Evaluation of the Effects of an Undenatured Collagen Type-2-Based Nutraceutical (ARTHROSHINE® HA²) on Recovery Time after TPLO in Dogs: A Prospective, Randomized Study with Objective Gait Analysis as the Primary Outcome Measure.

This randomized, prospective clinical trial investigates the impact of a novel undenatured collagen type 2 (T2NDC)-based nutraceutical, ARTHROSHINE® HA² (AS), on postoperative rehabilitation following Tibial Plateau Leveling Osteotomy (TPLO) in 50 dogs with unilateral cranial cruciate ligament rupture (CCLR). The patients were randomly allocated to either group A, receiving AS once daily for 24 weeks post-TPLO surgery, or group B, without any supplementation. Frequency matching was applied to enhance group comparability. Assessment of outcomes included computerized gait analysis and a validated owner questionnaire. AS supplementation was well received, without any reported side effect. Consistently, patients in group A exhibited significantly higher peak vertical force values during all follow-up assessments. By the 12-week mark, gait analysis indicated a return to a physiological gait pattern in group A, while group B achieved this normalization only by the 24-week point. The administration of AS post-TPLO surgery demonstrates promise in enhancing limb function, leading to faster restoration of a physiological gait pattern. The inclusion of AS, a T2NDC-based nutraceutical, in the post-TPLO rehabilitation protocol may contribute to improved limb function and an expedited recovery, potentially facilitating a quicker return to normalcy. It is noteworthy that subjective owner perceptions did not differ between the two groups.

Quantification of skin wound tension using a newly designed wound tensiometer.

OBJECTIVE: To (i) quantitatively measure wound tension in experimental skin wounds using a newly developed wound tensiometer and (ii) establish reference values for primary skin wound closure in medium- and large-breed dogs. STUDY DESIGN: Experimental cadaveric study. ANIMAL POPULATION: Nineteen dogs of medium to large breeds (BW 20 to 40 kg). METHODS: Elliptical skin wounds of different sizes were created on the chest and abdomen. The wounds were gradually enlarged. Experienced surgeons (ECVS diplomates or professors of small animal surgery) and inexperienced surgeons (1st year after graduation) independently assessed wound tension through manual manipulation and determined whether the wound could be closed without tension-relieving measures. In addition, wound tension was objectively quantified using a newly developed wound tensiometer. RESULTS: The upper threshold for wound tension at which direct appositional wound closure was recommended by the experienced surgeons was 5.4 N, and the median minimal tension without recommendations for closure was 6.0 N. The data also demonstrate that wound tension and wound size do not necessarily correlate, and inexperienced surgeons need to develop a feel for wound tension. CONCLUSION: The intraoperative use of the wound tensiometer, in combination with established cut-off values, might facilitate decision-making regarding primary wound closure. CLINICAL RELEVANCE: The findings of this study provide evidence for the applicability of a wound tensiometer in guiding inexperienced surgeons in their choice of the skin wound closure method.

Retrospective multicentre evaluation of common calcaneal tendon injuries in 66 cats. Part 2: treatment, complications and outcomes.

OBJECTIVES: The aims of the second part of this retrospective multicentre study were to describe the surgical techniques used in the treatment of common calcaneal tendon (CCT) injuries, and evaluate the short- and long-term outcomes and complications. METHODS: The medical records of five different small animal referral centres and veterinary teaching hospitals between 2010 and 2020 were reviewed. Surgical vs conservative treatment was evaluated. Treatment type, type of postoperative immobilisation, and short- and long-term outcomes and complications were recorded. Minor complications were defined as not requiring surgical intervention. Long-term outcome was evaluated by an owner questionnaire. RESULTS: Sixty-six cats met the inclusion criteria. Mean time to surgery was 9.6 days (range 0-185). Most cats (83.3%) were treated surgically. Regardless of treatment modality, all limbs were immobilised for a mean time of 48.2 days (range 2-98). For 63 cats that had the temporary tarsal joint immobilisation technique recorded, a transarticular external skeletal fixator (ESF; 57.1%) or a calcaneotibial screw (33.3%) were used most commonly. The method of immobilisation had a notable, although non-significant, influence on the occurrence of short-term complications, with most complications being reported for the transarticular ESF group. The total short-term complication rate was 41.3%, the minor complication rate was 33.3% and the major complication rate was 7.9%, with pin tract infections being the most commonly occurring minor complication. Three cats (6%) had a total of four major complications over the long term. Most cats (86%) were free of lameness at the long-term evaluation, with an overall successful clinical long-term outcome of 84.9%, according to the owner questionnaire. Cats with traumatic injuries and injuries treated surgically had higher questionnaire scores than those with atraumatic injuries and those treated conservatively. CONCLUSIONS AND RELEVANCE: Outcome was generally good in cats with CCT injury, irrespective of the type of treatment. Complications included a high proportion of minor complications associated with the technique of tarsal joint immobilisation. ESF frames were more commonly involved in complications than other techniques. Surgically treated cats had a slightly better long-term outcomes.

