The Effect of Femur Positioning on Measurement of Tibial Plateau Angle: An In Vitro Study.

Five canine cadaveric pelvic limbs with intact cranial cruciate ligaments were used to quantify the effect of variation in limb positioning on the radiographic measurement of the tibial plateau angle (TPA) with reference to the degree of femoral condyle superimposition. Intra-osseous pin placement and a custom jig design allowed the controlled three-dimensional manipulation of limbs. Medio-lateral digital radiographic projections were taken with perfect femoral hemicondylar superimposition to establish a "reference" TPA (difference in position = 0 mm), and subsequently in varying degrees of supination/pronation and abduction/adduction. The lack of femoral hemicondylar superimposition for each radiograph was quantified using a tangential line technique with reference to the long tibial axis. A total of 176 radiographs were each assessed by three observers. "True" TPA was measured and it ranged within 17-25° across all limbs assessed. Variation in femoral condylar positioning ranged from -13 mm to +13 mm proximo-distally, and -11 mm to +11 mm cranio-caudally. Moreover, 3 mm non-superimposition of the femoral condyles produced 90.6% of measurements with 1° difference between measured and "true" TPA, and a sensitivity of 97.9% for a 2° difference. Further reduction in femoral condylar superimposition to 4 mm reduced the frequency of 1° difference between measured and "true" TPA to 84.9%, and to 94.8% for a 2° difference. In conclusion, measurement of TPA in large breed dogs from radiographs with greater than 3 mm variation in femoral condylar superimposition should be interpreted with caution.

Humero-anconeal elbow incongruity in spaniel breed dogs with humeral intracondylar fissure: Arthroscopic findings.

OBJECTIVE: To report arthroscopic findings in dogs with humeral intracondylar fissure (HIF) and compare these findings in joints of dogs not affected by HIF on preoperative CT images. STUDY DESIGN: Controlled clinical study. ANIMALS: Dogs with HIF (14 dogs, 21 elbows) and dogs without HIF (20 dogs, 31 elbows). METHODS: A caudo-medial arthroscope portal was used to inspect all elbow joints. Arthroscopic features of 21 joints of dogs with HIF were compared with 31 control elbows of HIF- negative dogs. RESULTS: All elbows with HIF showed a focal cartilage lesion on the caudal aspect of the humeral condyle. The lesions ranged from a simple indentation into the articular surface to a full thickness cartilage erosion. Humero-anconeal incongruity was identified in all elbows with HIF as absence of joint space at the point of contact between the tip of the anconeal process and the cartilage lesion, with a wider joint space distally within the ulnar trochlear notch. None of the elbows without HIF showed the cartilage lesion or evidence of humero-anconeal incongruity. CONCLUSION: Use of a novel arthroscope portal allowed description of a previously unreported cartilage lesion on the caudal humeral condyle of dogs with HIF. The lesion was found in all dogs with HIF but in no dogs without HIF. CLINICAL SIGNIFICANCE: Humero-anconeal incongruity and an associated cartilage lesion appear to be present in dogs with HIF. We propose that this lesion may be associated with humero-anconeal incongruity. This may be considered as a possible future therapeutic target for HIF.

Complications after proximal abducting ulnar osteotomy and prognostic factors in 66 dogs.

OBJECTIVE: To report complications and prognostic factors in dogs undergoing proximal abducting ulnar osteotomy (PAUL). To evaluate the ability to predict complications on the basis of post-operative radiographic examination. STUDY DESIGN: Retrospective cohort study. ANIMALS: Sixty-six dogs. METHODS: Medical records of dogs treated with PAUL between 2014 and 2019 were reviewed for demographics, intraoperative findings, and post-operative complications. Post-operative radiographs were reviewed by two masked expert orthopedic surgeons, who were asked to predict the likelihood of major mechanical complications. The prognostic value of variables was tested with univariate and multivariable logistic regression. Inter-investigator agreement to predict complications was evaluated with two-by-two tables and kappa coefficient. RESULTS: Seventy-four PAULs in 66 dogs were included. Duration of follow-up ranged from 12 to 75 months (median: 53 months). Post-operative complications were documented in 19/74 limbs (16 dogs), including major complications in 13 limbs. These complications consisted mainly of non-union (six limbs), implant failure (two limbs), and infection (two limbs) requiring revision surgery in nine limbs. Body weight was the only variable associated with an increased risk of post-operative complications (p = .04). Agreement between expert predictions was low (respectively k = -0.08 and k = 0.11). CONCLUSION: Major complications were reported in one fourth of limbs treated with PAUL and were more likely as body weight increased. Suboptimal plate and screw placement or osteotomy reduction on post-operative radiographs were poorly predictive of complications. CLINICAL SIGNIFICANCE: Complications are fairly common after PAUL, particularly in heavier dogs, and post-operative radiographic examination seems unreliable to predict those.

