Ex vivo evaluation of the soft tissue components of the equine stifle using 3 Tesla magnetic resonance imaging under flexion, extension, and loading.

High-field MRI of the equine stifle provides high-resolution information about soft tissues that is useful in the diagnosis of stifle lameness. The aim of this prospective anatomic study was to describe the appearance, position, size, and shape of the equine femorotibial ligaments, meniscal ligaments, and menisci using 3 Tesla MRI under extended, extended-loaded, and flexed conditions. Additionally, histologic examination of the collateral and cruciate ligaments (CLs) of a single stifle was performed to compare with MRI images. In extension, mild variations in MRI signal intensity were apparent in the CLs, and the cranial had two distinct longitudinal regions indicating two ligament bundles. Flexion had minor effects on CL signal intensity and altered the tibial angles of attachment. Histology indicated that both CLs were comprised of two fiber bundles. The collateral ligaments were the same low-signal intensity. The medial collateral ligament had a smaller cross-sectional area than the lateral, and flexion increased the length of the medial collateral ligament and the cross-sectional area of the lateral. Low loads in extension did not affect the MRI appearance of stifle soft tissues. Flexion of the stifle impacted cruciate ligament insertion angles and the size and shape of collateral ligaments. This study provides support for the use of MRI to understand the anatomy and function of stifle ligaments.

Comparative histomorphometric analysis of cellular phenotype in canine stifle ligaments and tendon.

OBJECTIVE: To measure the density of cellular phenotypes in canine caudal cruciate ligament (CaCL), cranial cruciate ligament (CrCL), medial collateral ligament (MCL), and long digital extensor tendon (LDET). STUDY DESIGN: Ex-vivo study. METHODS: Ten CaCL, CrCL, MCL, and LDET obtained from 1 stifle of 10 dogs with no gross pathology were analyzed histologically. The density of cells with 3 nuclear phenotypes (fusiform, ovoid, and spheroid) was determined within the core region of each specimen. RESULTS: Cells with fusiform nuclei were most dense in the MCL (median [range], 319 [118-538] cells/mm2 ) and LDET (331 [61-463]), whereas cells with ovoid nuclei were most dense in the CaCL (276 [123-368]) and CrCL (212 [165-420]). The spheroid nuclear phenotype had the lowest density in all structures (31 [5-61] in CaCL, 54 [5-90] in CrCL, 2 [0-14] in MCL, and 5 [0-80] in LDET); however, the CrCL contained a denser population of spheroid cells compared with MCL and LDET (P < .05). Total cell densities did not differ among the 4 structures (P > .05). CONCLUSION: Phenotype density varied within the ligaments and tendon tested here. The cell population of CaCL and CrCL differed from that of dense collagenous tissues such as MCL and LDET. CLINICAL SIGNIFICANCE: The relatively higher density of spheroid phenotype in CrCL may reflect a distinctive native cellular population or a cellular transformation secondary to unique mechanical environment or hypoxia. This intrinsic cellular population may explain altered tissue properties prone to pathological rupture or poor healing potential of the canine CrCL.

Effect of osteoarthritis on the repeatability of patella tendon angle measurement in dogs.

OBJECTIVE: To evaluate the influence of osteoarthritis on the measurement of patella tendon angle (PTA) and determine intraobserver and interobserver variability. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: Eighty-seven mediolateral radiographs that were obtained prior to tibial tuberosity advancement. METHODS: Radiographic osteoarthritis was scored by 2 observers using guidelines derived from the International Elbow Working Group Protocol. Patella tendon angle was measured by 3 observers on 3 occasions, with at least 7 days between measurements. The data were statistically analyzed via weighted κ and Kruskal-Wallis testing. RESULTS: A fair strength of agreement was found among observers scoring osteoarthritis, with the same grades in 48% of radiographs. The intraobserver average bias between PTA measurements 1 and 3 ranged from -0.38° to -0.94°. Interobserver bias in angle measurement ranged from -0.92° to -2.00°. Observer 1 had the narrowest range of PTA differences (12.1°), and observer 3 had the highest range of PTA differences (23.5°). Observer 2 had the lowest mean bias (-0.38°). The mean bias was lowest between observers 1 and 2 (-0.92°) and highest between observers 1 and 3 (-2.0°). The mean intraobserver standard deviation of the PTA measurement differences was 2.90°, and interobserver standard deviation of the PTA measurement differences was 2.26°. The degree of osteoarthritis did not influence PTA measurements or their variability. CONCLUSION: The current study did not find evidence of an influence of osteoarthritis on PTA or on the repeatability of measurements. CLINICAL SIGNIFICANCE: Our findings suggest that osteoarthritis should not affect the radiographic planning for tibial tuberosity advancement surgery. The high variances in PTA measurement in less experienced observers may influence the clinical outcome of surgery.

