the canine cranial cruciate-deficient stifle joint: an in vitro study

OBJECTIVE

To evaluate the effect of tibial plateau leveling on joint motion in canine stifle joints in which the cranial cruciate ligament (CCL) had been severed.

STUDY DESIGN

In vitro cadaver study.

ANIMALS

Six canine cadaver hind legs.

METHODS

Radiographs of the stifle joints were made to evaluate the tibial plateau angle with respect to the long axis of the tibia. The specimens were mounted in a custom-made testing device to measure cranio-caudal translation of the tibia with respect to the femur. An axial load was applied to the tibia, and its position was recorded in the normal stifle, after transection of the CCL, and after tibial plateau leveling. Further, the amount of caudal tibial thrust was measured in the tibial plateau leveled specimen while series of eight linearly increasing axial tibial loads were applied.

RESULTS

Transection of the CCL resulted in cranial tibial translation when axial tibial load was applied. After tibial plateau leveling, axial loading resulted in caudal translation of the tibia. Increasing axial tibial load caused a linear increase in caudal tibial thrust in all tibial plateau-leveled specimens.

CONCLUSIONS

After tibial plateau leveling, axial tibial load generates caudal tibial thrust, which increases if additional axial load is applied.

CLINICAL RELEVANCE

Tibial plateau leveling osteotomy may prevent cranial translation during weight bearing in dogs with CCL rupture by converting axial load into caudal tibial thrust. The amount of caudal tibial thrust seems to be proportional to the amount of weight bearing.

Concentrations of chondroitin sulfate epitopes 3B3 and 7D4 in synovial fluid after intra-articular and extracapsular reconstruction of the cranial cruciate ligament in dogs

OBJECTIVE

To evaluate effects of intra-articular and extracapsular reconstruction of the cranial cruciate ligament (CCL) on metabolism of articular cartilage as reflected by concentrations of chondroitin sulfate epitopes 3B3 and 7D4 in synovial fluid.

ANIMALS

13 adult dogs.

PROCEDURE

Each dog underwent unilateral CCL transection (CCLT). One month after CCLT, sham CCL reconstruction (3 dogs), intra-articular CCL reconstruction (5), or extracapsular CCL reconstruction (5) was performed. Synovial fluid was collected by direct arthrocentesis from CCLT and contralateral stifle joints immediately before (time 0) and 1, 3, and 5 months after CCLT. Fluid was examined for concentrations of 3B3 and 7D4 epitopes and total sulfated glycosaminoglycan (GAG) content.

RESULTS

Concentrations of 3B3, 7D4, and GAG, 3B3:GAG, or 7D4:GAG in CCLT joints did not differ significantly among treatment groups nor in the ratios of these variables in CCLT joints to contralateral joints at 3 months. In a longitudinal analysis, concentrations of 3B3 and 7D4, 3B3:GAG, and 7D4:GAG in CCLT joints in all groups changed significantly with time, but we did not detect time X group interactions.

CONCLUSIONS AND CLINICAL RELEVANCE

Transection of CCL resulted in significant perturbation in articular cartilage metabolism as reflected by alterations in concentrations of 3B3 and 7D4 in synovial fluid. These changes over time were not significantly influenced by method of CCL reconstruction. We did not find evidence that surgical stabilization of CCL-deficient joints by intra-articular or extracapsular techniques had any effect on preventing alterations in composition of synovial fluid that have been associated with secondary osteoarthritis.

Effects of an orally administered mixture of chondroitin sulfate, glucosamine hydrochloride and manganese ascorbate on synovial fluid chondroitin sulfate 3B3 and 7D4 epitope in a canine cruciate ligament transection model of osteoarthritis

OBJECTIVE

To evaluate effects of an orally administered mixture of chondroitin sulfate, glucosamine hydrochloride and manganese ascorbate (CS-G-M) on articular cartilage metabolism in dogs with cranial cruciate ligament (CCL) deficient and reconstructed knees, as reflected by concentrations of synovial fluid 3B3, 7D4 and total sulfated glycosaminoglycan (GAG).

METHODS

Sixteen adult dogs that underwent unilateral CCL transection were randomized into four groups. Thereafter, group I (N=3) had a sham CCL reconstruction, group II (N=3) had CS-G-M and sham CCL reconstruction, group III (N=5) had CCL reconstruction, and group IV (N=5) had CS-G-M and CCL reconstruction. Synovial fluid collected at 0, 1, 3 and 5 months was examined by ELISA for 3B3 and 7D4 epitope, and by DMMB assay for total GAG.