Bilateral locking compression plate and transcondylar screw fixation for stabilization of canine bicondylar humeral fractures.

OBJECTIVE: To report the surgical management, complications, and short-term outcomes for dogs with humeral Y-T fractures (ie, fractures affecting the medial and lateral aspect of the humeral condyle extending from the articular surface) that had been approached bilaterally (medial and lateral) and stabilized with two locking compression plates (LCP) and to investigate risk factors for major complications in the short term. STUDY DESIGN: Retrospective case series. ANIMALS: Twenty-eight client-owned dogs. METHODS: Medical records of 28 dogs that presented with 29 consecutive Y-T fractures that had been approached bilaterally, reduced, and stabilized by using a transcondylar screw (in lag or positional fashion) and two or three LCP were reviewed. All dogs had at least 6 weeks clinical follow-up, and in some cases, responses from the long-term owner-based University of Liverpool questionnaire for owners of dogs with mobility problems (Liverpool Osteoarthritis in Dogs) was obtained. RESULTS: Twenty-eight dogs (29 fractures) presented with Y-T fractures and met the inclusion criteria. The fractures were reduced and stabilized with bilateral LCP and screws. The French bulldog (n = 7) was the most commonly represented breed. Age ranged from 4 months to 9.5 years (mean, 43.53 ± 34.63 months); seven (25%) dogs were considered skeletally immature. Twenty-seven (96.4%) dogs were considered to have had resolution of lameness at 6 weeks. Major complications were registered in two (7%) dogs; one dog required surgical revision, and one dog had catastrophic complications leading to amputation of the limb. The owner-based questionnaire was available for 18 (64%) dogs. CONCLUSION: Management of canine Y-T humeral fractures stabilized with bilateral LCP and transcondylar screws led to a low complication rate with a good to excellent long-term outcome according to responses on the client questionnaire. Risk factors for major complications were not identified in our sample population. CLINICAL SIGNIFICANCE: Management of Y-T humeral fractures stabilized with bilateral LCP and transcondylar screws can lead to good to excellent short-term outcome with a low complication rate in mature and immature dogs.

Locking Plate Fixation for Canine Acetabular Fractures.

OBJECTIVE: The aim of this study was to document application of locking plates for stabilization of acetabular fractures along with complications and clinical outcomes. We hypothesized that complications and clinical outcomes would be comparable to historical reports using non-locking plate and screw constructs. STUDY DESIGN: Medical records of dogs presented with acetabular fractures at a single referral centre between 2010 and 2018 were reviewed. Cases surgically managed by open reduction and internal fixation, involving placement of at least one locking plate and screws, were included. Signalment, fracture classification, type of implant used, additional methods of stabilization, along with complications and neurological deficits, were collected. Long-term follow-up was based on Liverpool Osteoarthritis in Dogs questionnaire. RESULTS: Eighteen acetabula were repaired in 17 dogs. Locking implants were VetLOX (4/18), string-of-pearls (7/18) and locking compression plates (7/18). Locking plates and screws were used as the sole method of fixation in 10/18 acetabula, and as adjunctive fixation with other implants in 8/18 acetabula. Two minor complications and one catastrophic complication were reported. Sixteen of seventeen dogs returned to function with radiographic documentation of fracture healing. Complication rate was comparable to historic reports using non-locking implants. Long-term outcomes assessed by Liverpool Osteoarthritis in Dogs questionnaire were positive in most cases. CONCLUSION: Locking plates are a viable means of stabilizing acetabular fractures in dogs and can provide positive clinical outcomes. Surprisingly, problems including inaccurate fracture reduction and implant loosening were not fully avoided by use of locking implants but incidence was low.