Arthroscopic approach and anatomy of the stifle joint in the rabbit.

OBJECTIVE: To describe a technique and normal findings for arthroscopy of the stifle in rabbits. STUDY DESIGN: Cadaver study. ANIMALS: Twenty cadaveric stifles from New Zealand White rabbits were examined. METHODS: The arthroscope was placed through a medial portal, and instrument portals were created on the lateral aspect of the joint. The same portals were used for examination of the entire joint and palpation of structures with a probe. RESULTS: Structures identified in the proximal aspect of the stifle included the suprapatellar pouch, suprapatella, patella, medial and lateral proximal recesses, medial and lateral trochlear ridges, trochlear groove. Structures identified in the distal aspect of the joint included the cranial and caudal cruciate ligaments, medial and lateral menisci, medial and lateral femoral condyles, the long digital extensor tendon, and the cranial meniscal ligaments were identified. All of the proximal structures could be seen in 16/20 limbs. Distally, the cranial cruciate ligament could be identified and manipulated most often (17/20 limbs), followed by the caudal cruciate ligament (11/20), the menisci (9/20), and condyles (9/20). The average examination time was 27 minutes. There was a variably present femorotibial membrane. CONCLUSION: We conclude that the arthoscopic evaluation of the stifle in rabbits is a viable surgical approach and could be used for rabbit models or to examine clinical cases with stifle pathology. Precise portal placement and adequate infrapatellar fat pad debridement were critical for success.

Optical clearing in collagen- and proteoglycan-rich osteochondral tissues.

OBJECTIVE: Recent developments in optical clearing and microscopy technology have enabled the imaging of intact tissues at the millimeter scale to characterize cells via fluorescence labeling. While these techniques have facilitated the three-dimensional (3D) cellular characterization within brain and heart, study of dense connective tissues of the musculoskeletal system have been largely unexplored. Here, we quantify how optical clearing impacted the cell and tissue morphology of collagen-, proteoglycan-, and mineral-rich cartilage and bone from the articulating knee joint. METHODS: Water-based fructose solutions were used for optical clearing of bovine osteochondral tissues, followed by imaging with transmission and confocal microscopy. To confirm preservation of tissue structure during the clearing process, samples were mechanically tested in unconfined compression and visualized by cryo-SEM. RESULTS: Optical clearing enhanced light transmission through cartilage, but not subchondral bone regions. Fluorescent staining and immunolabeling was preserved through sample preparations, enabling imaging to cartilage depths five times deeper than previously reported, limited only by the working distance of the microscope objective. Chondrocyte volume remained unchanged in response to, and upon the reversal, of clearing. Equilibrium modulus increased in cleared samples, and was attributed to exchange of interstitial fluid with the more viscous fructose solution, but returned to control levels upon unclearing. In addition, cryo-SEM-based analysis of cartilage showed no ultrastructural changes. CONCLUSION: We anticipate large-scale microscopy of diverse connective tissues will enable the study of intact, 3D interfaces (e.g., osteochondral) and cellular connectivity as a function of development, disease, and regeneration, which have been previously hindered by specimen opacity.

