A study using a canine hydrotherapy treadmill at five different conditions to kinematically assess range of motion of the thoracolumbar spine in dogs.

BACKGROUND: Incline treadmill and underwater treadmill (UWTM) exercises are common canine rehabilitation modalities , which are often used in isolation in dogs recovering from spinal surgery. Early use of an incline during UWTM exercise may have the potential to improve rehabilitation outcomes in dogs, but, it is hypothesised that dorsoventral movement of the spine may be excessive meaning it is unsuitable in some circumstances. OBJECTIVES: The purpose of this study was to identify changes in canine spinal kinematics in dogs when using a dry treadmill at different angles of incline compared to an underwater treadmill using the same inclines. METHODS: Eight dogs were encouraged to walk on a dry, horizontal, underwater treadmill as well as under the same conditions with both a 10% and 20% incline. This was then repeated at a 10% and 20% incline with the addition of water to hock level. Data were collected using reflective anatomical markers placed at the occipital protuberance, T1, T13, L3, L7 and sacral apex, captured by a high-speed camera facing the lateral aspect of the treadmill. Dorsoventral motion of the spine as well as flexion, extension and range of motion (ROM) of T1, T13, L3 and L7 were recorded. RESULTS: We found significant differences in dorsoventral spinal ROM at T1, L3 and L7, but no significant differences in T13 ROM. No significant differences were found in flexion and extension of any of the joints assessed when comparing dry conditions to the use of water (P>0.05). CONCLUSIONS: The lack of significant differences in joint flexion and extension at T1, T13, L3 and L7 indicates the potential safe use of combining underwater treadmill and incline exercise in canine rehabilitation. However, a lack of uniformity in results makes distinguishing any patterns of significance difficult. More research is needed to establish the effects of these exercises in additional planes of motion before a treatment protocol can be established.

Limbs kinematics of dogs exercising at different water levels on the underwater treadmill.

BACKGROUND: With hydrotherapy rising in the United Kingdom, before understanding the effect of hydrotherapy in animals with pathologies, kinematics data for healthy animals is required. OBJECTIVES: To assess how different water levels on an underwater treadmill (UWTM) can affect joint kinematics. METHODS: Zinc oxide markers were placed on bony landmarks on the limbs of 10 healthy dogs, randomly split into five groups. An UWTM was used with water levels to the digits, tarsus, stifle and hip. The maximum flexion, extension and ROM were determined and a repeated measures ANOVA or Friedman's was used to determine significant differences. RESULTS: We have detected various changes in kinematics following exercise at different water levels, in comparison with a dry treadmill, including consistent increases in flexion of the elbow, stifle and tarsal joints, which were observed for all water levels. The carpal joint had increases in flexion all water levels apart from digit level. An increase in shoulder flexion was seen only with water on or above stifle level, while hip kinematics had the fewest changes with only ROM increasing at high water level (hip level). Extension of the limbs joints was not markedly affected, with only a few data being significant. The carpal joint had an overall decrease in extension with water at all levels, and the stifle joint had a decreased extension when water was at stifle height. CONCLUSIONS: Water level can significantly affect joint kinematics, and knowledge of how each water level affects the joints is relevant to design tailored hydrotherapy protocols.

Optimising soft tissue in-growth in vivo in additive layer manufactured osseointegrated transcutaneous implants.

Osseointegrated transcutaneous implants could provide an alternative and improved means of attaching artificial limbs for amputees, however epithelial down growth, inflammation, and infections are common failure modalities associated with their use. To overcome these problems, a tight seal associated with the epidermal and dermal adhesion to the implant is crucial. This could be achieved with specific biomaterials (that mimic the surrounding tissue), or a tissue-specific design to enhance the proliferation and attachment of dermal fibroblasts and keratinocytes. The intraosseous transcutaneous amputation prosthesis is a new device with a pylon and a flange, which is specifically designed for optimising soft tissue attachment. Previously the flange has been fabricated using traditional machining techniques, however, the advent of additive layer manufacturing (ALM) has enabled 3-dimensional porous flanges with specific pore sizes to be used to optimise soft tissue integration and reduce failure of osseointegrated transcutaneous implants. The study aimed to investigate the effect of ALM-manufactured porous flanges on soft tissue ingrowth and attachment in an in vivo ovine model that replicates an osseointegrated percutaneous implant. At 12 and 24 weeks, epithelial downgrowth, dermal attachment and revascularisation into ALM-manufactured flanges with three different pore sizes were compared with machined controls where the pores were made using conventional drilling. The pore sizes of the ALM flanges were 700, 1000 and 1250 µm. We hypothesised that ALM porous flanges would reduce downgrowth, improve soft tissue integration and revascularisation compared with machined controls. The results supported our hypothesis with significantly greater soft tissue integration and revascularisation in ALM porous flanges compared with machined controls.

In vitro and in vivo study of commercial calcium phosphate cement HydroSet™.

