Internet-based survey on diagnosis and treatment recommendations for medial shoulder syndrome and instability in dogs.

Objective: The aim of this study was to document perceived frequency of medial shoulder syndrome and instability (MSS/MSI) among dogs, and preferred diagnostic and treatment options related to the condition, among American or European Colleges of Veterinary Surgeons (ACVS/ECVS) diplomates, American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR) diplomates, and dual diplomates of ACVS/ECVS and ACVSMR (double-Boarded diplomates). Procedure: An invitation to complete an online survey was sent to diplomates via email listservs. Results: The known response rate for the survey was 15.8% (160 of 1014 email addresses). There was a difference (P = 0.006) among groups in number of cases of MSS/MSI seen, with ACVS/ECVS diplomates and double-Boarded diplomates seeing 0 to 5 cases per year (80.7 and 72.7%, respectively) and ACVSMR diplomates (32% of total respondents) seeing 11 to 26+ cases annually. The majority of all respondents (56.4%) felt the likely cause of MSS/MSI to be chronic/repetitive strain. Diagnostically, most respondents (78%) relied on shoulder abduction angles; however, most felt it was a questionable or somewhat accurate diagnostic test. The ACVSMR diplomates (88%) relied on musculoskeletal ultrasound as their preferred diagnostic modality, compared to only 35% of ACVS/ECVS diplomates and 45% of double-Boarded diplomates. Preferred treatment was rehabilitation with surgery for unresponsive cases, as reported by 86.9% of all respondents. Preferred surgical treatment was prosthetic ligament reconstruction (62.7%). Conclusion: Despite the low known response rate of this survey, there were significant differences among specialties regarding frequency of MSS/MSI cases seen per year and preferred diagnostic modalities. However, there were no differences among specialties regarding the suspected underlying causes of MSS/MSI and initial treatment strategies.

Enquête en ligne sur le diagnostic et les recommandations thérapeutiques pour le syndrome et l'instabilité médiale de l'épaule chez le chien. Objectif: Le but de cette étude était de documenter la fréquence perçue du syndrome et de l'instabilité médiale de l'épaule (MSS/MSI) chez les chiens, ainsi que les options de diagnostic et de traitement préférées liées à cette maladie, parmi les spécialistes des collèges américains ou européens de chirurgiens vétérinaires (ACVS/ECVS), les spécialistes de l'American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR) et les spécialistes doubles ACVS/ECVS et ACVSMR. Procédure: Une invitation à répondre à un sondage en ligne a été envoyée aux spécialistes via des listes de diffusion de courrier électronique. Résultats: Le taux de réponse connu pour l'enquête était de 15,8 % (160 sur 1 014 adresses courriel). Il y avait une différence (P = 0,006) entre les groupes dans le nombre de cas de MSS/MSI vus, les spécialistes de l'ACVS/ECVS et les spécialistes doubles voyant 0 à 5 cas par an (respectivement 80,7 et 72,7 %) et les spécialistes de l'ACVSMR (32 % du total des répondants) voient 11 à 26+ cas par an. La majorité de tous les répondants (56,4 %) ont estimé que la cause probable du MSS/MSI était une tension chronique/répétitive. Sur le plan diagnostique, la plupart des répondants (78 %) se sont appuyés sur les angles d'abduction de l'épaule; cependant, la plupart estimaient qu'il s'agissait d'un test diagnostique douteux ou quelque peu précis. Les spécialistes de l'ACVSMR (88 %) ont eu recours à l'échographie musculosquelettique comme modalité diagnostique privilégiée, contre seulement 35 % des spécialistes de l'ACVS/ECVS et 45 % des spécialistes doubles. Le traitement préféré était la réadaptation chirurgicale pour les cas qui ne répondaient pas, comme l'ont indiqué 86,9 % de tous les répondants. Le traitement chirurgical préféré était la reconstruction ligamentaire prothétique (62,7 %). Conclusion: Malgré le faible taux de réponse à cette enquête, il existe des différences significatives entre les spécialités concernant la fréquence des cas de MSS/MSI observés par an et les modalités de diagnostic préférées. Cependant, il n'y avait aucune différence entre les spécialités concernant les causes sous-jacentes suspectées de MSS/MSI et les stratégies de traitement initiales.(Traduit par Dr Serge Messier).