Magnetic resonance imaging study in a normal Bengal tiger (Panthera tigris) stifle joint.

BACKGROUND: The purpose of this study was to describe the normal appearance of the bony and soft tissue structures of the stifle joint of a Bengal tiger (Panthera tigris) by low-field magnetic resonance imaging (MRI), and the use of gross anatomical dissections performed as anatomical reference. A cadaver of a mature female was imaged by MRI using specific sequences as the Spin-echo (SE) T1-weighting and Gradient-echo (GE) STIR T2-weighting sequences in sagittal, dorsal and transverse planes, with a magnet of 0.2 Tesla. The bony and articular structures were identified and labelled on anatomical dissections, as well as on the magnetic resonance (MR) images. RESULTS: MR images showed the bone, articular cartilage, menisci and ligaments of the normal tiger stifle. SE T1-weighted sequence provided excellent resolution of the subchondral bones of the femur, tibia and patella compared with the GE STIR T2-weighted MR images. Articular cartilage and synovial fluid were visualised with high signal intensity in GE STIR T2-weighted sequence, compared with SE T1-weighted sequence where they appeared with intermediate intensity signal. Menisci and ligaments of the stifle joint were visible with low signal intensity in both sequences. The infrapatellar fat pad was hyperintense on SE T1-weighted images and showed low signal intensity on GE STIR T2-weighted images. CONCLUSIONS: MRI provided adequate information of the bony and soft tissues structures of Bengal tiger stifle joints. This information can be used as initial anatomic reference for interpretation of MR stifle images and to assist in the diagnosis of diseases of this region.

Comparison of tibial plateau angles in small and large breed dogs.

Cranial cruciate ligament (CCL) disease can affect dogs of all sizes. The literature describing tibial plateau angle (TPA) in small breed dogs is limited. A retrospective study was conducted in unselected dogs presented for stifle or tibial examination to compare TPA in small breed dogs (n = 146 dogs, 185 stifles) versus large breed dogs (n = 200 dogs, 265 stifles). Small breed dogs had a mean TPA 3.1° ± 0.6° higher than large breed dogs. There were higher TPAs in spayed females and castrated males for all dogs compared with intact males (3.6° ± 1.0° and 2.7° ± 1.0°, respectively). Dogs with unilateral and bilateral CCL disease had higher TPAs compared to dogs with intact CCLs (2.0° ± 0.7° and 2.5° ± 0.8°, respectively). Tibial morphology differs between large and small breed dogs; however, the significance of the impact of TPA on CCL disease in small breed dogs is unknown.

Comparaison des angles du plateau tibial chez les chiens de petite et de grande races. La maladie du ligament cruciforme crânien (LCC) peut affecter les chiens de toutes les tailles. La littérature décrivant l'angle du plateau tibial (APT) chez les chiens de petites races est limitée. Une étude rétrospective a été réalisée chez des chiens non sélectionnés présentés pour un examen du grasset ou du tibia pour comparer l'APT chez les chiens de petite race (n = 146 chiens, 185 grassets) par rapport aux chiens de grande race (n = 200 chiens, 265 grassets). Les chiens de petite race présentait un APT moyen de 3,1° ± 0,6° de plus que les chiens de grande race. Il y avait des APT supérieurs chez les femelles stérilisées et les mâles castrés pour tous les chiens comparativement aux mâles intacts (3,6° ± 1,0° et 2,7° ± 1,0°, respectivement). Les chiens atteints d'une maladie LCC unilatérale et bilatérale présentaient des APT supérieurs comparativement aux chiens avec des LCC intacts (2,0° ± 0,7° et 2,5° ± 0,8°, respectivement). La morphologie tibiale diffère entre les chiens de grande et de petite race. Cependant, l'importance de l'impact de l'APT sur la maladie LCC chez les chiens de petite race est inconnue.(Traduit par Isabelle Vallières).

Anterior cruciate ligament: an anatomical exploration in humans and in a selection of animal species.