Feline Distal Tibial Physeal Fracture Repair Using a Modified Cross-Pin Technique with Four Pins.

OBJECTIVE: The aim of this article was to report the surgical technique and clinical outcome of a modified cross-pin technique for the treatment of distal tibial physeal fractures in cats without postoperative external coaptation. STUDY DESIGN: This study was a retrospective clinical study. ANIMALS: A total of 9 cats were presented with fracture of the distal tibial physis. MATERIALS AND METHODS: Medical records from July 2014 to September 2018 were reviewed. In all cases, a second medial and a craniolateral Kirschner wires were added to the traditional cross-pin technique. Information reviewed included orthogonal radiographs pre- and post-surgery and at subsequent re-examinations, subjective assessment of lameness and passive range of motion, veterinary clinical assessment and completion of a functional questionnaire (feline musculoskeletal pain index) at the time of writing this report. Eight owners completed the questionnaire. The mean questionnaire follow-up time was 12.7 months. RESULTS: Uncomplicated fracture healing occurred in all patients. Two patients required implant removal due to Kirschner wire migration and protrusion through the skin at 5 and 12 months post-surgery. No other complications were noticed. Eight patients had an excellent outcome, and one patient had a good outcome. CONCLUSION: Distal tibial physeal fractures in cats can be treated successfully with the use of a modified cross-pin technique and without the use of external coaptation. Prognosis should be considered favourable for this type of fracture.

Total hip replacement after failed femoral head and neck excision in two dogs and two cats.

OBJECTIVE: To document outcome in 2 dogs and 2 cats after conversion of femoral head and neck excision (FHNE) to total hip replacement (THR). STUDY DESIGN: Case series. ANIMALS: Dogs (n = 2) and 2 cats. METHODS: For 1 dog and 2 cats, THR was performed using cemented acetabular and femoral components. Noncemented acetabular and cemented femoral components were used in 1 dog. RESULTS: All animals presented with severe hip pain and chronic lameness after unsuccessful FHNE. Potential causes of suboptimal outcome after FHNE were incomplete resection of the femoral neck (n = 3) and fibrous adhesions involving the sciatic nerve (n = 2). Post-FHNE remodeling of the proximal femur and acetabulum necessitated unconventional modifications of surgical technique. In all 4 cases, final clinical outcome and radiographic reassessment were satisfactory. Aseptic loosening of the acetabular bone-cement interface necessitating surgical revision was the only complication noted in 1 cat. CONCLUSIONS: Despite severe preoperative pain and chronic functional impairment in all cases, conversion of FHNE to THR produced marked clinical improvement including return to unrestricted exercise within 12 weeks of surgery.

Shoulder arthrodesis in 14 dogs.

OBJECTIVES: To report surgical technique and clinical outcome of shoulder arthrodesis in dogs. STUDY DESIGN: Multicenter clinical case series. ANIMALS: Dogs (n = 14). METHODS: Shoulder arthrodesis featured craniolateral plate and screw application, with application of a 2nd plate and screws craniolaterally or caudolaterally in 5 shoulders. Implants included the locking string of pearls (SOP)™ plate in 7 shoulders. Subjective preoperative, 5-8 weeks postoperative, and 11-16 weeks postoperative clinical and radiographic findings were documented. Owner questionnaire evaluation of outcome was performed 6-20 months postoperatively. RESULTS: Mean angle of arthrodesis was 114° (range 102°-122°). Progression of arthrodesis was noted in 13/14 cases at both the 5-8 and 11-16 weeks postoperative radiographic assessments. Nine complications occurred in 7/14 dogs, graded as catastrophic in 2/9, major in 2/9, and minor in 5/9. Where morbidity was successfully managed, 11-16-week and 6-10-month postoperative limb function was positive on both veterinary and owner evaluations in almost all cases, and in several, functional lameness was considered sufficiently mild as to be imperceptible on subjective veterinary evaluation. Where present, limb circumduction was noted as the major feature of persistent lameness. CONCLUSIONS: Shoulder arthrodesis in dogs results in acceptable limb function and should be considered for the management of debilitating shoulder pathology despite a high incidence of complications. Application of the SOP plate to aid shoulder arthrodesis warrants further study.

