Tibial plateau leveling osteotomy in dogs: an ex vivo comparative study of knee's surrounding structures protection methods

Background: Cranial cruciate ligament failure is one of the leading causes of pelvic limb lameness in dogs and one of the most recommended treatments is tibial plateau leveling osteotomy (TPLO) surgery. However, this procedure may lead to some complications as fractures of the fibula, laceration in varying degrees of the popliteal vasculature and its branches, neuropraxia, neurotmeses, among others. The goals of this study were to compare the effectiveness of 8 methods used during TPLO, to prevent damage to the cranial tibial artery, fibula, tibial and fibular nerve (surgical compresses, specific surgical retractors I and II and an osteotomy technique variation). Materials, Methods & Results: A total of 40 canine cadavers weighing 25.9 ± 3.7 kg were submitted to TPLO. Animals were previously prepared with 1: 4 barium red latex solution, to provide radiopacity of arteries surrounding the knee (n = 80). TPLO was performed using 8 methods to protect the cranial tibial artery, fibula, and tibial and fibular nerves. Each method was used in one of the knees of 5 animals. The contralateral knee was maintained as a control (without protection). The knees were radiographed in orthogonal projections before and after the osteotomies and then anatomically dissected. The evaluated structures were photographed, and the images sent to four blind evaluators (visual macroscopy) to classify the possible injuries. The highest incidence of injuries was identified when protection methods were used. However, this difference was not significant (P > 0.05). No significant differences regarding efficacy were found between all 8 protection methods. Discussion: In this study, the total incidence of injuries following TPLO was 20% was much higher than that presented in the literature which indicates when considering only intraoperative injuries. The dogs cadavers tissue resistance and stiffened latex may have predisposed the osteotomy injury, as soft tissues with greater flexibility are less susceptible to trauma caused by the oscillatory saw. When compared to others cadaveric studies that also evaluated the efficacy of surgical dressings to protect the cranial tibial artery, during TPLO, we also find a higher incidence of damage. Maybe the limb's position was responsible for this difference, once in the after mentioned researches the limb was positioned suspended to simulate a dorsal decubitus position and we choose the limb position with the lateral face resting on the surface of the operating table, and this may have provided extra pressure from the structures towards the osteotomy saw, increasing the occurrence of those damages. Although the present study did not reveal a significant difference for the use of protection methods, we believe that the dimensions of the compresses used herein may have contributed to a higher incidence of injuries. They probably increased the tissue trauma needed for their allocation and led to a lower positioning accuracy for the isolation of these structures. Maybe for the same reason, the specific type II surgical retractor was the only shield that, observationally, did not increase the occurrence of injuries, once less dissection was required to allocate it. The difference in geometric dimensions between the retractors may justify the superiority of the retractor II, since it allows a more careful and apparently less traumatic allocation. Performing TPLO without adopting these protection methods did not lead to a higher risk of injury to the cranial tibial artery, fibula, and tibial and fibular nerves.

Monocephalus dipygus dibrachius em cadela Shih Tzu / Monocephalus dipygus dibrachius in a Shih Tzu bitch

Background: Congenital anomalies are structural, functional, or metabolic defects caused by a combination of environmental, genetic, or even iatrogenic factors. Genetic defects, which can be inherited, are more common in purebred dogs. Teratogenic factors such as radiation, toxins, chemical agents, infectious diseases, mechanical influences, drugs given to the mother, and nutrition can affect the litter during gestational development. The incomplete division of a fertilized egg results in monozygotic, conjoined or Siamese twins, which are animals with complete or incomplete duplications. This paper reports on an adult bitch with monocephalus dipygus dibrachius and the surgical procedures. Case: A 2-year-old female Shih Tzu weighing 5 kg was admitted to a veterinary clinic, presenting with swelling and myiasis near the anus and several development disorders, characterized by 2 pelvises, 2 anuses, 2 vulvas, 2 forelimbs and 6 hindlimbs. Her physiological parameters were otherwise normal. Only the dog's myiasis was treated at this time due to the owner's financial straits. After 5 months, the owner brought the bitch back to the veterinary clinic because the animal presented with fecaloma in 1 of the anuses. Radiography revealed numerous alterations: seven lumbar vertebrae with marked vertebral axis deviation, reduced disc space, as well as ankylosis and fused ventral spondylosis at L6 and L7. Two pelvises fused medially by the wings of the ileum, with slight deviation and thinning of pelvic bones. Four hip joints and medial joints with pelvic avulsion and bone remnants of the pelvic limbs. Acetabular tearing slightly flattened femoral head and thickened femoral neck. Caudal vertebrae and vertebral axis located in left pelvis. Left lateral patella inserted in the trochlear groove and lateral dislocation of right patella. Right patellofemoral joint with smooth surface, preserved intra-articular density and cranial displacement of the tibia relative to the femoral condyles (cranial cruciate ligament rupture). An ultrasound analysis revealed 2 bladders. Two months later surgery was performed due to recurrent complications. During laparotomy 2 uteruses, 2 bladders and bifurcation of the intestine were observed. Ovariosalpingohysterectomy was performed in both uterus and enterectomy of the problematic intestinal portion. After 2 days of the surgery, blood transfusion was performed. After 2 days of the transfusion, there was extravasation of yellow fluid from the surgical cut and abdominal palpation was indicative of bladder rupture, so the patient was sent to emergency surgery. Unilateral nephrectomy and ureterectomy, and ruptured bladder cystectomy were performed. The dog remained hospitalized for 24 days after surgery, before it was released. Discussion: The classification of conjoined twins is based on the location of the junction and the number of limbs. Monocephalus dipygus dibrachius was diagnosed based on the fact that the dog had 1 skull, 2 thoracic limbs and 4 pelvic limbs, as well as the corresponding genitourinary and gastrointestinal tract alterations. Imaging scans are extremely important for a proper diagnosis to ensure appropriate surgery planning. The bitch was the result of inbreeding between a male dog and its offspring, which probably contributed to this malformation. There are very few reports of surviving adult conjoined animals, and even fewer descriptions of successful surgical treatments. To the best of knowledge of the authors, there are no previous reports of a surviving adult dog suffering from this malformation.