PURPOSE: Many anatomical anterior cruciate ligament (ACL) studies have indicated that the human ACL is composed of two functional bundles: the antero-medial (AM) and postero-lateral (PL). The purpose of this study is to compare the ACL anatomy among human and assorted animal species. METHODS: Twenty fresh-frozen knees specimen were used: five humans, ten porcine, one goat, one Kodiak bear, one African lion, one Diana monkey and one Gazelle antelope. All the specimens were dissected to expose the ACL and to visualize the number of bundles and attachment patterns on the tibia and femur. Following the fibre orientation of the individual bundles, a wire loop was used to bluntly separate the bundles starting from the tibial insertion site to the femoral insertion site. In the human and porcine ACL, each bundle was separated into approximately 2 mm diameter segments and then tracked in order to establish the individual bundle's specific pattern of insertion on the femur and tibia. RESULTS: It appeared that all human and animal knee specimens had three bundles that made up their ACL. In addition, it was noted that among the various specimens species, all viewed with an anterior view, and at 90° knee flexion, the ACL bony insertion sites had similar attachment patterns. CONCLUSION: In all the specimens, including human, the ACL had three distinct bundles: AM, intermediate (IM) and PL. The bundles were composed of multiple fascicles arranged in a definite order and similar among the different species.

Radiographic analysis in Thoroughbreds reveals morphological changes in healthy maturing stifle joints and possible association between subchondral lesions and femoral condyle width.

OBJECTIVE: Assess femorotibial features in foals with and without medial femoral condyle (MFC) subchondral radiolucencies (SR+ and SR-). METHODS: 3 independent, sequential radiographic studies were performed. Study 1 retrospectively measured femorotibial morphological parameters in repository radiographs (SR- and SR+). Study 2 qualitatively compared drawings of intercondylar notch shape in postmortem radiographs (SR-). Study 3 prospectively measured femorotibial parameters in 1-month-old foals (SR-). In studies 1 and 3, 13 morphologic parameters were measured. Limb directional asymmetry was assessed in 2 age groups (< 7 or ≥ 7 months). RESULTS: Study 1 (SR- group; n = 183 radiographs) showed increased femoral measurements with maturation, except the distal femoral intercondylar notch width (FINwal), which decreased. In contrast, in SR+ stifles (53 radiographs), 3 femoral parameters (MFC width [MFCwpf], MFC height, or FINwal) showed no changes. Tibial plateau width alone increased with maturation in both groups. Interobserver reliability was good to excellent. Study 2 (n = 53 radiographs) confirmed a distal FINw decrease in SR- foals. In study 1, left SR- stifles in greater than or equal to 7-month-old fillies had significantly larger femoral bicondylar width and FINw, while right SR+ stifles in fillies greater than or equal to 7 months had a significantly larger MFCw. In study 3 of 1-month-old foals (n = 94 SR- radiographs), the MFCw, femoral condyle bicondylar width, and lateral femoral condyle height were all greater on the left, whereas the intercondylar intereminence space width was larger on the right. CLINICAL RELEVANCE: In SR+ stifles, the distal femur exhibited divergent maturation, indicating a wider MFC in the right stifle in older foals. As SR lesions are more common on the right, this suggests a potential association with MFC morphology.

Ultrashort Echo Time Quantitative Magnetic Resonance Imaging of the Cruciate Ligaments in Normal Beagles.