String-of-pearls locking plate and cerclage wire stabilization of periprosthetic femoral fractures after total hip replacement in six dogs.

OBJECTIVE: To report use of, and outcome after, string-of-pearls (SOP™) plate and multiple cerclage wire fixation for treatment of periprosthetic femoral fractures (PFF) associated with total hip replacement (THR) in dogs. STUDY DESIGN: Case series. ANIMALS: Dogs (n=6) with PFF after THR. METHODS: Clinical records (2005-2010) and radiographic evaluations of dogs that had PFF associated with THR, treated with a SOP™ plate and cerclage wires were retrospectively reviewed. Clinical and radiographic postoperative assessments were performed 4, 12, and 24 weeks postoperatively. Telephone follow-up was performed >12 months postoperatively. RESULTS: Three fractures occurred intraoperatively and 3 occurred postoperatively. One SOP™ failed at 2 weeks necessitating revision using 2 parallel SOP™ implants. One dog was euthanatized because of quadriceps muscle tie-down at 6 weeks. Other dogs were free of lameness with full range of motion of the stifle and hip joints at final clinical examination, and positive outcomes were maintained at >12 month telephone questionnaire. There was no evidence of implant failure and positive evidence of fracture healing at final radiographic follow-up. CONCLUSIONS: Stabilization resulted in bone healing in 5 dogs; failure in 1 dog may be attributable to technical error. Optimal technical guidelines for use of the SOP™ in this circumstance are unknown, particularly where fracture configuration varies.

Total hip replacement with dorsal acetabular rim augmentation using the SOP(TM) implant and polymethylmethacrylate cement in seven dogs with dorsal acetabular rim deficiency.

OBJECTIVE: To describe a surgical technique for reinforced augmentation of the dorsal acetabular rim (DAR) using a string-of-pearls (SOP™) locking plate and polymethylmethacrylate (PMMA) bone cement, and to report clinical outcome in 7 dogs. STUDY DESIGN: Case series. ANIMALS: Dogs (n=7). METHODS: Medical records (November 2009-April 2010) of 7 dogs with large DAR deficits, that had total hip replacement (THR) with reinforced augmentation of the DAR using a SOP™ plate and PMMA were evaluated retrospectively. Reinforced augmentation of the DAR involved anchorage of a precontoured 2.0 or 2.7 mm SOP™ plate dorsal to the acetabulum followed by application of PMMA cement to cover the reamed acetabulum and plate. Cemented acetabular components were used. Implant associated complications were recorded and ≥6-month follow-up obtained. RESULTS: In all dogs, lameness improved at medium-term reassessment (median, 8 months; range, 6-11 months). Complications included transient sciatic neurapraxia in 2 dogs, which resolved by 3 months. CONCLUSIONS: Reinforced augmentation of the DAR using a SOP™ plate and PMMA cement may facilitate placement of acetabular THR component implantation in dogs with severe DAR insufficiency.

Computed tomographic documentation of the natural progression of humeral intracondylar fissure in a cocker spaniel.

OBJECTIVE: To report the computed tomographic (CT) documentation of humeral intracondylar fissure (HIF) developing after complete ossification of the humeral condyle (HC). STUDY DESIGN: Clinical report. ANIMALS: Male 3 year old working (English) Cocker Spaniel. METHODS: Sequential CT screening (659-day interval between analyses). RESULTS: A sagittal hypodense fissure typical of incomplete ossification of the humeral condyle (IOHC) was identified ≈ 22 months after screening CT examination documented a normal elbow joint. CONCLUSION: Even in dogs with clinical features typical of the condition most commonly termed IOHC, fissure formation and propagation can occur after ossification is complete.