Double plating technique for fixing tibial plateau leveling osteotomy and modified cranial closing wedge ostectomy of the tibia in a dog with cranial cruciate ligament disease and excessive plateau angle: case report / [Técnica de placa dupla para fixação concomitante da osteotomia de nivelamento do platô tibial e ostectomia modificada em cunha de fechamento cranial da tíbia em um cão com doença do ligamento cruzado cranial e ângulo de platô tibial excessivo: relato de caso]

Tibial plateau leveling osteotomy (TPLO) associated to cranial wedge closing ostectomy (CCWO) has been one of the best options to manage cranial cruciate ligament (CCL) disease and excessive tibial plateau angle (TPA) in large dogs, however, the complication rate is potentially high. It is believed that a more robust fixation is necessary to stabilize them and decrease the risk of implant failure. A 6-year-old male American Pit Bull, weighing 36kg, with 90-day history of right hind limb lameness, was diagnosed with CCL disease. Due to the excessive tibial plateau angle (42°), TPLO was associated with a modified CCWO using a double plating technique. A final TPA of 12° was accomplished, and a restricted level of exercises and physiotherapy were recommended. The patient was followed monthly until the fifth month postoperatively, when radiographic bone consolidation and no lameness were observed. By the date of this submission, 3 years after the procedure, the owner has reported no complications. The double plating technique for fixing TPLO and modified CCWO proved to be effective for the treatment of CrCL deficiency in a large dog with an excessive TPA.(AU)

A osteotomia de nivelamento do platô tibial (TPLO) associada à ostectomia modificada em cunha de fechamento cranial da tíbia (CCWO) tem sido uma das melhores opções para tratamento de cães grandes com doença do ligamento cruzado cranial (DLCCr) e ângulo excessivo do platô tibial, mas o índice de complicações é alto. Acredita-se haver necessidade de fixação mais robusta para reduzir as chances de falha nos implantes. Um cão macho, seis anos, da raça American Pit Bull, 36kg, com histórico de claudicação em membro pélvico direito há 90 dias, foi diagnosticado com DLCCr. Devido ao ângulo excessivo do platô tibial (42°), a osteotomia de nivelamento do platô tibial foi associada à ostectomia modificada em cunha de fechamento cranial da tíbia (CCWO) por meio da técnica de placa dupla. No pós-operatório imediato, identificou-se TPA de 12°; exercícios controlados e fisioterapia foram recomendados e a evolução do quadro foi analisada mensalmente até o quinto mês pós-cirurgia. Com 150 dias de evolução, não houve alterações de locomoção e havia ocorrido completa consolidação radiográfica das osteotomias. Até o momento da submissão deste artigo, três anos pós-procedimento, o tutor relata ausência de complicações, via contato telefônico. Portanto, a técnica modificada mostrou-se eficaz no tratamento da DLCCr.(AU)

Comparação de três métodos de imagem para análise da evolução da osteoartrite induzida pela ruptura do ligamento cranial em coelhos / Comparison of three imaging methods for the evaluation of osteoarthritis induced by cranial cruciate ligament transection in rabbits

Background: Osteoarthritis is a degenerative joint disease that affects specially cartilage, meniscus, and tendons. Ligaments, muscles, subchondral bone and synovium. This pathology is a common condition limiting the quality of life ofpatients. Imaging modalities have also been used for evaluation the progression of the osteoarthritis, or degenerative processes induced by acute injury. In order to use more accessible imaging modalities for experimentation, this study aimedto compare radiographic, computed tomography, and ultrasound findings in the evaluation of osteoarthritis induced by thecranial cruciate ligament transection model in rabbits.Materials, Methods & Results: Twenty-four male Norfolk rabbits aged approximately 5 months old were used. All rabbits were submitted to cranial cruciate ligament transection of the left stifle and evaluated 45 days after the surgery. Theradiographic findings were subchondral bone sclerosis (33.33%); joint space narrowing (66%); presence of osteophytesat medial femoral condyle (4.16%), lateral femoral condyle (4.16%), medial fabela (20.83%), lateral fabela (8.33%) andsesamoid of the popliteal muscle (4.16%). No osteophytes were seen at medial and lateral tibial condyles. The tomographiccomputed findings were joint space narrowing (62.5%); presence of osteophytes at medial femoral condyle (75%), lateralfemoral condyle (54.16%), medial fabela (66.66%), lateral fabela (37.5%), medial tibial condyle (75%), lateral tibialcondyle (20.83%) and sesamoid of the popliteal muscle (37.5%). The ultrasound findings were synovial hypertrophy(95.83%); effusion in the suprapatellar recess (75%), distal tibial recess (16.66%) and cranial joint space (75%); changes(hyperechogenic foci and heterogeneity) of the lateral meniscus (50%) and medial meniscus (25%); increased thickness ofthe medial condyle (54.16%) and lateral condyle (45.83%); irregularity of the medial condyle (66.66%) and lateral condyle...

Comparação de três métodos de imagem para análise da evolução da osteoartrite induzida pela ruptura do ligamento cranial em coelhos / Comparison of three imaging methods for the evaluation of osteoarthritis induced by cranial cruciate ligament transection in rabbits

Background: Osteoarthritis is a degenerative joint disease that affects specially cartilage, meniscus, and tendons. Ligaments, muscles, subchondral bone and synovium. This pathology is a common condition limiting the quality of life ofpatients. Imaging modalities have also been used for evaluation the progression of the osteoarthritis, or degenerative processes induced by acute injury. In order to use more accessible imaging modalities for experimentation, this study aimedto compare radiographic, computed tomography, and ultrasound findings in the evaluation of osteoarthritis induced by thecranial cruciate ligament transection model in rabbits.Materials, Methods & Results: Twenty-four male Norfolk rabbits aged approximately 5 months old were used. All rabbits were submitted to cranial cruciate ligament transection of the left stifle and evaluated 45 days after the surgery. Theradiographic findings were subchondral bone sclerosis (33.33%); joint space narrowing (66%); presence of osteophytesat medial femoral condyle (4.16%), lateral femoral condyle (4.16%), medial fabela (20.83%), lateral fabela (8.33%) andsesamoid of the popliteal muscle (4.16%). No osteophytes were seen at medial and lateral tibial condyles. The tomographiccomputed findings were joint space narrowing (62.5%); presence of osteophytes at medial femoral condyle (75%), lateralfemoral condyle (54.16%), medial fabela (66.66%), lateral fabela (37.5%), medial tibial condyle (75%), lateral tibialcondyle (20.83%) and sesamoid of the popliteal muscle (37.5%). The ultrasound findings were synovial hypertrophy(95.83%); effusion in the suprapatellar recess (75%), distal tibial recess (16.66%) and cranial joint space (75%); changes(hyperechogenic foci and heterogeneity) of the lateral meniscus (50%) and medial meniscus (25%); increased thickness ofthe medial condyle (54.16%) and lateral condyle (45.83%); irregularity of the medial condyle (66.66%) and lateral condyle...(AU)