RESULTS

Synovial fluid from CCL transected knees of CS-G-M treated dogs contained significantly elevated concentrations of 3B3 (P=0.029), 7D4 (P=0.036) and 7D4/GAG (P=0.007) in comparison to controls, in a cross-sectional analysis at 3 months. Furthermore, 7D4 and 7D4/GAG concentrations remained significantly elevated (P=0.012) in CCL transected knees of CS-G-M treated dogs over the 5 month period. However, when epitope concentrations were expressed as a ratio of CCL-transected to contralateral non-operated knee, treatment effect of CS-G-M was no longer significant. Reconstruction of the CCL had no significant effect on synovial fluid epitope.

CONCLUSIONS

Administration of CS-G-M was associated with altered concentrations of 3B3 and 7D4 epitope in synovial fluid, suggesting that these compounds may act to modulate articular cartilage matrix metabolism in vivo.

Gracilis or semitendinosus myopathy in 18 dogs

The clinical findings in 18 dogs with gracilis (n = 17) or semitendinosus (n = 1) myopathy are described. Each dog had a similar hind-limb gait abnormality characterized by a shortened stride with a rapid, elastic medial rotation of the paw, internal rotation of the hock and external rotation of the calcaneus [corrected] and internal rotation of the stifle during the mid-to-late swing phase of the stride. Medical management prior to or in lieu of surgery was attempted (n = 8) with no apparent response. Fifteen dogs had one or multiple surgical procedures. Although transection, partial excision, or complete resection of the affected muscle resulted in resolution of lameness following surgery, lameness recurred six weeks to five months (mean, 2.5 months; median, two months) following surgery. Adjunctive medical treatment did not prevent recurrence. Variable replacement of the affected muscle with fibrous connective tissue (predominantly along the caudolateral border of the muscle) was evident grossly, and replacement of myofibers with fibrous connective tissue was confirmed histologically. A definitive etiology could not be established.

Holding power of threaded external skeletal fixation pins in the near and far cortices of cadaveric canine tibiae

We compared the pin-bone interfaces at the near and far cortical penetration sites of positive-profile end-threaded external fixation pins in cadaveric canine tibiae. The holding power of the pins in each cortical surface was independently measured in 21 pin-bone sections. Scanning electron microscopy (SEM) was used to compare subjectively the microstructural appearance of the pin-bone interfaces at the near and far cortical penetration sites in eight pin-bone sections. The far cortical penetration site provided greater holding power than did the near cortical site. SEM evaluation suggested more bony microfractures and debris with less pin-bone SEM evaluation suggested more bony microfractures and debris with less pin-bone interlock in the near cortical penetration sites than in the corresponding far cortical penetration sites. This study showed that after low-speed power insertion of positive-profile end-threaded pins in canine cadaveric tibiae, the near cortical penetration site contributes approximately 25% less to the overall holding power of the pin than does the far cortical penetration site.

Distraction osteogenesis using modified external fixation devices in five dogs

Distraction osteogenesis was used to treat five dogs with limb deformities or limb shortening. The affected bones underwent osteotomy, and modified external fixators were attached. Complications included pin loosening, implant breakage, and soft-tissue contracture. Adequate limb length was attained in all cases, but clinical results varied from poor to excellent. Two dogs were not lame after the procedure, two dogs had improved function but were still lame, and one dog had complications necessitating amputation.

Intraosseous infusion using the osteoport implant in the caprine tibia

We evaluated the in vivo animal tolerance to intraosseous infusion via the Osteoport pediatric implant (model 2005PSO, Lifequest Medical, San Antonio, TX, U.S.A.) into the proximal tibia of immature goats and investigated the osseous effects of intermittent and sustained increases in intraosseous pressure (IOP). In group 1 (n = 3) autogenous whole blood was continuously infused (CI) for 5 days at flow rates producing an IOP of 30-45 mm Hg. Group 2 animals (n = 3) underwent a 5-s high-pressure infusion (HPI) of lactated Ringer solution (LRS) producing an IOP of 90-125 mm Hg twice daily for 10 days. In group 3, the Osteoports were left in place 5 (n = 2) or 10 days (n = 2) and evaluated for patency at 72-h intervals. An IOP > 35 mm Hg produced clinical evidence of bone pain. Bone mineral density was significantly increased (p < 0.05) in all implanted tibias (mean 1.04 g/cm2; range 0.87-1.21 g/cm2) compared with controls (mean 0.67 g/cm2; range 0.65-0.71 g/cm2). A nonsignificant increase (+9% to +31%) in periosteal new bone formation occurred in all implanted tibias. In the continuously infused group, there was a significant increase (p < 0.05) in cancellous new bone formation (+483%), percentage eroded bone surface (+143%), and osteoclast covered bone surface (+255%) compared with controls. HPI of LRS did not produce significant bone changes. Seemingly, the Osteoport provided a ready means of intraosseous infusion and may be associated with less complications than current methods of continual vascular access. Bone changes correlated more with the duration than the magnitude of increased intraosseous pressures.