Combined intramedullary and external skeletal fixation of metatarsal and metacarpal fractures in 12 dogs and 19 cats.

OBJECTIVE: To report surgical technique, clinical experiences, and long-term outcomes of combined intramedullary/external skeletal fixation of metatarsal (MT) and metacarpal (MC) fractures in dogs and cats. STUDY DESIGN: Case series. ANIMALS: Dogs (n = 12); 19 cats. METHODS: Clinical and radiographic records of animals managed by combined intramedullary/external fixation of MT/MC fractures were reviewed. Signalment, fracture configuration, complications, and subjective clinical findings were recorded. Surgical technique involved retrograde intramedullary pin placement into fractured MT/MC bones, and transverse pin placement in the base of the MT/MCs or tarsal/carpal bones. Contoured pin ends were enshrouded dorsally in epoxy resin and implants maintained until fracture union. Postoperative clinical and radiographic reassessment was performed where possible. RESULTS: Small breed dogs (n = 12) and 19 cats were operated. Fixator removal occurred in < 10 weeks in all cases. Complications included synostosis (n = 2), pin tract discharge (7), excessive postoperative swelling (8), skin abrasions from the frame (2), and paw distortion associated with frame impingement (2). Long-term radiography documented degenerative changes associated with MT-phalangeal or MC-phalangeal joints in 2 dogs; 7 cats, but changes were typically graded mild or moderate and affected only 1 or 2 joints. CONCLUSIONS: Combined intramedullary/external fixation of MT/MC fractures is viable, particularly juxta-articular fractures. Pin penetration of MT-phalangeal or MC-phalangeal joints may cause morbidity and requires further study.

Intraosseous transcutaneous amputation prosthesis (ITAP) for limb salvage in 4 dogs.

OBJECTIVE: To report clinical application of intraosseous transcutaneous amputation prosthesis (ITAP) for limb salvage. STUDY DESIGN: Retrospective case series. SAMPLE POPULATION: Client owned dogs with malignant neoplasia of the distal aspect of the limb. METHOD: Distal limb amputation allowed press-fit insertion of the ITAP into the radius (n = 3) or tibia (1). Remaining soft tissues including skin were attached directly to the ITAP. Limb stump and ITAP were protected by bandaging (1) or external skeletal fixation (3) for 5-6 weeks before exoprosthesis attachment. Measures of outcome included subjective assessments of limb function by owners and veterinarians, radiographic (4) and histologic (1) examination. RESULTS: Dermal integration with the ITAP was achieved by 3 weeks and dogs were walking in a pain-free manner by 8 weeks. One dog was administered adjunctive carboplatin chemotherapy. No evidence of local tumor recurrence occurred. In 1 dog, ITAP fracture occurred at 10 weeks and was successfully managed by ITAP replacement. Three dogs were euthanatized because of confirmed or assumed metastatic disease at 8, 12, and 17 months. Histologic examination of the ITAP-limb interface at 1 year documented osseous and dermal integration. CONCLUSION: Implantation of ITAP to the distal limb of dogs is feasible and can result in favorable functional outcomes. Biological integration of osseous and dermal tissues with ITAP is reliable and robust.

Osteochondral autograft transfer for treatment of osteochondritis dissecans of the caudocentral humeral head in dogs.