Technique proposition and material comparison for surgery rope making / Proposição de técnica e comparação de materiais para confecção de corda cirúrgica

The most tension resistant, nonmetallic, surgical suture is 5 polyester. Comparing its resistance to those of the dogs cranial cruciate ligament and the canine gastrocnemius tendons up until they rupture, its possible to detect a considerably inferior resistance on the implants part. With the goal of achieving high mechanical resistances from sutures, these were grouped and twisted, resulting in a surgical rope that is adjustable to the patients needs. We analyzed manufacturing methodology, final conformation and tension resistance, based on three sutures models: A (1 polyglactin 910), B (1 polyester) and C (5 polyester). Considering averages of thickness and final load, the B implants obtained lower values than A, indicating that polyglactin 910 ropes are more resistant than those of polyester. Moreover, the C implants resulted in the highest values of load and thickness, indicating that final thickness is predictive towards tension resistance. Size 1 Polyester was the only one to generate linear regression for supported load, ensuring the 25,34 Newtons (N) increment to every suture added to the implant, which suggests its use for the creation of non absorbable ropes. The use of 1 polyglatctin 910 promotes load averages superior to 1 polyester;therefore, it is indicated for making absorbable surgical ropes.(AU)

O fio cirúrgico não metálico com maior resistência à tração é o poliéster nº 5. Comparando a sua resistência com a do ligamento cruzado cranial de cães e do tendão gastrocnêmico canino até suas rupturas, é possível perceber uma resistência consideravelmente inferior da parte do implante. Com objetivo de alcançar grandes resistências mecânicas a partir de fios de sutura, estes foram agrupados e torcidos, resultando em uma corda cirúrgica ajustável de acordo com a necessidade do paciente. Foram analisadas a metodologia de confecção, a conformação final e a resistência à tração, baseados em três modelos de fios: A (poliglactina 910 nº 1), B (poliéster nº 1) e C (poliéster nº 5). Considerando as médias de espessura e carga final, os implantes B obtiveram menores valores do que A, indicando que cordas de poliglactina 910 são mais resistentes que as de poliéster. Ademais, os implantes C resultaram nos maiores valores de carga e espessura, indicando que a espessura final é preditiva para resistência à tração. O poliéster nº 1 foi o único a gerar regressão linear para carga suportada, garantindo o incremento de 25,34 Newtons (N) a cada fio acrescido ao implante, o que sugere seu uso para criação de cordas não absorvíveis. A utilização da poliglactina 910 nº 1 promove médias de carga superiores ao poliéster nº 1, portanto, é indicada para confecção de cordas cirúrgicas absorvíveis.(AU)

Diagnosis of canine rheumatoid arthritis / Diagnóstico da artrite reumatoide canina

Canine rheumatoid arthritis is a chronic inflammatory disease that affects the joints of dogs. The inflammation can cause damage to cartilage and bones and early diagnosis is the main factor determining treatment success. This report describes an unusual case of rheumatoid arthritis in a dog, highlighting the relevance of radiographic examination in association with histopathology in the definitive diagnosis. An 8 year old, male German Spitz dog, weighing 5kg was admitted with a history of cruciate ligament rupture and grade IV patella dislocation. Previously, surgery had been performed to correct the cranial cruciate ligament rupture, without success. On physical examination, the dog showed a palmigrade stance, severe pelvic limb lameness, and pain on palpation of all joints. Blood count and biochemical analysis were within normal ranges. Orthogonal radiographs of the joints of the pelvic and thoracic limbs were performed. The lesions were bilaterally symmetrical. Samples were taken from the patellofemoral joints for cytology, microbiology, and histopathologic analysis. Rheumatoid factor antibody assay was negative. In conclusion, the combination of more than one clinical sign and diagnostic tests, such as radiographs suggestive of rheumatoid arthritis, histopathologic analysis of the joints, and rheumatoid factor testing is required to reach a definitive diagnosis of rheumatoid arthritis.

A artrite reumatóide canina é por definição uma doença crônica inflamatória que acomete as articulações de cães. Como resultado, a artrite reumatoide pode causar lesões na cartilagem e nos ossos e o diagnóstico precoce é o principal fator para o sucesso do tratamento ideal. Este relato de caso objetivou descrever um caso incomum de artrite reumatóide em um cão, destacando a relevância do exame radiográfico associado à histopatologia no diagnóstico definitivo. Foi atendido um cão da raça Spitz Alemão, 8 anos, com 5kg de peso. Anteriormente, foi realizada procedimento cirúrgico para correção da ruptura bilateral de ligamento cruzado e luxação de patela grau IV, porém sem sucesso. Ao exame físico, o cão apresentava posição palmígrada, intensa claudicação dos membros pélvicos e sensibilidade dolorosa de todas as articulações à palpação. As análises de hemograma e bioquímica sérica básica estavam dentro dos limites normais. Foram realizadas radiografias ortogonais das articulações dos membros pélvicos e torácicos. A distribuição das lesões foi simétrica e em ambos os lados. Considerando esses achados, foram obtidas amostras biológicas das articulações para análise citológica, microbiológica e análise histopatológica. O anticorpo fator reumatóide também foi realizado e o resultado foi negativo. Diante do exposto, é necessária a associação de mais de um sinal clínico e diferentes exames, como por exemplo, radiografias sugestivas de artrite reumatóide, análise histopatológica das articulações e anticorpo fator reumatóide para alcançar o diagnóstico definitivo de artrite reumatóide.