OBJECTIVE: The aim of this study was to provide normative ultrashort echo time magnetic resonance imaging (UTE MRI) data of the patellar ligament (PL), cranial cruciate ligament (CrCL) and caudal cruciate ligament (CdCL) in non-lame Beagles. STUDY DESIGN: Eight stifles from four subjects obtained immediately postmortem were imaged using UTE MRI in the true sagittal plane. Regions of interest were drawn manually and the total (T2*), short T2* (T2*S) and long T2* (T2*L) values of the signal decay were calculated to evaluate the bound and free water components of the tendon. The T2*S, T2*L and T2* values were compared between the PL, CrCL and CdCL RESULTS: The mean and standard deviation of T2*S, T2*L and T2* were as follows: 0.54 ± 0.13, 4.65 ± 1.08 and 8.35 ± 0.82 ms for the PL; 0.46 ± 0.14, 5.99 ± 0.52 and 8.88 ± 0.4 ms for the CrCL and 0.41 ± 0.13, 7.06 ± 0.57 and 9.26 ± 0.18 ms for the CdCL. Significant differences were found between the T2*L component of the PL and each CrCL/CdCL and a smaller difference was noted between the T2*L of the CrCL and CdCL (p = 0.05). No difference of the T2*S value was found between any of the ligaments. CONCLUSION: Establishing normative UTE data of the canine stifle is valuable for comparison in future studies in which normal and damaged ligaments may be evaluated, particularly in those affected limbs in which no instability is identified on physical examination in which normal and damaged ligaments may be evaluated.

Meniscal mineralisation in little spotted cats.

BACKGROUND: The aim of this study was to evaluate the stifle joints of little spotted cats in captivity using radiographic and CT studies. The hypothesis was that these animals would have meniscal mineralisation that could be detectable by imaging studies. Twelve intact little spotted cats (Leopardus tigrinus), 2 females and 10 males, aged from 1.5 to 11.11 years old and weighing 1.9-3.05 kg were studied. These animals, which were living in the Quinzinho de Barros Municipal Zoo, had no symptoms or known disease processes at the time of the study. The plain radiographs and computed tomography (CT) scans of both stifle joints were performed under general anaesthesia. Sequential transverse images were acquired on a spiral scanner. RESULTS: No signs of articular disease were observed in any of the animals. Radiographically, the meniscal mineralisation was detected as an oval radiopacity in the cranial compartment on the mediolateral projection, located within the area of the medial meniscus. On craniocaudal projection, the mineralisation was more difficult to visualise. In one of the animals, it was not possible to identify the meniscal mineralisation in either of the stifle joints. Using CT, meniscal mineralisation was best identified in the transverse plane images. CONCLUSIONS: Meniscal mineralisation appears to be a normal anatomic feature in little spotted cats.

Magnetic resonance imaging (MRI) anatomy of the ovine stifle.

OBJECTIVE: To describe magnetic resonance imaging (MRI) anatomy of the ovine stifle and investigate meniscotibial and cruciate ligaments anatomy. STUDY DESIGN: Descriptive ex vivo study. ANIMALS: Pelvic limbs (n = 44) from 22 adult Texel ewes. METHODS: Forty limbs (n = 40) were scanned using 3 Tesla MRI before gross anatomic dissection. Two other limb pairs were frozen and transected to obtain sections that were compared with MRI images for identification of anatomic structures. RESULTS: In all stifles, the craniomedial bundle of the cranial cruciate ligament inserted caudally to the cranial attachment of the medial meniscus. No transverse intermeniscal ligament was identified in 80% of stifles, whereas a few small ligamentous fibers were seen crossing from 1 cranial horn to the other in 20% of stifles. There was good differentiation of menisci, ligaments, and synovial cavities on MRI images. Two bundles were identified in all cranial cruciate ligaments on MRI. Sensitivity and specificity of 3T MRI for detection of transverse intermeniscal ligament were 42% and 84%, respectively. CONCLUSION: 3T MRI provided well defined reference images for menisci, synovial cavities, and most ligaments.

Radiographic localization and isometry of the origin and insertion of the canine cranial cruciate ligament.