Retrospective multicentre evaluation of common calcaneal tendon injuries in 66 cats. Part 1: study population, injury specification and classification.

OBJECTIVES: The objective of the first part of this retrospective multicentre study was to identify and classify common calcaneal tendon (CCT) injuries in a study population of 66 cats. METHODS: The medical records of five different small animal referral centres and veterinary teaching hospitals between 2010 and 2020 were reviewed. In addition to patient-specific data, CCT injuries were characterised in detail. Diagnostic modalities and further comorbidities were recorded. RESULTS: Sixty-six cats met the inclusion criteria. The mean age of the cats was 7.5 years (range 0.5-16.3) and their mean body weight (BW) was 4.6 kg (range 1.5-9.0). Thirty-four spayed females (51.5%), five intact females (7.6%) and 27 castrated males (40.9%) were included. Most cases involved closed injuries of the CCT (69.7%). Twenty-one of 46 cats had closed atraumatic injuries (45.7%). Open injuries (30.3%) were most commonly lacerations (65%). Twenty-one injuries were classified as atraumatic (31.8%), whereas 25 were traumatic (37.9%). With every year of age, the odds of having an atraumatic injury increased by a factor of 1.021. Cats with atraumatic injuries had a higher mean BW than cats with traumatic injuries, but the difference was not statistically significant. Acute injuries were recorded in 40.9% of cases, whereas 51.5% of cats had a subacute CCT injury and 7.6% had chronic lesions. Most acute lesions were Meutstege type I injuries (55.6%). Subacute and chronic lesions were more commonly Meutstege type IIc injuries (58.8% and 60%, respectively). Considering all CCT injuries, a Meutstege type IIc injury was most common (53%). CONCLUSIONS AND RELEVANCE: The most common type of injury was Meutstege type IIc. Cats with atraumatic injuries had a higher mean BW than cats with traumatic injuries, but the difference was not statistically significant. Older cats more commonly presented with atraumatic CCT injuries.

[Life-threatening acute neutrophilic vasculitis in a Shar-Pei puppy]. / Lebensbedrohliche, akute neutrophile Vaskulitis bei einem Shar Pei-Welpen.

A 3-month old male Shar-Pei was presented for lethargy, fever and cutaneous edema. Further investigations revealed superficial pyoderma with Streptococcus canis and an acute neutrophilic vasculitis. Symptomatic and antibiotic treatment in combination with immunosuppressive treatment (initially prednisolone, later cyclosporine) treatment was performed. In the course of the disease complications such as dyspnea, anemia, skin ulceration, skin necrosis and secondary bacterial skin infection with multiresistant bacteria occurred. After intensive care treatment the dog was discharged from the hospital 38 days later. Within the following weeks the dosage of the immunosuppressants were reduced and the drugs were discontinued after 4 months.

Partial lung lobectomy with the Caiman® Seal & Cut device in a dog with spontaneous pneumothorax: Case report.

Background: Spontaneous pneumothorax in dogs is characterized by an accumulation of air in the interpleural space without underlying trauma and consecutive acute onset of respiratory distress. Underlying causes for spontaneous pneumothorax vary with ruptured bullae being one of the main causes. Treatment after initial stabilization often requires partial or complete surgical resection of affected lung lobes. Partial lung lobectomy can be performed with stapling devices or sealing devices for example, by different surgical approaches including video-assisted thoracoscopic surgery. However, inter-thoracic surgery in small-sized dogs using either of the techniques is challenging. Case Description: A 12-year-old Shih Tzu was presented with spontaneous pneumothorax. Further diagnostics with computed tomography and intercostal thoracoscopy revealed a bulla in the right middle lung lobe. Partial lung lobectomy (2.5 × 2.5 × 2 cm) of the respective lung lobe was performed by an intercostal approach using the Caiman® 5 Seal & Cut sealing device. The Caiman® 5 Seal & Cut device allowed quick and safe partial lung lobectomy in the treatment of spontaneous pneumothorax without intra- or post-operative complications. The dog was discharged 2 days after surgery in good clinical condition. This report demonstrates the in-vivo efficacy and safety of the Caiman® 5 Seal & Cut sealing device for partial lung lobectomy in a small breed dog. Conclusion: Using the Caiman® 5 Seal & Cut device lung tissue could be resected without intra- or post-operative complications in a small breed dog. This case may emphasize the use of the device in fully video-assisted thoracoscopic surgery also in small-sized patients.

