Complications and short-to-midterm results in a case series of 52 CUE procedures using a modified caudo-medial approach.

Background: Medial coronoid process disease is the most common manifestation of canine developmental elbow disease which can progress to a more severe medial compartment disease (MCompD) characterized by full-thickness cartilage loss of the medial coronoid process and the medial humeral condyle. Among others, the "Canine Unicompartmental Elbow" (CUE) has been reported to be an effective treatment strategy for MCompD, with full in 47.6% and acceptable function in 43.7% at 6 months or later of follow-up. Aim: To report on our clinical experiences with the CUE system using the caudo-medial approach in terms of both complications and functional outcome. Methods: Medical records of dogs that underwent CUE procedure using a caudo-medial approach over a 3-year period were retrospectively reviewed. This covered epidemiological data, bi-planar radiographs, subjective gait analysis, owner questionnaire, surgical reports, as well as second-look arthroscopic findings when available. Results: In total, 52 CUE procedures were performed in 44 dogs with a median age of 8.0 years (IQ: 5.0-10.0) and a median bodyweight of 31.9 kg (ranging 20-48 kg) at the surgery. Four cases never return for follow-up, but were included in the analysis to increase the number of cases with pre- and intra-operative data. Mean follow-up time available for the remaining 48 cases was 7.1 (SD: 5.2) months. Radiographic derived implant positioning and alignment proved to be satisfactory in the sagittal plane but parallelism in the frontal plane was only present in three cases. Second-look arthroscopy in five cases with delayed or disappointing functional improvement showed evidence of implant-related contact lesions and progressive erosion of the medial coronoid area in three elbows. Overall, complications occurred in 11 cases (21%), being major in eight (15%) and minor in three (6%). Major complications included refractory pain and lameness 6 to 12 months postoperatively in five cases. At last follow-up, 12 cases (25%) were considered to have full function, 35 cases (73%) acceptable function, and in one case, the function was considered unacceptable. As the only variable related to functional outcome, age had a negative predictive value for full function. Conclusion: The CUE procedure appears to be an effective treatment option for patients with MCompD. Older dogs might be at risk of having an inferior clinical outcome when compared to young patients. The reason for this is unknown and will have to be evaluated in future studies. Compared to a CUE case series of 103 elbows operated through a medial approach, using a caudo-medial approach decreased the incidence of approach-related complication. Nevertheless, the functional outcome in the current case series was less favorable than previously reported. These conflicting findings as well as the occurrence of potentially implant mechanical conflict at the medial joint compartment despite CUE warrants further studies.

Radiographic location of the origin and insertion of the canine medial glenohumeral ligament. / Radiographische Lokalisation der Ansatz- und Ursprungspunkte des medialen glenohumeralen Bandes beim Hund.

OBJECTIVE: To define the radiographic origin and insertion of the canine medial glenohumeral ligament (MGHL) at the scapula and the humerus of dogs as radiographic aim points for the surgical ligament reconstruction. MATERIAL AND METHODS: The forelimbs (n = 20) from 10 adult, orthopaedically unaffected dogs (> 20 kg body weight) were used. Radiopaque markers (1 mm steel bullet) were placed into the visual origin and insertion of the MGHL. Finally, virtual digital radiographs were produced in medio-lateral and cranio-caudal projection and the location of the origin and insertion points were expressed using four different methods (4x4 grid box method, percentage position in the grid box for the medio-lateral projection, the percentage position orientated at different landmarks and the clock-face scale method). RESULTS: The relative positions of the centre of origin and insertion points of the MGHL were located constantly in radiographs in relation to anatomical landmarks in the canine shoulder. Therefore the described methods are useful for determination. CONCLUSION: The radiographic location of the origin and insertion points of the MGHL can be consistently predicted in radiographs of dogs with a body weight above 20 kg. CLINICAL SIGNIFICANCE: The reported data can be used to verify the correct placement of the insertion of bone anchors for stabilising a medial shoulder instability by ligament reconstruction in dogs.

Prospective Evaluation of the Leipzig Stifle Distractor.

OBJECTIVES: To evaluate the Leipzig Stifle Distractor (LSD) for arthroscopic evaluation of the medial meniscus. STUDY DESIGN: Prospective clinical multi-center study. ANIMALS: 64 stifles of 64 dogs (mean body weight 35 kg) with suspected cranial cruciate ligament rupture. METHODS: The LSD was used to distract the medial compartment and to evaluate the medial meniscus. The degree of exposure of the caudal pole of the medial meniscus (CMM) and ease of diagnosis was quantified after either distraction with the LSD or manipulation of the stifle with valgus stress and external rotation. Time for pin placement, level of difficulty and associated complications with LSD application were recorded. Medial collateral ligament integrity was tested by stress radiographs. RESULTS: The mean time for applying the LSD was 1.4 minutes (range 0.5-3.0). Application was considered easy in 90% and moderate in 10% of joints, with no complications recorded. LSD application increased exposure (P < .001) and facilitated probing of the CMM (P < .001), allowing for the diagnosis of 10 meniscal tears missed without the LSD. The use of LSD increased the likelihood of diagnosing a meniscal tear by 1.9 times. Based on the stress radiographs, medial collateral ligament integrity was maintained in all tested stifles. CONCLUSION: Diagnosis of medial meniscal tears was improved using LSD. The LSD provided a safe and effective method for improved visualization and access to the caudal portion of the medial meniscus, which may allow for better arthroscopic assessment of meniscal pathology in dogs.

[Leishmania infantum induced bone lesions in a dog]. / Leishmania-infantum-bedingte Knochenläsionen bei einem Hund.

