The Efficacy of the Mulligan Concept to Treat Meniscal Pathology: A Systematic Review.

Background: Meniscal pathologies are common knee injuries and arthroscopic surgery is the current accepted gold standard for treatment. However, there is evidence to support the use of the Mulligan Concept (MC) Mobilization with Movement (MWM) for meniscal pathologies including the 'Squeeze' technique, tibial internal rotation (IR), and tibial external rotation (ER). Hypothesis/Purpose: The purpose of this systematic review was to critically appraise the literature to investigate the effectiveness of MC MWMs for meniscal lesions on patient reported pain, function, and multi-dimensional health status in patients with clinically diagnosed meniscal pathologies. Study Design: Systematic Review. Methods: A literature search was completed across multiple databases using combinations of the words "knee, function, mobilization with movement, MWM, mulligan concept, MC, meniscal pathology, meniscal derangement, and meniscal tear." Studies written within the prior 10 years that examined MC MWM techniques to treat knee meniscal injury were included. Articles that met the inclusion criteria (used MC MWM 'Squeeze' technique, tibial IR, or tibial ER for treatment of clinically diagnosed meniscal pathologies; Patient reported outcome [PRO] measures had to be used in the assessment of knee pain or function) were analyzed for quality. Randomized control trials were analyzed using the PEDro scale and the Downs & Black (D&B) checklist, case series were analyzed using the Joanna Briggs Institute (JBI) checklist, and case reports were analyzed using the CARES checklist. Results: Six articles met the inclusion criteria and were included in this review, two randomized controlled studies, two case series, and two case reports consisting of 72 subjects. All six papers included reports of improvements in pain and function that were either statistically significant or met the minimal clinically important difference (MCID). Five studies reported the Disablement in the Physically Active (DPA) scale that also demonstrated statistically significant differences or met the MCID. The MC MWM 'Squeeze' technique, tibial IR, or tibial ER demonstrated the ability to reduce pain, improve function, and improve patient perceived disability following treatment of a clinically diagnosed meniscal pathology. These studies demonstrated short term results lasting from one week to 21 weeks. Conclusion: Treatment interventions incorporating MC MWM techniques demonstrated reduction of pain and improvement in function in the short term in patients with clinically diagnosed meniscal pathologies. Level of Evidence: 2a.

Use of Blumensaat's line for assessment of cranial tibial subluxation in dogs with cranial cruciate ligament deficiency.

BACKGROUND: This study aimed to determine whether Blumensaat's line, a consistently present radiographic feature delineating the peak of the femoral intercondylar fossa, could be used to assess for cranial tibial subluxation in canine stifles with cranial cruciate ligament disease. METHODS: Thirty sequential, neutrally positioned, standing-angle stifle radiographs were taken from dogs presenting to a specialist referral centre for treatment of cruciate ligament disease. Thirty similarly positioned radiographs of healthy canine stifles were used as a control group. The radiographs were anonymised and submitted to blinded observers for measurement of the tibial plateau angle, patella tendon angle, Blumensaat's line length and the length of Blumensaat's line cranial to the tibial mechanical axis. RESULTS: Finding that the tibial mechanical axis intersects Blumensaat's line cranial to its midpoint, as a marker of cranial tibial subluxation, had a positive predictive value of 76% for subsequent surgical identification of cruciate ligament disease. CONCLUSIONS: Tibial cranial subluxation is detectable and quantifiable radiographically using the intersection of the tibial mechanical axis and Blumensaat's line. Once quantified, this measurement could be used both as a radiographic marker of cruciate ligament disease and to adjust tibial osteotomy procedures to minimise the risk of under advancement of the tibial tuberosity resulting in a persistently unstable stifle.

Influence of radiographic examination findings on recommendations made during routine clinical re-evaluation of dogs with uncomplicated tibial plateau leveling osteotomy.