Principles of bone healing and biomechanics of external skeletal fixation

External skeletal fixation is being used to treat an increasing number of orthopedic conditions in veterinary medicine. Study of the variables affecting the biomechanics of external fixation and bone healing is vital if patient morbidity is to be minimized. These are reviewed and incorporated into strategies that can be applied to decision making using external fixation in the clinical setting.

System behavior of commonly used cranial cruciate ligament reconstruction autografts

Biomechanical analysis was performed on the cranial cruciate ligament (CCL) and three autogenous tissues used for CCL reconstruction in the canine stifle. The autogenous tissues were patellar ligament-based autografts described for over-the-top CCL replacement and included the central one third of the patellar ligament, the medial one third of the patellar ligament, and the lateral one third of the patellar ligament with fascia lata. Tension testing produced abrupt failure of the central and medial autografts but sequential failure of the lateral autograft. Structural properties were determined for the overload condition and within the load range of normal activity for the CCL (physiologic range). None of the autograft systems approached the stiffness, maximum load, and energy absorbed to maximum load of the CCL. The central and lateral autografts were stiffer, had greater maximum loads, and absorbed more energy to maximum load than the medial autograft. The central and lateral autografts had an elastic range, as defined by proportional limit, which corresponded to the physiologic range of loading for the CCL. Loads that corresponded to physiologic displacement of the lateral and central autografts were near the maximum load of the fixation site, which underscored the need for postoperative support of the repaired stifle.

Corrective osteotomy for pes varus in the dachshund

Five dachshunds were treated for a distal varus deformity of one tibia. Angulations of 20 degrees to 30 degrees resulted from shortening of the medial tibial length with the maximum curvature at the distal metaphysis. Comparison with the contralateral limbs was required to determine the amount of correction necessary for functional and cosmetic results. Open wedge osteotomies stabilized with a modified type II external fixator resulted in correction of the deformities, early return of limb function, and healing of the osteotomies.

Mechanical evaluation of two canine iliac fracture fixation systems

Twenty-three canine pelves were tested bilaterally to determine the stiffness and strength of intact ilium and stabilized oblique iliac osteotomies that simulated a common clinical fracture. Fixation systems tested were three 4.0 mm cancellous screws inserted ventral to dorsal across the osteotomy site and one laterally placed five hole 3.5 mm dynamic compression plate. Specimens were mechanically tested to failure under torsional, axial, or axial plus bending loads. Lag screw fixation was stiffer and stronger than plate fixation in all testing modes. The differences were statistically significant (p less than .05) in the torsional and axial plus bending loading modes. Fatigue testing was performed on implanted specimens with low-level cyclic loading under axial plus bending loading conditions. Physiologic loading conditions failed to produce mechanical failure of either fixation system after 100,000 cycles.

A comparison of standard femoral head and neck excision and femoral head and neck excision using a biceps femoris muscle flap in the dog

Sixteen normal 20 to 30 kg dogs had standard femoral head and neck excision (8 dogs) or femoral head and neck excision with interposition of a biceps muscle flap (8 dogs). Lameness lessened at week 6, and did not differ between groups; neither group returned to a completely normal gait. Weightbearing decreased on the operated pelvic limb compared to controls (forceplate analysis). Weightbearing force of the muscle flap dogs was significantly less at weeks 6 and 16 than that of the standard femoral head and neck excision dogs. The operated limb of both groups was shortened; shortening was significantly greater for the muscle flap group. Hip extension was limited in both groups. Both groups had decreased (more acute) hip, stifle, and hock angles measured in standing position. Thigh muscle atrophy was more pronounced in the muscle flap group at week 6. More soft tissue was interposed in the muscle flap group at necropsy compared to the group with standard femoral head and neck excision, but the difference was not statistically significant. Skeletal muscle fibers were present in the interposed fibrous connective tissue of the muscle flap group, and the healed surfaces were smoother than those of the standard femoral head and neck excision group.

Carpal hyperextension in two-month-old pups

Abnormal carpal configuration was observed in a litter of ten 2-month-old pups raised in a research colony. Five of the pups were exercised daily, and carpal configuration returned to normal within 7 to 10 days. The other 5 pups remained confined, and their carpal configuration returned to normal after 6 weeks. It was concluded that poor muscle tone was responsible for the carpal hyperextension.

Transoral hypophysectomy with mandibular symphysiotomy in the dog

A surgical approach that offered direct visualization and removal of the hypophysis was evaluated in 17 dogs. Ten of the dogs were euthanatized and used to identify reliable landmarks for the drill site in the basisphenoid bone to expose the hypophysis. The intersphenoidal suture was an accurate landmark in that 1 cm caudal to the intersphenoidal suture was determined to be the precise point for the center of the drill hole. The remaining 7 dogs were hypophysectomized, using this approach. The landmarks were accurate, the surgery had a high degree of safety, and all hypophyses were removed.