OBJECTIVE: To radiographically define the anatomic origin and insertion of the cranial cruciate ligament translated to the lateral radiographic projection of the stifle (CrCL-Lo and CrCL-Li, respectively), to correlate these landmarks for identification of the CrCL-Lo intraoperatively, and to compare the isometry of the CrCL-Lo to the lateral fabella. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Pelvic limbs (n = 12) from dogs weighing 13-26 kg. METHODS: A radiographic quadrant method was used to localize the CrCL-Lo. Mediolateral radiographic projections of each stifle were taken through a range of motion. Maximum percent change in length between each tibial marker and femoral marker during range of motion determined isometry. RESULTS: The CrCL-Lo is located at the caudal 33% and distal 50% of the lateral femoral condyle using Blumensaat's line or a line from the origin of the long digital extensor (LDE) to the lateral fabella, with no significant difference (P = .766) between the 2 reference lines. The CrCL-Li is located at the proximal 20% of the tibial plateau. No significant difference (P < .05) in isometry was found between the CrCL-Lo and lateral fabella. CONCLUSION: The CrCL-Lo is located at the caudal 1/3 and distal ½ of the lateral femoral condyle. The CrCL-Lo and lateral fabella are not significantly different in isometry when used as a proximal anchor point in extracapsular stifle stabilization.

The effectiveness of 3D animations to enhance understanding of cranial cruciate ligament rupture.

Cranial cruciate ligament (CCL) rupture is one of the most important orthopedic diseases taught to veterinary undergraduates. The complexity of the anatomy of the canine stifle joint combined with the plethora of different surgical interventions available for the treatment of the disease means that undergraduate veterinary students often have a poor understanding of the pathophysiology and treatment of CCL rupture. We designed, developed, and tested a three dimensional (3D) animation to illustrate the pertinent clinical anatomy of the stifle joint, the effects of CCL rupture, and the mechanisms by which different surgical techniques can stabilize the joint with CCL rupture. When compared with a non-animated 3D presentation, students' short-term retention of functional anatomy improved although they could not impart a better explanation of how different surgical techniques worked. More students found the animation useful than those who viewed a comparable non-animated 3D presentation. Multiple peer-review testing is required to maximize the usefulness of 3D animations during development. Free and open access to such tools should improve student learning and client understanding through wide-spread uptake and use.

The role of the superficial region in determining the dynamic properties of articular cartilage.

OBJECTIVE: The objective of this study was to elucidate the role of the superficial region of articular cartilage in determining the dynamic properties of the tissue. It is hypothesised that removal of the superficial region will influence both the flow dependent and independent properties of articular cartilage, leading to a reduction in the dynamic modulus of the tissue. METHODS: Osteochondral cores from the femoropatellar groove of three porcine knee joints were subjected to static and dynamic loading in confined or unconfined compression at increasing strain increments with and without their superficial regions. Equilibrium moduli and dynamic moduli were measured and the tissue permeability was estimated by fitting experimental data to a biphasic model. RESULTS: Biochemical analysis confirmed a zonal gradient in the tissue composition and organisation. Histological and PLM analysis demonstrated intense collagen staining in the superficial region of the tissue with alignment of the collagen fibres parallel to the articular surface. Mechanical testing revealed that the superficial region is less stiff than the remainder of the tissue in compression, however removal of this region from intact cores was found to significantly reduce the dynamic modulus of the remaining tissue, suggesting decreased fluid load support within the tissue during transient loading upon removal of the superficial region. Data fits to a biphasic model predict a significantly lower permeability in the superficial region compared to the remainder of the tissue. CONCLUSIONS: It is postulated that the observed decrease in the dynamic moduli is due at least in part to the superficial region acting as a low permeability barrier, where its removal decreases the tissue's ability to maintain fluid load support. This result emphasises the impact that degeneration of the superficial region has on the functionality of the remaining tissue.

Measurement of femoral and tibial joint reference angles and pelvic limb alignment in cats.