OBJECTIVE: To determine the influence of follow-up radiographic examination on recommendations made during routine clinical re-evaluation of dogs that had undergone uncomplicated tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: Retrospective multi-institutional case series. ANIMALS: Client-owned dogs (N = 1010) that underwent uncomplicated TPLO. METHODS: Records from 11 institutions were searched for dogs that had been treated with unilateral TPLO and had no history of postoperative complications before their routine follow-up examination. The frequency of change in further clinical recommendations resulting from client- or clinician-voiced concerns or radiographic abnormalities was investigated. RESULTS: Follow-up evaluation was performed at a median of 6 (range, 4-15) weeks after TPLO. Radiographic examination findings contributed to a change in recommendations in 4.15% (38/915) of dogs presented without client concerns and without abnormalities at orthopedic examination. Abnormal radiographic findings alone influenced the management of 3.76% (38/1010) of dogs. An association was detected between clinical features and radiological findings leading to a change in recommendations (P < .0001). Administration of analgesia at the time of follow-up was associated with radiographic abnormalities (P = .017) and change in postoperative plans (P = .0007). CONCLUSION: Radiographic examination findings at follow-up did not influence the management of most dogs with uncomplicated TPLO. CLINICAL SIGNIFICANCE: Radiographic examination findings are unlikely to influence the treatment of dogs that seem to be recovering uneventfully from an uncomplicated TPLO without concerns from clients, analgesia, or abnormal findings on thorough orthopedic examination by a surgical specialist, at the time of the planned clinical re-evaluation.

Prescrotal urethrotomy for urethroscopic ablation of a hemorrhagic urethral mucosal mass.

A 7-year-old neutered male Staffordshire bull terrier dog was presented for investigation of chronic profuse urethral hemorrhage. A vascular mucosal mass lesion was identified in the proximal penile urethra on ultrasound examination; prescrotal urethrotomy was performed to allow rigid urethroscopy and mass removal. Histopathological changes were consistent with proliferative urethritis. Key clinical message: Prescrotal urethrotomy to facilitate rigid urethroscopy has not been previously described and is a useful technique to allow visualization of the male canine proximal penile urethra distal to the pelvic flexure. Proliferative urethritis is an important differential diagnosis for dogs presenting with profuse urethral hemorrhage.

Urétrotomie préscrotale pour l'ablation urétroscopique d'une masse mucosale urétrale hémorragique. Un Staffordshire bull terrier mâle castré de 7 ans a été présenté pour exploration d'une hémorragie urétrale chronique profuse. Un examen échographique a permis d'identifier une masse mucosale vascularisée dans la partie proximale de l'urètre pénien; une urétrotomie préscrotale a été réalisée pour permettre une urétroscopie rigide et le retrait de la masse. Les changements histopathologiques étaient compatibles avec une urétrite proliférative.Message clinique clé:L'urétrotomie préscrotale pour faciliter la réalisation d'une urétroscopie rigide n'a pas été décrite précédemment et constitue une technique utile pour permettre la visualisation de la partie proximale de l'urètre pénien du chien mâle distalement à la courbure pelvienne. L'urétrite proliférative est un diagnostic différentiel important à considérer chez les chiens présentant une hémorragie urétrale profuse.(Traduit par les auteurs).

Cranial tibial fascia autograft for wound closure following hemipelvectomy in a cat.

A 13-year-old cat underwent an extensive caudal external hemipelvectomy to excise a soft tissue sarcoma affecting the left proximal thigh. The cranial tibial fascia was harvested from the ipsilateral limb following amputation and used as a free graft in the reconstruction of the resultant pelvic and abdominal wall defect. Wound healing was uncomplicated, and 6 months following surgery there was no evidence of tumor recurrence or loss of integrity of the abdominal wall or lateral rectal support. Key clinical message: The cranial tibial fascia appears to be an effective autograft tissue for reconstructive surgery and may be applicable for closure of extensive hemipelvectomy procedures performed for tumors affecting the femoral region.