Diagnosis of canine rheumatoid arthritis / Diagnóstico da artrite reumatoide canina

Canine rheumatoid arthritis is a chronic inflammatory disease that affects the joints of dogs. The inflammation can cause damage to cartilage and bones and early diagnosis is the main factor determining treatment success. This report describes an unusual case of rheumatoid arthritis in a dog, highlighting the relevance of radiographic examination in association with histopathology in the definitive diagnosis. An 8 year old, male German Spitz dog, weighing 5kg was admitted with a history of cruciate ligament rupture and grade IV patella dislocation. Previously, surgery had been performed to correct the cranial cruciate ligament rupture, without success. On physical examination, the dog showed a palmigrade stance, severe pelvic limb lameness, and pain on palpation of all joints. Blood count and biochemical analysis were within normal ranges. Orthogonal radiographs of the joints of the pelvic and thoracic limbs were performed. The lesions were bilaterally symmetrical. Samples were taken from the patellofemoral joints for cytology, microbiology, and histopathologic analysis. Rheumatoid factor antibody assay was negative. In conclusion, the combination of more than one clinical sign and diagnostic tests, such as radiographs suggestive of rheumatoid arthritis, histopathologic analysis of the joints, and rheumatoid factor testing is required to reach a definitive diagnosis of rheumatoid arthritis.(AU)

A artrite reumatóide canina é por definição uma doença crônica inflamatória que acomete as articulações de cães. Como resultado, a artrite reumatoide pode causar lesões na cartilagem e nos ossos e o diagnóstico precoce é o principal fator para o sucesso do tratamento ideal. Este relato de caso objetivou descrever um caso incomum de artrite reumatóide em um cão, destacando a relevância do exame radiográfico associado à histopatologia no diagnóstico definitivo. Foi atendido um cão da raça Spitz Alemão, 8 anos, com 5kg de peso. Anteriormente, foi realizada procedimento cirúrgico para correção da ruptura bilateral de ligamento cruzado e luxação de patela grau IV, porém sem sucesso. Ao exame físico, o cão apresentava posição palmígrada, intensa claudicação dos membros pélvicos e sensibilidade dolorosa de todas as articulações à palpação. As análises de hemograma e bioquímica sérica básica estavam dentro dos limites normais. Foram realizadas radiografias ortogonais das articulações dos membros pélvicos e torácicos. A distribuição das lesões foi simétrica e em ambos os lados. Considerando esses achados, foram obtidas amostras biológicas das articulações para análise citológica, microbiológica e análise histopatológica. O anticorpo fator reumatóide também foi realizado e o resultado foi negativo. Diante do exposto, é necessária a associação de mais de um sinal clínico e diferentes exames, como por exemplo, radiografias sugestivas de artrite reumatóide, análise histopatológica das articulações e anticorpo fator reumatóide para alcançar o diagnóstico definitivo de artrite reumatóide.(AU)

Use of hyaluronic acid associated with triamcinolone acetonide or ozone gas in the treatment of induced osteoarthritis in rabbits

Purpose: To evaluate the effects of the intra-articular application of hyaluronic acid associated with triamcinolone acetonide, and ozone gas in the treatment of induced osteoarthritis in rabbit’s stifles.Methods: Twenty-one Norfolk rabbits were submitted to cranial cruciate ligament transection of the left stifle. After six weeks of the surgery, the rabbits were randomized assigned into three groups: G1 (control) – saline solution (0.9%); G2 – hyaluronic acid associated with triamcinolone; G3 – ozone gas, submitted to three intra-articular applications every seven days. Results: Significant differences occurred: osteophytes at medial femoral condyle (G2 > G1, G2 > G3) on radiography exam; thickening of the medial condyle (G1 > G3, G2 > G3) on ultrasound exam; osteophytes at lateral tibial condyle (G2 > G1, G2 > G3), and medial femoral condyle (G1 > G2, G3 > G1) on computed tomography. Histologically, mean values of chondrocytes in the femur and tibia in G3 and G2 were statistically lower. Conclusions: The intra-articular injection of hyaluronic acid associated with triamcinolone accentuated degenerative joint disease by imaging and macroscopic evaluations, and by histological findings, this treatment and the ozone gas treatment showed similar effects and were inferior to the saline solution (0.9%).

Uso do plasma rico em plaquetas como adjuvante no tratamento de lesão meniscal e tendinose de calcâneo em um cão / Use of platelet-rich plasma as an adjuvant on treatment of meniscal lesion and tendinosis of calcaneus in a dog

O objetivo deste trabalho é relatar o caso de um cão com lesão meniscal associado à tendinose de calcâneo tratado com aplicação única de plasma rico em plaquetas (PRP) intraarticular e intratendínea. Foi atendido um cão da raça Boxer com dificuldade de deambulação há três meses. Observou-se claudicação grau II/IV em ambos os membros pélvicos, atrofia muscular bilateral, dor e leve crepitação em joelho esquerdo, discreta instabilidade aos testes de gaveta e tibial cranial, com intensa fibrose medial à articulação e espessamento/rigidez do tendão calcâneo direito. O estudo radiográfico demonstrou artrose moderada no joelho esquerdo e, ao exame ultrassonográfico, constatou-se áreas de hipoecogenicidade em menisco medial esquerdo e ruptura de fibras musculares do tendão calcâneo direito. Sendo assim, o paciente foi diagnosticado com insuficiência do ligamento cruzado cranial crônica, com estabilidade fibrótica periarticular, e lesão meniscal em joelho esquerdo e tendinose de calcâneo direito. Foram prescritos condroprotetores, diacereína, fisioterapia e uma aplicação de PRP intra-articular e intratendínea. Para a concentração do PRP, foram coletados 50mL de sangue autólogo, os quais foram depositados em frascos contendo citrato de sódio. Foi realizada dupla centrifugação, sendo a primeira com força de120g e a segunda 240g, ambas por dez minutos. Ao final, obteve-se 2mL de PRP com246.000 plaquetas/µL (antes da concentração o sangue tinha 141.000 plaquetas/µL). A aplicação ocorreu de forma asséptica, sob anestesia geral e guiada por ultrassom. Foram injetados 1ml intra-articular em joelho esquerdo, 0,25mL em região perilesional e 0,75mLintralesional em tendão calcâneo direito. Após 14 dias, notou-se grau de claudicação I/IV e discreto fortalecimento muscular. Foi mantido o tratamento clínico com fisioterapia e condroprotetores com retornos periódicos para acompanhamento da evolução. Conclui-se que o uso do PRP foi importante adjuvante na terapia clínica empregada.