OBJECTIVE: To report pelvic limb joint reference angles, limb alignment, and mechanical axis deviation for the feline pelvic limb. STUDY DESIGN: Cadaveric radiographic anatomic study. ANIMALS: Skeletally mature, mixed breed cats (n = 50). METHODS: Extended pelvic limb radiography was performed and images analyzed to determine femoral anatomic joint reference angles, femoral and tibial mechanical joint reference angles, tibiofemoral angle, metatarsotibial angle, mechanical axis-femur and mechanical axis-metatarsus angles, and mechanical axis deviation of the stifle and tarsus. Mean ± SD and 95% confidence intervals (95% CI) were calculated. RESULTS: Mean ± SD angles and 95% CI were: anatomic lateral proximal femoral (103.9° ± 3.8°; 103.1° - 104.6°), anatomic lateral distal femoral (93.8° ± 2.5°; 93.3° - 94.3°), mechanical lateral proximal femoral (100.5° ± 3.7°; 99.8° - 101.2°), mechanical lateral distal femoral (97.2° ± 2.2°; 96.7° - 97.6°), mechanical medial proximal tibial (88.0° ± 3.2°; 87.3° - 88.6°), mechanical medial distal tibial (107.6° ± 4.8°; 106.6° - 108.5°), mechanical tibiofemoral (7.4° varus ± 2.5°; 6.9° - 7.9°), mechanical metatarsotibial (6.0° valgus ± 3.5°; 5.3° - 6.7°); mechanical axis-femur (3.2° ± 1.4°; 2.9° - 3.5°) and mechanical axis-metatarsus (2.4° ± 2.0°; 1.7° - 2.1°). Mechanical axis deviation of the stifle and of the tarsus were 2.0% ± 0.9% (95% CI: 1.9-2.2) and 0.8% ± 1.0% (95% CI: 0.7-1.0), respectively. CONCLUSIONS: Mean pelvic limb joint reference and limb alignment angles can be used for diagnosing angular limb deformities of the feline pelvic limb and for planning corrective osteotomies in affected cats.

Arthroscopic approach to the subextensorius recess of the lateral femorotibial joint of the foal.

OBJECTIVE: To (1) develop an arthroscopic approach to the subextensorius recess of the lateral femorotibial (LFT) joint in foals and (2) report its use in foals with LFT joint sepsis. STUDY DESIGN: (1) Anatomic study and (2) retrospective case series. SAMPLE POPULATION: (1) Cadaveric hind limbs (n = 32 foals) to delineate the anatomy of the subextensorius recess; 13 foal limbs for cadaver surgery to assess the approach to the subextensorius recess; and (2) foals (n = 8) with LFT joint sepsis. METHODS: (1) The LFT joint was distended and examined ultrasonographically. Dissection was used to document periarticular landmarks, potential distal arthroscopic portals, and assess iatrogenic damage after cadaveric surgery. (2) Retrieval of data from 8 foals with LFT joint sepsis treated using the arthroscopic approach. RESULTS: (1) The optimal arthroscopic approach to the distal subextensorius recess is craniolaterally, 8-10 cm distal to the tibial plateau, immediately caudal to the peroneus tertius muscle, through the long digital extensor muscle belly, entering the distal extent of the subextensorius recess. Thirteen limbs dissected after cadaver surgery had no iatrogenic damage to the peroneus tertius muscle or peroneal nerve. (2) Two foals were euthanized. Resolution of sepsis occurred in 6 foals, and all were sound at follow-up >9 months after surgery. CONCLUSION: The subextensorius recess may be safely accessed arthroscopically in foals.

Arthroscopic approach and intraarticular anatomy of the stifle in South American camelids.

OBJECTIVE: To describe a cranial arthroscopic approach to the stifle of South American camelids and to report our clinical experience with camelid stifle arthroscopy. STUDY DESIGN: Experimental study and retrospective case series. ANIMALS: (1) Cadaveric alpaca hindlimbs (n = 18; 9 alpacas); (2) 1 alpaca and 1 llama METHODS: Polymethylmethacrylate joint casts (n = 2) were made to define stifle joint dimensions. Cadaveric stifle joints (n = 16) were evaluated arthroscopically to determine arthroscopic portal locations, describe the intraarticular anatomy, and report potential complications. An alpaca and a llama with stifle joint disease had diagnostic arthroscopy. RESULTS: Successful entry into the stifle joint was achieved in 16 cadaver limbs. Observed structures were: the suprapatellar pouch, articular surface of the patella, femoral trochlear ridges and groove, cranial aspect of the femoral condyles (n = 16); distal aspect of the cranial and proximal aspect of the caudal cruciate ligaments (14); and cranial aspects of the medial and lateral menisci (11), and cranial meniscotibial and intermeniscal ligaments (8). Stifle arthroscopy allowed for joint evaluation and removal of osteochondral fragments in 1 alpaca and 1 llama with naturally occurring stifle disease. Complications of cadaver or live procedures included minor cartilage scoring (3 stifles) and subcutaneous periarticular fluid accumulation (8 stifles). CONCLUSIONS: Arthroscopy provides a safe approach for diagnosis and treatment of stifle lesions in South American camelids.