Autogreffe de fascia tibial crânial pour la fermeture de plaie à la suite d'une hémipelvectomie chez un chat. Un chat âgé de 13 ans a subi une hémipelvectomie caudale extensive afin d'exciser un sarcome des tissus mous affectant la cuisse proximale gauche. Le fascia tibial crânial fut prélevé du membre ipsilatéral suite à l'amputation et utilisé pour la greffe dans la reconstruction du défaut restant de la paroi abdominale et pelvienne. La guérison de la plaie s'est faite sans complication, et 6 mois suite à la chirurgie il n'y avait aucune évidence de récurrence de la tumeur ou de perte d'intégrité de la paroi abdominale ou du support rectal latéral.Message clinique important :Le fascia tibial crânial semble être un tissu d'autogreffe approprié lors de chirurgie reconstructive et pourrait être applicable pour la fermeture de procédures d'hémipelvectomie extensive réalisées lorsque des tumeurs affectent la région fémorale.(Traduit par Dr Serge Messier).

Outcome of two variations of a surgical technique performed for canine unilateral arytenoid lateralisation.

Background The purpose of this study is to compare the rate of aspiration pneumonia and survival time of dogs undergoing two unilateral arytenoid lateralisation (UAL) techniques.Methods Eighty dogs diagnosed with laryngeal paralysis were treated by one of two UAL techniques: (1) a standard technique (ST) and (2) an anatomic preservation technique (APT). Outcome was assessed by in clinic re-examination and an owner follow-up questionnaire.Results Minor complications were reported for 22 per cent of dogs undergoing ST and 26 per cent for APT. Major complications were 7 per cent for ST versus 23 per cent for APT. Postoperative aspiration pneumonia was reported for 7 per cent of cases in ST and 17 per cent in APT. The median survival time for ST was 636 days and was 1067 days for APT. Cause of death was related to the laryngeal paralysis in 22 per cent, neurological deterioration in 16 per cent and for non-associated reasons in 59 per cent of cases. There was no statistically significant difference in the rate of aspiration pneumonia or survival time among the treatment groups. Owners reported that their dogs improved after both surgical procedures, with 90 per cent of the owners satisfied with the surgical outcome. Eighteen per cent of the dogs suffered recurrence of clinical signs.Conclusions In this study, there was no significant difference in risk of aspiration pneumonia or survival time following arytenoid lateralisation by either an ST or an APT.

Synovial cell sarcoma in a dog: A misnomer-Cytologic and histologic findings and review of the literature.

A 4-year-old Irish Setter was presented with a history of progressive left pelvic limb lameness. Orthopedic examination revealed pain on manipulation of the left stifle. Radiographs showed an osteolytic lesion in the subchondral bone of the medial tibial condyle. Fine-needle aspirates were taken, and cytology revealed numerous cohesive clusters of plump, oval to spindloid cells often with perivascular distribution and moderate cellular atypia. A diagnosis of sarcoma was made with synovial cell sarcoma (SCS) and histiocytic sarcoma being the 2 main differentials. Histopathology confirmed the diagnosis of sarcoma and provided the same differentials. All neoplastic cells were positive for vimentin, and approximately 5% of them also stained with pan-cytokeratin using immunohistochemical staining methods. Neoplastic cells did not express CD18. The combination of this immunohistochemical profile and cell morphology was consistent with an SCS. Synovial cell sarcoma is a rare and poorly understood canine tumor entity. This is the first extensive description of the cytologic features of this neoplasm. The literature was also reviewed, focusing on comparative aspects of dogs and people, with a special emphasis on the cell of origin and diagnostic tools. Controversies regarding the nomenclature of this tumor are also presented. The authors propose a new term (cytokeratin-positive joint-associated sarcoma) for addressing this neoplasm until the cell of origin of this tumor is elucidated.

Subtotal colectomy by rectal pull-through for treatment of idiopathic megacolon in 2 cats.

Surgical management of idiopathic megacolon is described in 2 cats by a rectal pull-through with subtotal colectomy performed outside of the abdomen. This newly described technique facilitates access to the rectum for suturing an anastamosis without the need for pubic osteotomy and with minimal risk of abdominal contamination.