Accuracy of needle arthroscopy for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture.

OBJECTIVE: To determine the accuracy of needle arthroscopy (NA) for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture (CCLR). STUDY DESIGN: Prospective clinical trial. ANIMALS: Twenty-six client-owned dogs. METHODS: Dogs with CCLR and scheduled to undergo tibial plateau leveling osteotomy were recruited for the study. Needle arthroscopy was performed by an experienced surgeon; the same dog subsequently underwent standard arthroscopy (SA) by another experienced surgeon who was blinded to the NA findings. The SA arthroscopy findings were used as the gold standard. Arthroscopy time, visibility of the menisci, ability to probe the menisci, and the presence of meniscal tears were recorded for both arthroscopies. The degree of lameness before and after NA was subjectively quantified. RESULTS: The sensitivity and specificity to diagnose medial meniscal tears with NA was 95% and 100%, respectively. Visibility of the menisci was lower (P < .01), probing of the lateral meniscus was harder (P = .0017), and procedure time was shorter (P = .073) with NA when compared to SA. The lameness scores did not differ before and after NA (P = .25). CONCLUSION: Needle arthroscopy could be performed rapidly with low morbidity, and had high accuracy for detecting medial meniscal tears in dogs with CCLR. CLINICAL SIGNIFICANCE: Needle arthroscopy is a promising minimally invasive technique for diagnosing medial meniscal tears in dogs with CCLR.

Use of a bone-to-tendon plate to stabilize a comminuted calcaneus fracture in a dog.

OBJECTIVE: To report the use of an ancillary plate spanning from the calcaneus to the common calcaneal tendon to stabilize a comminuted fracture in a dog. STUDY DESIGN: Case report ANIMALS: Two year old male neutered mix-breed dog. METHODS: The dog presented for a grade IIIa open highly comminuted fracture of the shaft and tuber of the left calcaneus from a suspected gunshot wound. Plantar and lateral locking plates were applied to the calcaneus, with the lateral plate extending proximally and sutured directly to the common calcaneal tendon. Autogenous cancellous and allogenic corticocancellous bone grafts were placed into the fracture site, and a human placental matrix was injected after closure. A lateral tarsal splint was applied for 17 weeks postoperatively. The lateral bone-to-tendon plate was replaced with a smaller lateral plate spanning only the calcaneus 9 weeks after the initial surgery. RESULTS: Radiographic union was documented at 17 weeks. At 25 weeks, both plates were removed due to suspected implant associated infection. At the final follow-up assessment, 36 weeks after initial surgery, the dog had returned to normal function with no observable lameness. CONCLUSION: Incorporation of the common calcaneal tendon as a proximal segment for plate fixation led to successful union of a highly comminuted calcaneal fracture.

Subsequent meniscal tears following tibial tuberosity advancement and tibial plateau leveling osteotomy in dogs with cranial cruciate ligament deficiency: An in vivo experimental study.

OBJECTIVE: To evaluate the short- and mid-term effects of tibial tuberosity advancement (TTA) and tibial plateau leveling osteotomy (TPLO) on subsequent meniscal tears. STUDY DESIGN: Experimental in vivo study. ANIMALS: Purpose-bred beagle dogs (n = 15). METHODS: For each dog, the cranial cruciate ligaments were transected; one limb underwent TTA and the other limb underwent TPLO. Orthopedic and radiographic examinations were performed preoperatively and at 12 and 32 weeks postoperatively. Gross evaluation of the stifle joint was performed after euthanasia at 12 (n = 10) and 32 (n = 5) weeks. RESULTS: Lameness scores were not different between TTA and TPLO limbs at any time point. Radiographic osteoarthritis scores of TTA stifles (1.33 ± 0.49) were higher than TPLO stifles (0.67 ± 0.49) (p = .002) at 12 weeks postoperatively, but there was no difference between groups at 32 weeks postoperatively. Subsequent medial meniscal tears occurred in 6/10 TTA stifles, and 0/10 TPLO stifles at 12 weeks postoperatively and in 5/5 TTA stifles, and 1/5 TPLO stifles at 32 weeks postoperatively. Subsequent lateral meniscal tears occurred in 4/5 TTA stifles at 32 weeks postoperatively. Medial meniscal total gross pathology score was higher in TTA than TPLO stifles. TTA stifles had more articular cartilage damage when compared with TPLO stifles at 32 weeks postoperatively. CONCLUSION: In this within-dog experimental comparison, subsequent medial meniscal tears and cartilage injury was more prevalent following TTA when compared to TPLO. CLINICAL SIGNIFICANCE: In an experimental model, TPLO protects the medial meniscus and articular cartilage better than TTA in stifles with complete cranial cruciate ligament deficiency.