Short-term outcomes of 43 dogs treated with arthroscopic suturing for meniscal tears associated with cranial cruciate ligament disease.

OBJECTIVE: To describe short-term outcomes and complications in dogs receiving meniscal suturing and concurrent tibial plateau leveling osteotomy (TPLO) with or without augmentation with an extracapsular suture. STUDY DESIGN: Retrospective case series. ANIMALS: Forty-three client-owned dogs submitted for cruciate ligament disease. METHODS: Dogs were included if meniscal suturing was performed during or after a TPLO procedure. Criteria included an unstable medial meniscus without evidence of a tear, a caudal vertical longitudinal tear with or without displacement, or if a bucket-handle tear was debrided and the remaining rim was unstable. Stifle stabilization was performed by either a standard TPLO or an augmented TPLO (TPLO + internal brace [IB]). Outcome measures included physical examination findings, radiographs, subjective gait examination, Liverpool Osteoarthritis in Dogs (LOAD) scores, and second-look arthroscopy. RESULTS: Forty-four meniscal repairs were performed in 43 dogs. Five types of meniscal tears were treated employing eight suture materials. Complications were documented in 15 cases (34%). The stabilization technique had a significant impact on the outcome (p = .049): TPLO + IB had a 93.3% success rate and the success rate was 71.4% in the TPLO-only group. CONCLUSION: Five types of meniscal pathology were addressed successfully in the study, indicating that currently accepted criteria for meniscal suturing in dogs may be overly conservative. The majority of complications were not related to the meniscal suturing itself and did not compromise the outcome. The stifle stabilization technique had an impact on outcome. CLINICAL SIGNIFICANCE: The authors found arthroscopic meniscal suturing to be practical and successful in this patient population. Postoperative stifle stability had an impact on successful treatment.

Ex vivo evaluation of arthroscopically assisted shoulder stabilization in dogs using an intra-articular aiming device.

OBJECTIVE: To evaluate the use of an intra-articular aiming device (IAD) for medial shoulder stabilization with a suture-toggle repair or an interference screw repair using bone anchors in dogs. STUDY DESIGN: Ex-vivo Study METHODS: Specimens were randomly divided into 2 groups (anchor and suture-toggle) with 10 shoulders each. Abduction angles were measured by goniometry prior to and following medial glenerohumeral ligament transection and after receiving arthroscopically assisted stabilization with either bone anchors or suture-toggle constructs. Bone stock and insertion angles were measured with computed tomography scans. All specimens were inspected by dissection. RESULTS: Abduction angles increased post-transection in both groups, and were restored to normal in the anchor group, but 2° smaller than normal in the suture-toggle group following stabilization. Median magnitude of bone stock surrounding all tunnels ranged between 5.9 and 12.9 mm in the anchor group and 8.8 and 15.6 mm in the suture-toggle group (p = .002). Median insertion angles at the cranial glenoid, caudal glenoid, and humerus were 17.3°, 36.8 ° and 43.4° in the anchor group, respectively, and median insertion angles at the glenoid and humerus were 38.2° and 35.6° in the suture-toggle group, respectively (p = .91). Placement of anchors were not feasible in 3 specimens in the anchor group, and mild violations of the articular surfaces were detected in 3 specimens overall. CONCLUSION: Arthroscopically assisted shoulder stabilization with an IAD was feasible in canine cadavers. CLINICAL SIGNIFICANCE: An IAD may facilitate arthroscopic shoulder stabilization in dogs. Further studies are warranted to evaluate safety and efficacy in a clinical setting.