A 3-year-old Labrador Retriever originating from Spain was presented with a left-sided hind limb lameness for several months. The orthopedic examination revealed a pain response when palpating the left tarsal joint. Radiographic and computed tomographic studies showed polyostotic, aggressive osteolytic bone lesions with mild erosive arthritis. The diagnosis of canine leishmaniasis was confirmed by bone biopsy and the detection of the pathogen by PCR. Three weeks after initiation of therapy with allopurinol, the dog presented no signs of lameness. Eight months after start of therapy, radiographic examination revealed moderate regression of the osteolytic bone lesions.

Development and in situ application of an adjustable aiming device to guide extra- to intraarticular tibial tunnel drilling for the insertion of the cranial cruciate ligament in dogs.

OBJECTIVE: To develop and test an arthroscopic aiming device for extra- to intraarticular tibial tunnel drilling emerging at the center of the tibial insertion (CenterTib) of the cranial cruciate ligament (CCL) in medium to large breed dogs. STUDY DESIGN: Descriptive experimental study. SAMPLE POPULATION: Fifty-two cadaveric hind limbs of dogs >or=20 kg BW. METHODS: The mediolateral position and craniocaudal position (ccPos) of CenterTib in relation to the caudomedial meniscotibial ligament were measured on photographs of 46 dissected tibial plateaus. The proximal tibial depth (TibDepth) was determined on lateral radiographs and its correlation with ccPos was assessed using linear regression analysis. Extra- to intraarticular arthroscopic tibial tunnel drilling was performed in 6 independent cadaveric stifles. A C-guide with an adjustable craniocaudal offset was constructed and adjusted according to ccPos estimated based on TibDepth. The position of the resulting bone tunnels was compared with the position of the CenterTib. RESULTS: Pearson's correlation between TibDepth and ccPos was strong (R=0.86; P<.001). ccPos (y) as a function of TibDepth (x) can be expressed as y=-4.8+0.3x. Arthroscopic tunnel drilling resulted in a median deviation of the drill tunnels around the CenterTib of 1 mm. CONCLUSION: The regression equation and aiming device permit localization and targeting of CenterTib during extra- to intraarticular tibial bone tunnel drilling in vitro. CLINICAL RELEVANCE: The proposed technique may reduce tibial tunnel misplacement when performing intraarticular CCL repair using a tibial bone tunnel.

Value of low-field magnetic resonance imaging in diagnosing meniscal tears in the canine stifle: a prospective study evaluating sensitivity and specificity in naturally occurring cranial cruciate ligament deficiency with arthroscopy as the gold standard.

OBJECTIVE: To evaluate the sensitivity and specificity of low-field magnetic resonance imaging (lfMRI) for detection of meniscal tears in the canine stifle. STUDY DESIGN: Double-blinded prospective clinical study. ANIMALS: Forty-two consecutive stifles of dogs (>or=20 kg; n=34) with clinical and radiologic signs suspicious for cranial cruciate ligament (CCL) insufficiency. METHODS: Each stifle had 7 predefined lfMRI sequences using a 0.5 T magnet with a human knee coil. After lfMRI, diagnostic arthroscopy was performed by 1 surgeon unaware of the MRI findings. After completion of the study MRI images were read by 1 investigator, unaware of the intraoperative findings. RESULTS: At arthroscopy, 22 stifles had meniscal tears requiring subtotal meniscectomy. Of these only 14 were identified by lfMRI. Overall sensitivity and specificity of lfMRI for detection of meniscal tears were 0.64 (95% confidence interval [95% CI]=0.43, 0.80) and 0.90 (95% CI=0.70, 0.97), respectively. Positive and negative predictive values were 0.88 (95% CI=0.64, 0.97) and 0.69 (95% CI=0.50, 0.83), respectively. Neither the state of dislocation of vertical longitudinal tears nor the amount of CCL rupture had an influence on lfMRI accuracy (P=1.00). CONCLUSION: lfMRI was of low diagnostic accuracy in detecting meniscal tears, when compared with arthroscopy. Especially negative lfMRI findings should be interpreted with caution. CLINICAL RELEVANCE: When using lfMRI as a noninvasive preoperative screening tool for the diagnosis of meniscal tears, a high percentage of missed meniscal tears has to be expected.

A novel pin distraction device for arthroscopic assessment of the medial meniscus in dogs.

OBJECTIVE: To describe an extra-articular joint distractor for meniscal examination and treatment during canine stifle arthroscopy. STUDY DESIGN: Case series. ANIMALS: Dogs >or=20 kg with suspected cranial cruciate ligament (CrCL) deficiency. METHODS: A custom designed linear side bar was constructed to allow invasive pin distraction of the stifle joint. Its design efficacy for distraction of the medial joint compartment, observation and probing of the medial meniscus, and value during meniscal surgery was evaluated by clinical use. RESULTS: Application of the stifle distractor medial to the stifle joint using 2 negative threaded pins was easily performed percutaneously without the need of power equipment; however, unintended intra-articular placement of 1 threaded pin occurred in 2 stifles, without appreciable consequence to joint function. Observation as well as thorough probing of the caudal horn of the medial meniscus, even in the presence of a prominent remnant of the CrCL or severe periarticular fibrosis, was possible. Partial meniscectomy was effectively performed as needed without apparent damage to the associated articular surfaces. CONCLUSIONS: Distraction and translation of the medial compartment of the stifle joint using invasive pin distraction allowed observation and palpation of the caudal horn of the medial meniscus so that assessment and treatment were readily accomplished without apparent morbidity. CLINICAL RELEVANCE: With careful attention to accurate pin placement, invasive pin distraction of the medial compartment of the canine stifle joint may improve arthroscopic evaluation and treatment of meniscal pathology.