The aim of this paper is to report the case of a dog with meniscal lesion associated with calcaneal tendinosis treated with single application of intra-articular and intratendinous platelet rich plasma (PRP). A dog of the Boxer racer with difficulty walking was treated three months ago. Grade II/IV lameness was observed in both pelvic limbs, bilateral muscle atrophy, pain and slight crepitation in the left knee, slight instability to the drawer and cranial tibial tests, with intense medial fibrosis to the joint and right calcaneal tendon thickening/stiffness. The radiographic study showed moderate arthrosis in the left knee, and ultrasound examination revealed areas of hypoechogenicity in the left medial meniscus and rupture of the right calcaneal tendon muscle fibers. Thus, the patient was diagnosed with chronic cranial cruciate ligament insufficiency, periarticular fibrotic stability, and left meniscal injury and right calcaneal tendinosis. Chondroprotectors, diacerein, physiotherapyand an application of intra-articular and intratendinous PRP were prescribed. For the PRP concentration, 50mL of autologous blood were collected and deposited in vials containing sodium citrate. A double centrifugation was performed, the first strength of 120g and the second 240g, both for ten minutes. At the end, 2mL of PRP was obtained with 246.000platelets/µL (before concentration the blood had 141.000 platelets/µL). The application occurred aseptically, under general anesthesia and guided by ultrasound. We injected 1mlintra-articular in the left knee, 0.25mL in the perilesional region and 0.75mL intralesional in the right calcaneal tendon. After 14 days, I/IV lameness and slight muscle strengthening were noted. Clinical treatment with physiotherapy and chondroprotectors was maintained, with periodic returns to follow the evolution. It was concluded that the use of PRP was an important adjuvant in the clinical therapy employed.

Uso do plasma rico em plaquetas como adjuvante no tratamento de lesão meniscal e tendinose de calcâneo em um cão / Use of platelet-rich plasma as an adjuvant on treatment of meniscal lesion and tendinosis of calcaneus in a dog

O objetivo deste trabalho é relatar o caso de um cão com lesão meniscal associado à tendinose de calcâneo tratado com aplicação única de plasma rico em plaquetas (PRP) intraarticular e intratendínea. Foi atendido um cão da raça Boxer com dificuldade de deambulação há três meses. Observou-se claudicação grau II/IV em ambos os membros pélvicos, atrofia muscular bilateral, dor e leve crepitação em joelho esquerdo, discreta instabilidade aos testes de gaveta e tibial cranial, com intensa fibrose medial à articulação e espessamento/rigidez do tendão calcâneo direito. O estudo radiográfico demonstrou artrose moderada no joelho esquerdo e, ao exame ultrassonográfico, constatou-se áreas de hipoecogenicidade em menisco medial esquerdo e ruptura de fibras musculares do tendão calcâneo direito. Sendo assim, o paciente foi diagnosticado com insuficiência do ligamento cruzado cranial crônica, com estabilidade fibrótica periarticular, e lesão meniscal em joelho esquerdo e tendinose de calcâneo direito. Foram prescritos condroprotetores, diacereína, fisioterapia e uma aplicação de PRP intra-articular e intratendínea. Para a concentração do PRP, foram coletados 50mL de sangue autólogo, os quais foram depositados em frascos contendo citrato de sódio. Foi realizada dupla centrifugação, sendo a primeira com força de120g e a segunda 240g, ambas por dez minutos. Ao final, obteve-se 2mL de PRP com246.000 plaquetas/µL (antes da concentração o sangue tinha 141.000 plaquetas/µL). A aplicação ocorreu de forma asséptica, sob anestesia geral e guiada por ultrassom. Foram injetados 1ml intra-articular em joelho esquerdo, 0,25mL em região perilesional e 0,75mLintralesional em tendão calcâneo direito. Após 14 dias, notou-se grau de claudicação I/IV e discreto fortalecimento muscular. Foi mantido o tratamento clínico com fisioterapia e condroprotetores com retornos periódicos para acompanhamento da evolução. Conclui-se que o uso do PRP foi importante adjuvante na terapia clínica empregada.(AU)

The aim of this paper is to report the case of a dog with meniscal lesion associated with calcaneal tendinosis treated with single application of intra-articular and intratendinous platelet rich plasma (PRP). A dog of the Boxer racer with difficulty walking was treated three months ago. Grade II/IV lameness was observed in both pelvic limbs, bilateral muscle atrophy, pain and slight crepitation in the left knee, slight instability to the drawer and cranial tibial tests, with intense medial fibrosis to the joint and right calcaneal tendon thickening/stiffness. The radiographic study showed moderate arthrosis in the left knee, and ultrasound examination revealed areas of hypoechogenicity in the left medial meniscus and rupture of the right calcaneal tendon muscle fibers. Thus, the patient was diagnosed with chronic cranial cruciate ligament insufficiency, periarticular fibrotic stability, and left meniscal injury and right calcaneal tendinosis. Chondroprotectors, diacerein, physiotherapyand an application of intra-articular and intratendinous PRP were prescribed. For the PRP concentration, 50mL of autologous blood were collected and deposited in vials containing sodium citrate. A double centrifugation was performed, the first strength of 120g and the second 240g, both for ten minutes. At the end, 2mL of PRP was obtained with 246.000platelets/µL (before concentration the blood had 141.000 platelets/µL). The application occurred aseptically, under general anesthesia and guided by ultrasound. We injected 1mlintra-articular in the left knee, 0.25mL in the perilesional region and 0.75mL intralesional in the right calcaneal tendon. After 14 days, I/IV lameness and slight muscle strengthening were noted. Clinical treatment with physiotherapy and chondroprotectors was maintained, with periodic returns to follow the evolution. It was concluded that the use of PRP was an important adjuvant in the clinical therapy employed.(AU)

Estudo da técnica intracapsular assistida por artroscopia para o tratamento da ruptura do ligamento cruzado cranial em cadáveres de cães / Study in dog's cadavers of the assisted by arthroscopy intracapsular technique for the treatment of the cranial cruciate ligament rupture in the dog