Ultra Short Echo Time MRI of Iron-Labelled Mesenchymal Stem Cells in an Ovine Osteochondral Defect Model.

Multipotent Mesenchymal Stem/Stromal Cells (MSCs) are widely used in cellular therapy for joint repair. However, the use of MSC therapies is complicated by a lack of understanding of the behaviour of cells and repair within the joint. Current methods of MSC tracking include labelling the cells with Super Paramagnetic Iron Oxide nanoparticles (SPIOs). However, standard acquisition sequences (T2 and T2*) give poor anatomical definition in the presence of SPIOs. To avoid anatomical compromise in the presence of SPIOs, we have investigated the use of Ultra-short Echo Time (UTE) MRI, using a 3D cones acquisition trajectory. This method was used to track SPIO labelled MSC injected into joints containing osteochondral defects in experimental sheep. This study demonstrates that multiple echo times from UTE with 3 T MRI can provide excellent anatomical detail of osteochondral defects and demonstrate similar features to histology. This work also monitors the location of SPIO-labelled cells for regenerative medicine of the knee with MRI, histology, and Prussian blue staining. With these methods, we show that the SPIOs do not hone to the site of defect but instead aggregate in the location of injection, which suggests that any repair mechanism with this disease model must trigger a secondary process.

Meniscal click in cranial cruciate deficient stifles as a predictor of specific meniscal pathology.

OBJECTIVE: To determine the predictive value of meniscal click for specific meniscal tear morphology. STUDY DESIGN: Prospective cohort. ANIMALS: Client-owned dogs (104) with cranial cruciate ligament (CCL) deficiency treated with stifle arthroscopy (111). METHODS: All stifles underwent a standardized examination for meniscal click before anesthesia (EBA) and during anesthesia (EDA). Presence or absence of a medial meniscal tear and diagnosis of tear morphology were confirmed with arthroscopic examination. RESULTS: Complete CCL tears were noted in 93 dogs, and incompetent partial tears were noted in 18 dogs. Medial meniscal tears were noted in 40.5% (55/111) of dogs, including bucket handle tears (BHT) in 65.6% (36/55) of tears. Frays of the lateral meniscus were noted in 6.3% of dogs (7/111). Examination for meniscal click before anesthesia was 38% sensitive and 94.5% specific, and EDA was 38% sensitive and 98.2% specific for all meniscal tear morphologies. Positive meniscal click at EBA was associated with a meniscal BHT but not with a meniscal non-BHT (P < .0001 and P = .3515, respectively). Positive meniscal click at EDA was associated with a meniscal BHT but not with a meniscal non-BHT (P < .0001 and P = .1909, respectively). CONCLUSION: A meniscal click is more commonly associated with a meniscal BHT than with a non-BHT. CLINICAL SIGNIFICANCE: Meniscal tear morphology influences the presence or absence of meniscal click. Because of the high incidence of meniscal disease, this study provides evidence to support joint exploration in the treatment of CCL disease.