OBJECTIVE: To establish whether osteochondral autograft transfer (OAT) procedures for osteochondritis dissecans (OCD) of the canine caudocentral humeral head would restore articular contour, resurface osteochondral defects, and resolve lameness in dogs with OCD. STUDY DESIGN: Case series. ANIMALS: Dogs (n=14) with caudocentral humeral head OCD (16 shoulders). METHODS: After arthroscopic assessment, the humeral head was exposed by arthrotomy. The OCD lesion was debrided and OATS(™) instrumentation used for resurfacing the defect with osteochondral core grafts collected from the stifle. Recipient sockets were created to maximally resurface articular lesions. Outcomes measures included clinical, radiographic, and arthroscopic examination at 12-18 weeks and clinical examination at 12-46 months (mean, 30.8 months) postoperatively. RESULTS: Resurfacing of the humeral head was achieved in all dogs. Subjectively, lameness resolved in 9 of 16 limbs by 5-6 weeks postoperatively, and in 13 limbs by 12-18 weeks. Radiographically, all autografts were maintained. On second-look arthroscopy, the grafted section was intact, resilient on probing, satisfactorily conformed to the adjacent articular contour, and grossly appeared consistent with hyaline or fibrocartilage depending on the graft source. Of 12 limbs available for 12-46 months reevaluation, none were considered lame and mild discomfort on shoulder manipulation was recorded for only 1 joint. CONCLUSIONS: OAT procedures are technically feasible in the caudocentral aspect of the canine humeral head. Articular contour reconstruction, resurfacing of osteochondral defects, and amelioration or resolution of short-term lameness may be achieved.

Tibial plateau leveling and medial opening crescentic osteotomy for treatment of cranial cruciate ligament rupture in dogs with tibia vara.

OBJECTIVE: To report clinical application of a tibial plateau leveling and medial opening crescentic osteotomy (TPLMOCO) by a single blade cut to ameliorate lameness in dogs with cranial cruciate ligament (CCL) rupture (CCLR) and concurrent tibia vara. STUDY DESIGN: Case series. ANIMALS: Bullmastiff-type dogs (n=4; 5 stifles). METHODS: Dogs were evaluated clinically and radiographically and records retrospectively reviewed. Pins were driven through both cortices of the proximal and distal tibia and a multidirectional jig attached medially. Tibial plateau leveling osteotomy was performed with torsional realignment of the calcaneo-patellar axis. A rigid connecting bar applied to the pins laterally before distraction of the medial jig allowed medial opening of the osteotomy while maintaining contact on the lateral aspect of the osteotomy. A 3.5 mm plate was applied. RESULTS: Meniscal and articular cartilage pathology was identified in the medial joint compartment in 4 stifles, and in both medial and lateral compartments in 1 stifle. Postoperatively, subjectively assessed lameness resolved in 4/5 limbs and improved in 1 limb. All osteotomies healed uneventfully, with superficial wound infection being the only complication in 1 dog. CONCLUSIONS: TPLMOCO is a potential treatment methodology for dogs with CCLR and tibia vara with or without tibial torsion. Clinical lameness was successfully ameliorated. Intraoperative assessment and correction of sagittal and rotational malalignment was sufficient to achieve satisfactory clinical outcome in these 4 dogs. CLINICAL RELEVANCE: TPLMOCO offers a potential treatment option and warrants further investigation for use in selected cases.

Treatment of incomplete ossification of the humeral condyle with autogenous bone grafting techniques.

OBJECTIVE: To report clinical experience with autogenous bone grafting, with and without metallic implants, for treatment of lameness attributed to incomplete ossification of the humeral condyle (IOHC). STUDY DESIGN: Case series. ANIMALS: Dogs (n=8; 9 elbows) with IOHC. METHODS: A transcondylar humeral bone core was removed and the resultant socket grafted using autogenous bone harvested as either free cancellous bone or a corticocancellous dowel using an osteochondral autograph transfer system. In 8 elbows, additional support for the humeral condyle was provided with metallic implants. Postoperative outcome was assessed by clinical, radiographic, computed tomographic (CT) and owner questionnaire examinations in the short and medium term. RESULTS: Eight dogs (9 elbows) were treated surgically for IOHC. Graft types were free cancellous graft (n=2) or corticocancellous dowel (7). Condylar augmentation was performed using epicondylar cross pins (1); transcondylar Acutrak (AT) screw and epicondylar cortical screw (1); and a single transcondylar AT screw (7). Lameness resolved in 1-12 weeks. Bone bridging was documented in 7 of 8 elbows assessed by CT examination. Owner questionnaires (6 dogs) assessing daily functions were available for 7 of 9 elbows (follow-up, 6-45 months). Relevant follow-up function scores were significantly improved compared with preoperative values. One dog was intermittently lame and was administered nonsteroidal antiinflammatory medication. CONCLUSION: Use of autogenous bone grafting techniques leads to resolution of lameness attributed to IOHC. Augmentation of grafts with implants like the AT screw is recommended. CLINICAL RELEVANCE: Autogenous bone grafting techniques represent a viable alternative or adjunct to existing techniques for clinical management of IOHC in the dog.