O objetivo foi estudar e aprimorar a técnica intracapsular de reparação do ligamento cruzado cranial assistida por artroscopia em cadáveres de cães com a confecção dos túneis tibial e femoral e utilização de autoenxerto osso-tendão patelar-osso. Foram utilizados 10 membros pélvicos de cães > 20kg. Os túneis ósseos foram confeccionados de forma independente e na posição anatômica original dos locais de inserção do ligamento cruzado cranial. Foram realizados estudo radiográfico e tomográfico para avaliar a articulação. A coleta das porções ósseas do enxerto foi feita com osteótomo e martelo. Ocorreram fratura em três patelas e em três tuberosidades tibiais. Os enxertos apresentaram comprimento médio 7,56cm. Os túneis tibiais e os túneis femorais foram confeccionados no local de inserção do ligamento cruzado cranial em 80% e 90% das articulações, respectivamente. Os túneis tibiais apresentaram ângulo médio de 62,95º mensurado por tomografia computadorizada. Os túneis femorais foram confeccionados em posição 13hs para o joelho esquerdo (100%) e 11hs para o direito (100%). Ao final do procedimento, obteve-se gaveta negativo em 100% das articulações. Pode-se concluir que a técnica proposta é viável de ser realizada no cão, porém faz-se necessário instrumental específico devido ao pequeno tamanho da articulação canina para obter melhor acurácia.

The aim was study and improve the intra-articular technique assisted by arthroscopy of the cranial cruciate ligament repair in dog's cadavers. The bone-patelar tendon-bone was used as a graft and were made the femoral and tibial tunnels. The hindlimb of 10 dogs cadavers weighing > 20kg were harvested. The femoral and tibial tunnels were made independent of each other, in the footprint of the original cranial cruciate ligament. Radiographic and tomographic studies were performed to evaluate the joint. The osseous portions of the graft were were harversted with osteotome and hammer. Fractures occurred in 3 patellas and 3 tibial tuberosities. The medium lenght of the grafts was 7,56cm. Tibial and femoral tunnels were in the footprint of the cranial cruciate ligament in 80% and 90% of the joints, respectively. The tibial tunnel had an average angle of 62,95º measured by computer tomography. The femoral tunnel was at 13h in the left knee and at 11h in the right knee in all joints (100%). At the end of the procedure the drawer test was negative in all joints (100%). It can be concluded that the proposed technique is feasible to be performed in the dog. But because to the small size of the canine joint it is necessary specific instruments in order to obtain better acuracy.

Estudo da técnica intracapsular assistida por artroscopia para o tratamento da ruptura do ligamento cruzado cranial em cadáveres de cães / Study in dog's cadavers of the assisted by arthroscopy intracapsular technique for the treatment of the cranial cruciate ligament rupture in the dog

O objetivo foi estudar e aprimorar a técnica intracapsular de reparação do ligamento cruzado cranial assistida por artroscopia em cadáveres de cães com a confecção dos túneis tibial e femoral e utilização de autoenxerto osso-tendão patelar-osso. Foram utilizados 10 membros pélvicos de cães > 20kg. Os túneis ósseos foram confeccionados de forma independente e na posição anatômica original dos locais de inserção do ligamento cruzado cranial. Foram realizados estudo radiográfico e tomográfico para avaliar a articulação. A coleta das porções ósseas do enxerto foi feita com osteótomo e martelo. Ocorreram fratura em três patelas e em três tuberosidades tibiais. Os enxertos apresentaram comprimento médio 7,56cm. Os túneis tibiais e os túneis femorais foram confeccionados no local de inserção do ligamento cruzado cranial em 80% e 90% das articulações, respectivamente. Os túneis tibiais apresentaram ângulo médio de 62,95º mensurado por tomografia computadorizada. Os túneis femorais foram confeccionados em posição 13hs para o joelho esquerdo (100%) e 11hs para o direito (100%). Ao final do procedimento, obteve-se gaveta negativo em 100% das articulações. Pode-se concluir que a técnica proposta é viável de ser realizada no cão, porém faz-se necessário instrumental específico devido ao pequeno tamanho da articulação canina para obter melhor acurácia.(AU)

The aim was study and improve the intra-articular technique assisted by arthroscopy of the cranial cruciate ligament repair in dog's cadavers. The bone-patelar tendon-bone was used as a graft and were made the femoral and tibial tunnels. The hindlimb of 10 dogs cadavers weighing > 20kg were harvested. The femoral and tibial tunnels were made independent of each other, in the footprint of the original cranial cruciate ligament. Radiographic and tomographic studies were performed to evaluate the joint. The osseous portions of the graft were were harversted with osteotome and hammer. Fractures occurred in 3 patellas and 3 tibial tuberosities. The medium lenght of the grafts was 7,56cm. Tibial and femoral tunnels were in the footprint of the cranial cruciate ligament in 80% and 90% of the joints, respectively. The tibial tunnel had an average angle of 62,95º measured by computer tomography. The femoral tunnel was at 13h in the left knee and at 11h in the right knee in all joints (100%). At the end of the procedure the drawer test was negative in all joints (100%). It can be concluded that the proposed technique is feasible to be performed in the dog. But because to the small size of the canine joint it is necessary specific instruments in order to obtain better acuracy.(AU)

Avaliação ultrassonográfica de cães com ruptura do ligamento cruzado cranial submetidos a artrotomia / Ultrasonographic evaluation of dogs with cranial cruciate ligament rupture undergoing to arthrotomy

Background: The cranial cruciate ligament rupture (CrCLR) is the most common disease of the stifle joint in dogs. Oneof the major concerns in the assessment of these animals is diagnosing the presence of a medial meniscus tears, which isa frequent consequence due to the instability of the joint. Ultrasonography is indicated in the evaluation of the meniscifrom human and canine patients, and the results are similar to magnetic resonance imaging. The aim of this study was tocompare the ultrasonography and the arthrotomy in the evaluation of the cranial cruciate ligament and medial meniscusof dogs with CrCLR undergoing surgery for stifle stabilization.Materials, Methods & Results: Ultrasonographic examination was performed prior to arthrotomy in 23 dogs with diagnosis of complete CrCLR and five with suspected partial CrCLR undergoing for stifle joint stabilization surgery. Theultrasonography identified the complete rupture in 82.6% and the arthrotomy in 100% of the joints with this diagnosis. Inthe joints with suspected CrCLR during the clinical exam, arthrotomy and ultrasonography identified respectively threeand four joints with partial CrCLR, and two and one with healthy ligaments. There was no difference between the twotechniques in the assessment of the cranial cruciate ligament (P = 0.20). The ultrasonography identified medial meniscaltears in 39.3%, while arthrotomy was found in 21.4% (P = 0.0006) of the joints. The most frequent meniscal tear type observed in the arthrotomy was folded caudal horn. The ultrasonography was able only in differentiate presence and absenceof meniscal injury. Besides the real tear that affects the meniscus morphology, the ultrasound also identified echogenicityand echotexture changes in the medial (5/28) and lateral (8/28) menisci. Other changes observed in all joints evaluated byultrasound were the presence of effusion and synovial membrane thickening...