Uso da técnica TightRope modificada em cães com ruptura do ligamento cruzado cranial / Use of modification TightRope technique in dogs with rupture of cranial crucial ligament

A ruptura do ligamento cruzado cranial (RLCCr) figura entre as principais enfermidades ortopédicas na espécie canina, sendo responsável por instabilidade da articulação do joelho, o que resulta em claudicação e desenvolvimento de doença articular degenerativa (DAD). O objetivo deste trabalho foi avaliar os resultados da técnica de TightRope modificada (TRM) na estabilização do joelho de cães com ruptura do ligamento cruzado cranial (RLCCr). O procedimento cirúrgico foi realizado em seis animais, os quais foram avaliados por 120 dias de pós-operatório. A modificação da técnica para estabilização extra capsular da RLCCr, consiste na utilização de fio de fluorcarbono, e fio de aço inoxidável de 1 mm como forma de fixação óssea. A TRM promoveu a estabilidade do joelho dos pacientes com ruptura do ligamento cruzado cranial no pós-operatório imediato e durante o acompanhamento clínico pós-cirúrgico demonstrou, aos 30 dias, progressiva melhora da marcha e suporte de peso à deambulação, estando todos os animais recuperados clinicamente aos 120 dias de pós-operatório.

Rupture of the cranial cruciate ligament is one of the leading orthopedic diseases in dogs. Thus aimed to evaluate the techniqueof “Tightrope” modified (TRM) in the knees of dogs with the purpose of providing less invasive and cost-effective surgery. Thesurgical procedure was performed in six animals, and these were evaluated up to 120 days postoperatively. The modification of thetechnique for stabilization of extra capsular CCL consists in using fluorocarbon and the stainless steel wire of 1 mm in order bonefixation. The “TRM” promoted the stability of the knee of patients diagnosed with cranial cruciate ligament rupture in the immediatepostoperative period. Clinical follow-up after surgery showed after 30 days postoperatively, improved gait and progressive weightsupport for ambulation, being all animals recovered clinically at 120 days postoperatively.

Patellar ligament-bone autograft for reconstruction of a distal patellar ligament defect in a dog.

A 3 · 5-year-old whippet was presented 4 weeks after sustaining a traumatic injury to the right stifle joint. A penetrating injury had resulted in patellar ligament (PL) rupture. Magnetic resonance imaging revealed a normal appearing proximal half of the PL and absence of normal fibres within the distal half of the ligament. Surgical repair involved reconstruction of the defect using an autogenous graft harvested from the medial third of the ipsilateral PL. This repair was augmented with a pedicle hamstring graft. A transarticular external skeletal fixator was used to protect the repair for 4 weeks. Seven months after surgery, the dog was able to exercise normally without lameness. To the author's knowledge, this is the first veterinary report of PL grafting of a PL defect, and the first report of surgical augmentation using a hamstring graft.

Effects of observer on the diagnostic accuracy of low-field MRI for detecting canine meniscal tears.

Low-field MRI (lfMRI) has become increasingly accepted as a method for diagnosing canine meniscal tears in clinical practice. However, observer effects on diagnostic accuracy have not been previously reported. In this study, 50 consecutive stifle joints with clinical and radiologic evidence of cranial cruciate ligament insufficiency were investigated by lfMRI and arthroscopy. Fifteen observers who had varying levels of experience and who were unaware of arthroscopic findings independently reviewed lfMRI studies and recorded whether lateral and medial meniscal tears were present. Diagnostic accuracy (sensitivity, specificity, positive (PPV) and negative predictive value (NPV)) was determined for each observer and median values were calculated for all observers, using arthroscopy as the reference standard. Interrater agreement was determined based on intraclass correlation coefficient (ICC) analysis. Observer level of experience was compared with diagnostic sensitivity and specificity using correlation analysis. Based on pooled data for all observers, median sensitivity, specificity, PPV, and NPV for lfMRI diagnosis of lateral meniscal tears were 0.00, 0.94, 0.05, and 0.94, respectively. Median sensitivity, specificity, PPV, and NPV for medial meniscal tears were 0.74, 0.89, 0.83, and 0.79, respectively. Interrater agreement for all menisci was fair (0.51). Menisci were less consistently scored as having no tears (ICC = 0.13) than those scored as having tears (ICC = 0.50). No significant correlations between observer experience and diagnostic sensitivity/specificity were identified. Findings indicated that the accuracy of lfMRI for diagnosing canine meniscal tears was poor to fair and observer-dependent. Future studies are needed to develop standardized and widely accepted lfMRI criteria for diagnosing meniscal tears.