Radiographic and arthroscopic findings in the elbow joints of 263 dogs with medial coronoid disease.

OBJECTIVE: To report clinical, radiographic, and arthroscopic findings in dogs with thoracic limb lameness attributed solely to disease of the medial aspect of the coronoid process (MCP). STUDY DESIGN: Case series. ANIMALS: Dogs (n=263) with MCP disease (MCD; 437 elbows). METHODS: Clinical records (January 2000-July 2006) and radiographs were reviewed and pertinent data recorded. Radiographic interpretation included measures of periarticular osteophytosis, gross assessment of MCP integrity, and measurement of ulnar subtrochlear sclerosis (STS). Statistical analysis was performed to evaluate associations between data; confidence interval was set at 95%. RESULTS: Labrador Retrievers were 50.2% of all dogs with MCD. Mean age at diagnosis was 32 months and duration of lameness was 14.5 weeks. Thirteen elbows (3%) were considered radiographically normal. Osteophytosis was identified on the anconeal process (70.2%), radial head (37.3%), and lateral epicondyle (56.5%), and STS was identified in 86.7% of elbows. Median osteophytosis score was 1; mean absolute osteophytosis score was 1.7. Arthroscopic findings included: fissuring (18.3%) and fragmentation (64.1%) of the MCP and kissing lesions (49.0%) of elbows. Median-modified Outerbridge score of the MCP was 2 and the humeral condyle, 0. Weak or moderate correlations were found between osteophytosis and modified Outerbridge scores and weak correlation between modified Outerbridge scores of the MCP and medial humeral condyle. CONCLUSIONS: Wide ranges in clinical, radiographic, and arthroscopic findings are recognized in dogs with MCD but correlations between such factors are generally weak. Radiographic and arthroscopic findings do not correlate with owner-reported duration of lameness. CLINICAL RELEVANCE: Radiographic measures of osteophytosis are poor predictors of severity of arthroscopic pathology for MCD.

Subtotal coronoid ostectomy for treatment of medial coronoid disease in 263 dogs.

OBJECTIVE: To document clinical outcomes after subtotal coronoid ostectomy (SCO) for treatment of medial coronoid disease (MCD). STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs (n=263) with MCD. METHODS: MCD was treated by a combination of SCO via mini-arthrotomy, cage confinement (6 weeks), leash restricted exercise (12 weeks) and pentosan polysulfate administration. Outcomes were assessed by clinical examination in the short-term (324 elbows), owner questionnaires (146 dogs), clinical examination (90 dogs), subjective assessment of gait (110 elbows) and radiographic examination (180 elbows), 4 months to 7 years 7 months after surgery. RESULTS: One intraoperative complication occurred (1 elbow with fissuring of the ulna) and 8.2% elbows had immediate postoperative complications, the most common being wound infection (7%). Improvement in subjective lameness assessment to a score of 0 was noted at 5 weeks in 74.4% of elbows (veterinary) and 45.6% (owner) and at 12 weeks in 71.5% (veterinary), and 91.2% (owner). Subjective assessments of outcomes in the medium-term revealed 81.9% dogs remained sound, with significantly (P<.05) improved daily function scores compared with preoperative values, 83.5% of dogs received no NSAID. Clinical examination revealed good limb function and subjective assessment showed 51% of limbs were free from lameness. Radiographic progression of osteophytosis occurred on average by one grade. CONCLUSION: Management of MCD using the described management regime, including SCO via mini-arthrotomy, deserves consideration and comparison with existing treatment methods. CLINICAL SIGNIFICANCE: Management of MCD by SCO can be considered when gross fissuring or fragmentation of the MCP is not evident. This technique does not require specialized instrumentation.