Avaliação ultrassonográfica de cães com ruptura do ligamento cruzado cranial submetidos a artrotomia / Ultrasonographic evaluation of dogs with cranial cruciate ligament rupture undergoing to arthrotomy

Background: The cranial cruciate ligament rupture (CrCLR) is the most common disease of the stifle joint in dogs. Oneof the major concerns in the assessment of these animals is diagnosing the presence of a medial meniscus tears, which isa frequent consequence due to the instability of the joint. Ultrasonography is indicated in the evaluation of the meniscifrom human and canine patients, and the results are similar to magnetic resonance imaging. The aim of this study was tocompare the ultrasonography and the arthrotomy in the evaluation of the cranial cruciate ligament and medial meniscusof dogs with CrCLR undergoing surgery for stifle stabilization.Materials, Methods & Results: Ultrasonographic examination was performed prior to arthrotomy in 23 dogs with diagnosis of complete CrCLR and five with suspected partial CrCLR undergoing for stifle joint stabilization surgery. Theultrasonography identified the complete rupture in 82.6% and the arthrotomy in 100% of the joints with this diagnosis. Inthe joints with suspected CrCLR during the clinical exam, arthrotomy and ultrasonography identified respectively threeand four joints with partial CrCLR, and two and one with healthy ligaments. There was no difference between the twotechniques in the assessment of the cranial cruciate ligament (P = 0.20). The ultrasonography identified medial meniscaltears in 39.3%, while arthrotomy was found in 21.4% (P = 0.0006) of the joints. The most frequent meniscal tear type observed in the arthrotomy was folded caudal horn. The ultrasonography was able only in differentiate presence and absenceof meniscal injury. Besides the real tear that affects the meniscus morphology, the ultrasound also identified echogenicityand echotexture changes in the medial (5/28) and lateral (8/28) menisci. Other changes observed in all joints evaluated byultrasound were the presence of effusion and synovial membrane thickening...(AU)

Técnica de avanço e transposição da tuberosidade tibial (TTTA) com uso de espaçador único de TTA-Maquet em cão / Technique of tibial tuberosity transposition and advancement (TTTA) with use of TTA-Maquet cage-only in dog

Background: The most common conditions that compromise the stifle joint in dogs are medial patellar luxation (MPL) and cranial cruciate ligament (CCL) rupture. Surgical procedures are usually indicated for the treatment of these diseases. One ordinarytechnique for the treatment of MPL is the tibial tuberosity transposition, and one prominent technique for CCL rupture is the tibialtuberosity advancement. These techniques can be associated in one surgical procedure called tibial tuberosity transposition andadvancement (TTTA) for the simultaneous treatment of both stifle diseases. The aim of this study is to report the surgical treatmentof a dog with MPL and CCL rupture affecting the same joint by the TTTA technique with the use of a TTA-Maquet cage-only.Case: A 3-year-old Pitbull dog weighing 39 kg was attended at Veterinary Hospital with a history of marked lameness in theleft pelvic limb. The orthopedic examination showed positive results for cranial drawer motion and tibial compression tests,and a complete CCL rupture was diagnosed. The presence of patellar luxation was evaluated by manual pressure on the patella, and grade 3 of MPL was diagnosed. Both conditions were affecting the same stifle joint. In addition, survey radiographsof the affected joint were performed. Surgical treatment was indicated by the TTTA technique. Radiographic measurementswere taken to calculate the cranial tibial tuberosity advancement by the tibial plateau and the common tangent methods, and atitanium TTA-Maquet cage-only of 10.5 x 20.0 mm was selected. Linear osteotomy was performed on the tibial tuberosity withthe aid of an oscillating saw, based on the Maquet hole technique. The tibial tuberosity was carefully displaced cranially and thecage was inserted at the site of osteotomy. The cage ears were molded on the tibial surface and fixed with 2.4 mm self-tappingcortical screws...

Técnica de avanço e transposição da tuberosidade tibial (TTTA) com uso de espaçador único de TTA-Maquet em cão / Technique of tibial tuberosity transposition and advancement (TTTA) with use of TTA-Maquet cage-only in dog

Background: The most common conditions that compromise the stifle joint in dogs are medial patellar luxation (MPL) and cranial cruciate ligament (CCL) rupture. Surgical procedures are usually indicated for the treatment of these diseases. One ordinarytechnique for the treatment of MPL is the tibial tuberosity transposition, and one prominent technique for CCL rupture is the tibialtuberosity advancement. These techniques can be associated in one surgical procedure called tibial tuberosity transposition andadvancement (TTTA) for the simultaneous treatment of both stifle diseases. The aim of this study is to report the surgical treatmentof a dog with MPL and CCL rupture affecting the same joint by the TTTA technique with the use of a TTA-Maquet cage-only.Case: A 3-year-old Pitbull dog weighing 39 kg was attended at Veterinary Hospital with a history of marked lameness in theleft pelvic limb. The orthopedic examination showed positive results for cranial drawer motion and tibial compression tests,and a complete CCL rupture was diagnosed. The presence of patellar luxation was evaluated by manual pressure on the patella, and grade 3 of MPL was diagnosed. Both conditions were affecting the same stifle joint. In addition, survey radiographsof the affected joint were performed. Surgical treatment was indicated by the TTTA technique. Radiographic measurementswere taken to calculate the cranial tibial tuberosity advancement by the tibial plateau and the common tangent methods, and atitanium TTA-Maquet cage-only of 10.5 x 20.0 mm was selected. Linear osteotomy was performed on the tibial tuberosity withthe aid of an oscillating saw, based on the Maquet hole technique. The tibial tuberosity was carefully displaced cranially and thecage was inserted at the site of osteotomy. The cage ears were molded on the tibial surface and fixed with 2.4 mm self-tappingcortical screws...(AU)

Carcinoma adrenocortical incidental em cão: aspectos clínicos, tomográficos e histopatológicos / Incidental adrenocortical carcinoma in dog: clinical, tomographic and histopathological aspects