Evaluation of Hindlimb Deformity and Posture in Dogs with Grade 2 Medial Patellar Luxation during Awake Computed Tomography Imaging while Standing.

OBJECTIVE: The aim of this study was to determine the degree of bone deformities and hindlimb postural abnormalities in a standing position in awake Toy poodles with and without grade 2 medial patellar luxation (MPL) using high speed 320-row computed tomography (CT). METHODS: The limbs with grade 2 MPL (MPL-G2 group) and without any orthopaedic disorders (control group) were imaged in a standing position, without sedation or anaesthesia, using CT. In MPL-G2 group, images were obtained when the patella was luxated (G2-L group) and reduced (non-luxation, G2-NL group). Bone morphologies of the femur and tibia were quantified three-dimensionally. Hindlimb standing posture was evaluated by measuring femoral rotation and abduction angles, tibial rotation angle, metatarsal rotation angle, foot rotation angle, angle between the femoral anatomical axis and the mechanical axis of hindlimb and stifle joint line convergence angle. RESULTS: There were no significant differences in bone morphologic parameters between the MPL-G2 group (5 limbs) and the control group (6 limbs). In the G2-NL group, there were no significant hindlimb postural abnormalities. In contrast, in the G2-L group, significant hindlimb postural abnormalities including external rotation of femur, internal rotation of tibia and foot, external rotation of tarsal joint, large stifle joint convergence angle, genu varum and toe-in standing were observed. CONCLUSION: Dogs with grade 2 MPL have no bone deformities but show abnormal standing posture when the patella is luxated.

Meniscal translocation and deformation throughout the range of motion of the equine stifle joint: an in vitro cadaveric study.

REASON FOR PERFORMING STUDY: By study of the translocation and deformation of equine menisci throughout the range of motion, it may be possible to identify potential mechanical factors in the pathogenesis of injury to the cranial horn of the medial meniscus. OBJECTIVE: To quantitatively document meniscal translocation and deformation using radiographic and MR imaging, and to evaluate for potential variation between the medial and lateral menisci. METHODS: Radiographic markers were embedded in the periphery of the menisci in 6 cadaver stifles. Proximal-distal radiographs were taken at 15° intervals ranging from full flexion (30°) to full extension (160°). Magnetic resonance imaging sequences of 3 additional cadaver stifles were obtained in axial and sagittal planes at the predetermined stifle angles. RESULTS: A significantly greater overall mean cranial-caudal translocation (1.6 times) of the lateral meniscus relative to the medial was seen from full extension to full flexion (P = 0.002). The cranial horn of the medial meniscus was the least mobile of the 4 horns, yet a significant cranial displacement relative to the cranial horn of the lateral meniscus was seen in the terminal 10° of extension. MRI images revealed a significantly greater axial compressive strain in the cranial horn of the medial meniscus relative to the cranial horn of the lateral meniscus in the terminal 10° of extension (P = 0.017). CONCLUSION: The equine menisci exhibit a cranial-caudal translocation over the tibia throughout the range of motion. While the cranial horn of the medial meniscus is the least mobile of the 4 horns, it undergoes significant cranial translocation and axial compression in the terminal 10° of extension. POTENTIAL RELEVANCE: Hyperextension of the stifle may place the cranial horn of the medial meniscus at risk of injury and thus explain the higher prevalence of meniscal tears at this location.