A retrospective study of the MRI findings in 18 dogs with stifle injuries.

OBJECTIVES: To make an objective assessment of the usefulness of magnetic resonance imaging in the diagnosis of meniscal damage and cranial cruciate ligament disease in the canine stifle by comparing magnetic resonance imaging findings with surgical findings. METHODS: Magnetic resonance images of 18 stifles from 18 dogs which had undergone magnetic resonance imaging for the investigation of stifle disease were reviewed. For every stifle, the menisci and cranial cruciate ligaments were assessed according to predetermined criteria. The magnetic resonance imaging findings were compared with the reported surgical findings and the sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated using the surgical findings as the gold standard. Kappa analysis was used as an objective measure of agreement between surgical and magnetic resonance imaging findings. For 11 stifles, meniscal evaluation by three different observers was used to measure interobserver agreement using Kappa analysis. RESULTS: Magnetic resonance imaging was demonstrated to be an accurate technique in the detection of meniscal injury (k=0.86), with excellent interobserver agreement (k=0.89 to 1.0). Disruption of cranial cruciate ligament continuity and an increase in ligament intensity were found to be useful criteria in the diagnosis of cranial cruciate ligament rupture. CLINICAL SIGNIFICANCE: Magnetic resonance imaging offers a non-invasive alternative to exploratory surgery in the evaluation of cranial cruciate ligament and meniscal disease.

The effects of preoperative extradural bupivacaine and morphine on the stress response in dogs undergoing femoro-tibial joint surgery.

OBJECTIVE: To evaluate the efficacy of preoperative extradural bupivacaine and morphine in attenuating the stress response in dogs undergoing femoro-tibial joint surgery. STUDY DESIGN: Prospective clinical study. Animal population Twelve client-owned dogs undergoing surgery for either repair of cruciate ligament rupture (ten) or correction of luxating patella (two). Body masses ranged from 12 to 45 kg (mean: 28.58 +/- 18.38). Age ranged from 19 to 121 months (mean: 66.5 +/- 49.5). MATERIALS AND METHODS: Six of the dogs received extradural bupivacaine (up to 1.5 mg kg(-1)) combined with morphine (0.1 mg kg(-1); ED) while the other six received no extradural analgesia (C). The levels of cortisol, acute phase proteins (APPs), and red and white blood cell variables were measured in both groups of dogs before, and at various times after surgery. Pain was also assessed at various times after surgery. The number of postoperative morphine doses required, and their time of administration, was recorded for each animal. Method of statistical analysis Data were analysed using anova for repeated measures with p-values of <0.05 considered significant. RESULTS: Cortisol levels in the ED group were significantly (p < 0.05) lower than those of the control group at the end of surgery. No statistically significant differences were found in APPs or red and white cell variables between dogs receiving, and those not receiving extradural bupivacaine and morphine. Four dogs in the control group and one in the ED group required postoperative morphine. CONCLUSIONS AND CLINICAL RELEVANCE: Pre-emptive extradural bupivacaine and morphine was effective in lowering the neuroendocrine stress response (cortisol) in the ED group but had no effect on the inflammatory response (acute phase response).

Proinflammatory cytokine activities, matrix metalloproteinase-3 activity, and sulfated glycosaminoglycan content in synovial fluid of dogs with naturally acquired cranial cruciate ligament rupture.