Background: Adrenal incidentalomas are masses accidentally discovered during imaging examinations performed whenthere is no suspicion of adrenal disease. Even with a low prevalence, it is important to perform a reliable evaluation observing biological behavior and determining whether the hormonal activity is stimulated. Frequently, these masses are notfunctional, but in some cases, there is increased cortisol activity, and patients with adrenal incidentalomas may presenthyperadrenocorticism. This report aims to describe the clinical, tomographic, and histopathological aspects of a case ofadrenal incidentaloma detected in a routine abdominal ultrasound.Case: An 8-year-old, male, maltese dog with occasional emesis, halitosis, claudication of the left pelvic limb, and previous compensated and untreated cardiomyopathy was treated at the Veterinary Hospital of the Federal University of MatoGrosso (HOVET-UFMT). Physical examination revealed arterial hypertension and claudication, with the positive posteriordrawer test suggesting rupture of the cruciate ligament. The blood count showed no alteration, and the serum biochemistryrevealed a slight increase in the activity of alanine aminotransferase. In order to investigate this increase, an abdominalultrasound was performed. Slight hepatomegaly and a heterogeneous mass of irregular edges were observed with a moderate and difficult-to-delimit vascularization of the adrenal gland. Left knee radiography raised the suspicion of rupture ofthe cranial cruciate ligament due to the cranial displacement of the tibia in relation to the femur. Computed tomographywas performed to define the extent and delimitation of the mass, which was compatible with a tumor of the right adrenalgland characterized by the visualization of an abdominal mass...(AU)

Carcinoma adrenocortical incidental em cão: aspectos clínicos, tomográficos e histopatológicos / Incidental adrenocortical carcinoma in dog: clinical, tomographic and histopathological aspects

Background: Adrenal incidentalomas are masses accidentally discovered during imaging examinations performed whenthere is no suspicion of adrenal disease. Even with a low prevalence, it is important to perform a reliable evaluation observing biological behavior and determining whether the hormonal activity is stimulated. Frequently, these masses are notfunctional, but in some cases, there is increased cortisol activity, and patients with adrenal incidentalomas may presenthyperadrenocorticism. This report aims to describe the clinical, tomographic, and histopathological aspects of a case ofadrenal incidentaloma detected in a routine abdominal ultrasound.Case: An 8-year-old, male, maltese dog with occasional emesis, halitosis, claudication of the left pelvic limb, and previous compensated and untreated cardiomyopathy was treated at the Veterinary Hospital of the Federal University of MatoGrosso (HOVET-UFMT). Physical examination revealed arterial hypertension and claudication, with the positive posteriordrawer test suggesting rupture of the cruciate ligament. The blood count showed no alteration, and the serum biochemistryrevealed a slight increase in the activity of alanine aminotransferase. In order to investigate this increase, an abdominalultrasound was performed. Slight hepatomegaly and a heterogeneous mass of irregular edges were observed with a moderate and difficult-to-delimit vascularization of the adrenal gland. Left knee radiography raised the suspicion of rupture ofthe cranial cruciate ligament due to the cranial displacement of the tibia in relation to the femur. Computed tomographywas performed to define the extent and delimitation of the mass, which was compatible with a tumor of the right adrenalgland characterized by the visualization of an abdominal mass...

Estudo comparativo entre métodos manual e digital no cálculo do ângulo do platô tibial em cães / Comparative study of manual and digital method in the calculation of the tibial plateau angle in dogs

São poucos os dados publicados sobre a aplicabilidade ou a confiabilidade dos métodos digitais para mensuração do ângulo do platô tibial (APT) em comparação à mensuração manual. O objetivo deste estudo foi comparar o APT obtido pelo cálculo manual padrão, em filmes radiográficos, com os valores obtidos por cálculos em imagens digitais, por meio do software do computador. Foram analisadas radiografias digitais do membro pélvico, direito e esquerdo, em perfil verdadeiro, de 20 cães saudáveis, com idade superior a um ano. Três observadores com graus de experiência semelhantes em cálculo do APT realizaram as mensurações em cada radiografia. Primeiramente, foram calculados os ângulos dos platôs tibiais manualmente nas películas radiográficas e, posteriormente, os cálculos foram realizados na imagem digital, por meio do software para medicina veterinária do sistema de raios X digital. Os resultados do presente estudo demonstraram diferenças significativas entre os métodos, com valor das médias do cálculo digital 20,48±3.71 e do cálculo manual 23.90±4.02. Valor de P foi < 0,01 na comparação entre médias dos dois grupos. Na avaliação interobservadores, houve diferença significativa no cálculo manual no perfil direito, o que sugere maior variação no cálculo manual quando comparado ao digital. O cálculo realizado pelo software apresentou menor variação nos valores interobservadores. Acredita-se que a menor variação obtida nos resultados aqui apresentados se dê em razão das facilidades proporcionadas pelo software. Conclui-se que houve diferença entre os valores obtidos por meio dos métodos convencional e digital no cálculo do ângulo do platô tibial, sendo os valores digitais menores entre os observadores, e que o método digital no cálculo do ângulo do platô tibial levou à menor variação quando comparado ao método manual.(AU)

There are few published data on the applicability and reliability of digital methods for measuring the TPA compared with manual measurement. The objective of this study was to compare the TPA obtained by calculating standard manual on conventional radiographs, with the values obtained by calculations in digital images through a computer program. Bilateral digital radiographs of hind limb were analyzed in true profile for 20 healthy dogs older than two years. Three observers with similar levels of experience in calculating the TPA conducted measurements on each radiograph. First we calculated the angle of the tibial plateaus manually in x-ray film and then the calculations were made through the program offered by the computer program in the digital image. The results of this study showed significant differences between the methods, with average value of 20.48±3.71 digital calculating average and 23.90±2.4 in the manual calculation. P value was < 0.01 when comparing averages. No significant difference in manual calculation in right profile were found between interobserver assessments, suggesting greater variation in manual calculation compared to digital. The calculation performed by the software showed less variation in values. The slight variation obtained in our results is believed to be due to the facilities provided by the software. There was a difference between the values obtained by means of conventional and digital methods for calculating the angle of the tibial plateau, and the smaller digital values between the observers and the digital method in the calculation of the tibial plateau angle led to less variation when compared to the manual method.(AU)