Early clinical experience with osteochondral autograft transfer for treatment of osteochondritis dissecans of the medial humeral condyle in dogs.

OBJECTIVE: To establish whether osteochondral autograft transfer (OAT) procedures for osteochondritis dissecans (OCD) of the canine elbow would restore articular contour, resurface osteochondral defects with hyaline cartilage, and resolve lameness in the short term. STUDY DESIGN: Case series. ANIMALS: Dogs (n=27) with medial humeral condylar OCD. METHODS: After arthroscopic assessment, the medial humeral condyle was exposed by arthrotomy. Medial coronoid disease (MCD) was managed by subtotal coronoid ostectomy, then the OCD lesion debrided and OATS instrumentation used for resurfacing the defect with osteochondral core grafts collected from the stifle. Recipient sockets were created to maximally resurface OCD lesions. Six elbows also had proximal ulnar osteotomy. Outcomes measures included subjective clinical, radiographic, and arthroscopic examination at 12-18 weeks. RESULTS: Of 33 treated elbows, 30 also had MCD. Accurate reconstruction of the medial humeral condylar surface was achieved in all joints. Lameness resolved in 3-13 weeks in 26 of 31 limbs with follow-up. Arthroscopic outcomes for elbows with concomitant MCD but without proximal ulnar osteotomy were variable (14/24 good, 5/24 intermediate, 5/24 poor). Short-term outcome for OCD without MCD (n=2) and when proximal ulnar osteotomy (n=5) was performed were positive. Long-term assessments of 7 dogs suggested minimal donor site morbidity. CONCLUSIONS: OAT procedures are technically feasible in the canine elbow. In elbows with concurrent MCD, proximal ulnar osteotomy may improve likelihood of positive clinical outcome. CLINICAL RELEVANCE: OAT procedures warrant further evaluation as a treatment option for selected cases of OCD involving the canine medial humeral condyle.

Techniques of application and initial clinical experience with sliding humeral osteotomy for treatment of medial compartment disease of the canine elbow.

OBJECTIVE: To determine medium-term clinical efficacy of sliding humeral osteotomy (SHO) for treatment of lameness and elbow pain associated with clinically diagnosed elbow disease featuring cartilage eburnation of the medial elbow compartment (medial compartment disease--MCD). STUDY DESIGN: Case series. ANIMALS: Dogs (n=49) with severe or persistent lameness attributable to MCD. METHODS: Signalment, lameness history, and preoperative imaging findings were recorded. A custom, locking, stepped SHO plate was applied to the medial aspect of the humerus, stabilizing a mid-diaphyseal transverse osteotomy, medially translating the distal segment relative to the proximal segment. Three variants of technique of application were used and outcomes compared between respective patient groups. Outcome measures included lameness scoring, anatomic measures, VAS scoring of elbow pain, and owner assessment of function. Measures recorded preoperatively, 12, and 26 weeks postoperatively were compared. RESULTS: Of 59 limbs that had SHO, 39 had preoperative focal treatment of the diseased medial aspect of the coronoid process. Mean +/- SD dog age was 45.5 +/- 37.48 months and body weight ranged from 13.6 to 46.7 kg. Mean preoperative duration of lameness was 14.7 +/- 18.50 months. Lameness improved for all limbs by 26 weeks, and resolved in 21/32 limbs. Significant improvements in postoperative elbow pain scores and most owner assessments of function were observed. Incidence of major complications requiring surgical intervention was 17.2%, 22.2%, and 4.8% for each of the 3 technique variants described. Histologic examination of 2 elbows at >12 months revealed fibrocartilage cover of medial aspect of humeral condyle. CONCLUSIONS: Canine SHO with or without focal treatment of the diseased medial aspect of the coronoid process ameliorates lameness and pain associated with MCD at medium-term follow-up. Application technique is critical to minimizing morbidity. CLINICAL RELEVANCE: SHO is appropriate for clinical management of pain and lameness in select cases of canine MCD.