OBJECTIVE: To measure and compare activities of interleukin-1beta (IL-1beta), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and matrix metalloproteinase-3 (MMP-3); as well as sulfated glycosaminoglycan (S-GAG) content in synovial fluid from dogs with cranial cruciate ligament rupture (CCLR) and dogs with clinically normal stifles. To determine whether correlations exist between demographic and disease-related variables and these synovial markers. STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs with CCLR (n=23) and Beagles with normal stifle joints (n=21). METHODS: Synovial fluid activities of proinflammatory cytokines (IL-1beta, IL-6, and TNF-alpha) were determined by bioassay. MMP-3 activity was measured using fluorogenic substrate. S-GAG contents were determined by dimethylmethylene blue dye-binding assay. Mann-Whitney U-test was used to compare results from CCLR joints with normal controls. Spearman's rank correlation test was used to evaluate associations between demographic and disease-related markers and synovial markers. RESULTS: Mean values for synovial markers were significantly higher in CCLR joints compared with controls. IL-1beta and MMP-3 were positively correlated with lameness duration. CONCLUSIONS: Activities of proinflammatory cytokines, MMP-3 activity and S-GAG contents were significantly elevated in synovial fluid from canine stifle joints with naturally acquired CCLR. These results indicate that there is joint inflammation and increased release of GAGs into synovial fluid, suggesting that these inflammatory changes are associated with depletion of proteoglycan from articular cartilage. CLINICAL RELEVANCE: Medical and surgical treatments designed to decrease joint inflammation and breakdown of proteoglycans may be of value in the management of CCLR in the dog.

Osteochondral dowel transplantation for repair of focal defects in the knee: an outcome study using an ovine model.

OBJECTIVE: A model system was developed to objectively assess the quality of articular cartilage after surgical reconstruction of focal defects in the median femoral condyle using osteochondral dowel grafts. STUDY DESIGN: The surgical technique was developed and customized to reproducibly minimize surgical trauma and graft instability in order to improve the survival of the transplanted cartilage and the long-term integrity of the joint surfaces. ANIMALS OR SAMPLE POPULATION: 24 adult female Suffolk-Romanoff crossbred sheep. METHODS: Biomechanical creep testing, paravital staining for chondrocyte viability, histological analysis, and gross morphological analysis were performed at 3, 6, and 12 months postoperatively to compare fresh autografted osteochondral dowels with allografts that had been subject to a freezing protocol known to kill chondrocytes. The latter was used to investigate the time course of cartilage degeneration after injury. These two groups were also compared with normal unoperated control tissue. RESULTS: Biomechanical behavior, chondrocyte survival, and cartilage histology differed significantly between fresh grafts and those that had been frozen. CONCLUSIONS: Indentation testing and paravital staining were able to identify degenerative changes earlier than other methods of assessment. The technique developed here reproducibly and reliably transplanted osteochondral dowel grafts while minimizing the confounding effects of surgical trauma and graft instability. CLINICAL RELEVANCE: The technique provides both a promising surgical technique for the repair of focal defects of the medial femoral condyle and a sensitive model for the future study of cryopreservation strategies for articular cartilage.

[Intra-articular knee stabilization with synthetic material. A practice-oriented stabilization technic]. / Intra-articulaire kniestabilisatie met synthetisch materiaal. Een op de praktijk gerichte stabilisatietechniek.

An intra-articular method designed to stabilise the knee joint using synthetic material after rupture of the anterior cruciate ligament is described. The results obtained in forty dogs and two cats treated by this method during the period from 1980 to 1985, are reported. The morbid-anatomical findings within fourteen months after surgery are referred to in one case. Rejection of the ligament was not observed in a single case. When habitual or stationary medial dislocation of the patella was present in addition to a lesion of the anterior cruciate ligament, the patella was no longer found to be subject to dislocation following stabilisation of the knee joint. Clinical results ranged from moderate to satisfactory, varying with the degree of arthrosis and the lesions of the meniscus which were present. This technique does not take up much time and consequently saves expenses.