Relation of Computed Tomography-Based Static Axial Radioulnar Incongruence Measurements under General Anaesthesia and Dynamic, In Vivo RUI during the Walk in Canine Elbow Joints with and without Medial Coronoid Process Disease.

OBJECTIVE: This study aimed to evaluate the correlation of static axial radioulnar incongruence (sRUI) measured under general anaesthesia with the real in vivo dynamic RUI (dRUI) during walking. STUDY DESIGN: This was a prospective clinical study that included 6 sound elbows (5 dogs) and 7 medial coronoid process disease (MCPD) affected elbows (6 dogs). MATERIALS AND METHODS: Static axial radioulnar incongruence was measured using the sphere fitting technique on computed tomography-based three-dimensional (3D) models of radius and ulna. The in vivo pose of radius and ulna was derived from radiostereometric analysis during the walk and transferred onto previously calculated 3D models. Dynamic RUI was measured on those adjusted models using the sphere fitting technique, providing a measurement of RUI over time during walk. RESULTS: Mean sRUI was 0.2 mm (standard deviation [SD]: 0.30) in control and 1.4 mm (SD: 0.73) in elbow joints with MCPD; being significantly different (p = 0.0035; confidence interval [CI]: 0.4772-1.8824). Mean dRUI in controls (-0.4 mm; SD: 0.47) was significantly different (p = 0.0004; CI: 0.9918-2.5225) from dRUI in the affected elbows (1.4 mm; SD: 0.73). Comparison of sRUI and dRUI within each group showed difference in the control group (0.2 vs. -0.4 mm; p = 0.0138; CI: 0.1820-1.0014). In affected elbows, no difference between sRUI and dRUI was found (1.4 vs. 1.4 mm; p = 0.8963). CONCLUSION: In normal elbow joints, sRUI does not represent the in vivo condition during weight bearing. Dynamic and slightly negative RUI occurs during loading (0.2 mm positive to -0.4 mm negative RUI). In MCPD affected elbows with sRUI, no dynamic change of RUI occurs during the walk.

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.

In vivo axial humero-ulnar rotation in normal and dysplastic canine elbow joints.

OBJECTIVE: To prospectively compare relative axial (internal-external) humero-ulnar rotation in normal and dysplastic canine elbow joints. MATERIAL AND METHODS: Six normal elbows (five dogs) and seven joints (six dogs) with coronoid disease were examined. After implantation of 0.8 mm tantalum beads into humerus and ulna, biplanar x-ray movies of the implanted elbows were taken while dogs were walking on a treadmill. Based on the 2D bead coordinates of the synchronized x-ray movies virtual 3D humero-ulnar animations were calculated. Based on these, relative internal-external humero-ulnar rotation was measured over the first third of stance phase and expressed as maximal rotational amplitude. Amplitudes from three consecutive steps were averaged and groupwise compared using an unpaired t-test. RESULTS: In normal elbow joints mean axial relative humero-ulnar rotation was 2.9° (SD 1.1). Dysplastic joints showed a significantly greater rotational amplitude (5.3°, SD 2.0; p = 0.0229, 95% confidence interval 0.4-4.4). CONCLUSION: Dysplastic elbow joints show greater relative internal-external humero-ulnar rotation compared to normal elbows, which might reflect rotational joint instability. CLINICAL RELEVANCE: Increased relative internal-external humero-ulnar rotation might alter physiological joint contact and pressure patterns. Future studies are needed to verify if this plays a role in the pathogenesis of medial coronoid disease.

In vivo fluoroscopic kinematography of dynamic radio-ulnar incongruence in dogs.

Aim of the study was to investigate dynamic radio-ulnar incongruence (dRUI) in the canine elbow joint comparing orthopedic healthy and dysplastic dogs in a prospective in vivo study design. In 6 orthopedic sound elbow joints (5 dogs, median age 17 months & mean body weight 27.9 kg) and 7 elbow joints with medial coronoid disease (6 dogs, median age 17.5 months & mean body weight 27.6 kg) 0.8 mm Ø tantalum beads were surgically implanted into radius, ulna and humerus for dynamic radiosteriometric analysis (RSA) using high-speed biplanar fluoroscopy with the dogs walking on a treadmill. dRUI, in the form of proximo-distal translation of the radius relative to the ulna, was measured for the first third of stance phase and compared between groups using unpaired t-testing. Healthy elbow joints exhibited a relative radio-ulnar translation of 0.7 mm (SD 0.31 mm), while dysplastic joints showed a translation of 0.5 mm (SD 0.30 mm). No significant difference between groups was detected (p = 0.2092, confidence interval -0.6 - 0.2). Based on these findings dRUI is present in every canine elbow joint, as part of the physiological kinematic pattern. However, dysplastic elbow joints do not show an increased radio-ulnar translation, and therfore dRUI cannot be considered causative for medial coronoid disease.