The commercial calcium phosphate cement, HydroSet™, was investigated in vitro, studying phase formation, compressive strength and setting time, followed by an ovine in vivo study to measure osseointegration, bone apposition and bone-to-graft contact. The X-ray diffraction and 31 P Magic Angle Spinning Nuclear Magnetic Resonance (MAS NMR) results showed the initial formation of octacalcium phosphate and hydroxyapatite at one hour. Over 7 days the octacalcium phosphate transformed to apatite, which was the only crystalline phase of the cement at 28 days. This apatite phase is thought to be a calcium deficient apatite. In the scanning electron microscopy, histological images of 12-week ovine in vivo results showed a high degree of osseointegration, 92.5%. Compressive strength comparisons between in vitro and in vivo measurements showed a dramatic difference between the in vitro measurements (highest 25.4 MPa) and in vivo (95 MPa), attributed to bone ingrowth into the cement in vivo. To the best of our knowledge this is the first time phase evolution of HydroSet™ and the properties studied in vitro complement the in vivo evaluation of the cement in a publication. The significance of the new finding of initial formation of octacalcium phosphate in this cement is discussed. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 21-30, 2018.

Augmentation and repair of tendons using demineralised cortical bone.

BACKGROUND: In severe injuries with loss of tendon substance a tendon graft or a synthetic substitute is usually used to restore functional length. This is usually associated with donor site morbidity, host tissue reactions and lack of remodelling of the synthetic substitutes, which may result in suboptimal outcome. A biocompatible graft with mechanical and structural properties that replicate those of normal tendon and ligament has so far not been identified. The use of demineralised bone for tendon reattachment onto bone has been shown to be effective in promoting the regeneration of a normal enthesis. Because of its properties, we proposed that Demineralised Cortical Bone (DCB) could be used in repair of a large tendon defect. METHODS: Allogenic DCB grafts in strip form were prepared from sheep cortical bone by acid decalcification and used to replace the enthesis and distal 1 cm of the ovine patellar tendon adjacent to the tibial tuberosity. In 6 animals the DCB strip was used to bridge the gap between the resected end of the tendon and was attached with bone anchors. Force plate analysis was done for each animal preoperatively and at weeks 3, 9, and 12 post operatively. At week 12, after euthanasia x-rays were taken and range of movements were recorded for hind limbs of each animal. Patella, patellar tendon - DCB and proximal tibia were harvested as a block and pQCT scan was done prior to histological analysis. RESULTS: Over time functional weight bearing significantly increased from 44% at 3 weeks post surgery to 79% at week 12. On retrieval none of the specimens showed any evidence of ossification of the DCB. Histological analysis proved formation of neo-enthesis with presence of fibrocartilage and mineralised fibrocartilage in all the specimens. DCB grafts contained host cells and showed evidence of vascularisation. Remodelling of the collagen leading to ligamentisation of the DCB was proved by the presence of crimp in the DCB graft on polarized microscopy. CONCLUSION: Combined with the appropriate surgical techniques, DCB can be used to achieve early mobilization and regeneration of a tendon defect which may be applicable to the repair of chronic rotator cuff injury in humans.

Silicate-substituted calcium phosphate with enhanced strut porosity stimulates osteogenic differentiation of human mesenchymal stem cells.

While many synthetic ceramic bone graft substitutes (BGSs) have osteoconductive properties (e.g. provide a physical scaffold for osteointegration of surrounding bone tissue), certain BGSs are osteostimulative in that they actively upregulate mesenchymal stem cell proliferation and stimulate differentiation into osteoblast-like cells. The osteostimulative properties of silicate-substituted calcium phosphate with enhanced porosity (SiCaP EP) were evaluated in vitro with STRO-1+ immunoselected human bone marrow derived mesenchymal stem cells (HBMSCs). Osteostimulative materials (SiCaP) and Bioglass 45S5 (Bioglass) were also assessed as positive controls along with non-silicate substituted hydroxyapatite as a negative control. HBMSCs were also assessed on Thermanox discs cultured in basal and osteogenic media to determine when osteogenic differentiation could be significantly detected with this in vitro cell system. HBMSC viability and necrosis, total DNA content, alkaline phosphatase (ALP) expression, and osteocalcin expression were evaluated after 7, 14, 21, and 28 days. It was demonstrated that SiCaP EP is osteostimulative based on its propensity to support STRO-1+ HBMSC proliferation and ability to promote the differentiation of HBMSCs down the osteoblastic lineage from ALP-expressing, matrix-producing osteoblasts to Osteocalcin-producing pre-osteocytes without the presence of external osteogenic factors. SiCaP EP permitted greater HBMSC attachment as well as ALP and Osteocalcin expression than Bioglass which may be attributed to its microstructure and chemistry.

Treatment of a periarticular tibial fracture in a foal with a hybrid external fixator.

OBJECTIVE: To report repair of a right proximal tibial Salter-Harris type II fracture in a foal with a hybrid external fixator (HEF). STUDY DESIGN: Case report. ANIMALS: A 5-month-old male foal. METHODS: After open surgical reduction, an HEF built with wires, 2 half-rings, 3 half-threaded connecting rods, and Schanz pins was used to stabilize the fracture. RESULTS: Immediately after surgery, the foal had relatively good weight bearing. The HEF was removed at 60 days after radiographic confirmation of healing. CONCLUSIONS: HEF can be used to stabilize a proximal tibial Salter-Harris type II fracture in a 5-month-old foal. CLINICAL RELEVANCE: HEF should be considered as another option for repair of proximal tibial Salter-Harris type II fractures in foals.