Muscle function assessment of the hindlimbs in healthy dogs using acoustic myography.

INTRODUCTION: Impaired muscle function is a frequent consequence of musculoskeletal disorders in dogs. Musculoskeletal disorders, especially stifle joint diseases, are common in dogs and assessment of muscle function in dogs is clinically relevant. Acoustic myography (AMG) is a non-invasive method to assess muscle activity. Quantifying muscle function in normal dogs could help identify clinically relevant changes in dogs with orthopaedic disease and allow targeted interventions to improve recovery in these. The objectives of the study were to characterize hindlimb muscle function in healthy dogs using AMG and to investigate the repeatability and reproducibility of AMG in dogs. METHODS: Healthy dogs (15-40 kg) without musculoskeletal disorders were recruited and screened for eligibility to participate in the study. The muscle activity in four hindlimb muscles related to the stifle was assessed using AMG. The degree of symmetry between the hindlimbs in these dogs was investigated and the reliability of AMG was evaluated. RESULTS AND CONCLUSIONS: The study population comprised 21 dogs. Reference intervals and symmetry indices for AMG scores of the hindlimb muscles were identified, with highest variability for the E-scores. For all AMG-scores, same-day variation was lower than between days variation, and both were lowest for S- and T-scores. Further investigation is needed to establish if AMG can enable discrimination between dogs with altered muscle function and healthy dogs.

Use of Stem Cells for the Treatment of Musculoskeletal Injuries in Horses.

Mesenchymal stem cells (MSCs) are used as a regenerative therapy in horses for musculoskeletal injury since the late 1990s and in some regions are standard of care for certain injuries. Yet, there is no Food and Drug Administration-approved MSC therapeutic in the United States for horses. In humans, lack of regulatory approval in the United States has been caused by failure of late-phase clinical trials to demonstrate consistent efficacy, perhaps because of nonuniformity of MSC preparation and application techniques. This article discusses clinical evidence for musculoskeletal applications of MSCs in the horse and current challenges to marketing approval.

Equine Autologous Conditioned Serum and Autologous Protein Solution.

Orthobiologics are used with increasing frequency in equine musculoskeletal disease to improve the quality of the repair tissue and prevent reinjury. Autologous blood-based products, or hemoderivatives, are made by processing the patient's blood using different systems to produce a final therapeutic product. Autologous conditioned serum (ACS) and autologous protein solution (APS) are commonly used to treat joint disorders and can also be used treat tendon and ligament injuries. Hemoderivatives contain increased concentrations of anti-inflammatory and immunomodulatory cytokines, and growth factors that help direct tissue healing and repair. The specifics of ACS and APS for treatment of musculoskeletal injuries are discussed.

Advances in Imaging Techniques to Guide Therapies and Monitor Response to the Treatment of Musculoskeletal Injuries.

Continual advancements in diagnostic imaging have allowed for more accurate and complete diagnoses of injuries in the performance horse. The use of several different imaging tools has further allowed the equine sports medicine clinician to more carefully direct treatment options, monitor response to therapy and guide rehabilitation recommendations. The advancements in diagnostic imaging and novel treatment options have led to the improvement in the overall prognosis of many injuries that affect the horse and their performance. The purpose of this section is to review the advancements made in diagnostic imaging of the horse and to aid the practitioner in the selection of the appropriate modality and how best to use them to guide treatment and monitoring decisions.

Incidence of disease, injury and death in Thoroughbred foals and yearlings on stud farms in the UK and Ireland.

BACKGROUND: Up-to-date estimates of early-life morbidity and mortality in Thoroughbreds are lacking. METHODS: A birth cohort was established on Thoroughbred stud farms across the UK and Ireland. All veterinary interventions for disease or injury between birth and 18 months of age or leaving the study were recorded. Multilevel Poisson regression models with farm and foal as random effects were fitted to estimate incidence rates. RESULTS: Data were available for 3328 foal-months at risk for 275 foals on seven farms. The overall rates of disease and injury requiring veterinary intervention and mortality were 11.9 cases/100 foal-months at risk (95% confidence interval [CI] 8.6-16.2) and 0.2 cases/100 foal-months at risk (95% CI 0.1-0.4), respectively. Almost half (n = 133/273, 49%, 95% CI 43-55) of the live-born cohort required veterinary intervention for musculoskeletal disease or injury, equating to 5.8 cases/100 foal-months at risk (95% CI 4.1-8.2), predominantly reported as developmental orthopaedic disease (DOD). LIMITATIONS: Convenience sampling of participants may affect the generalisability of the findings. CONCLUSIONS: Rates of musculoskeletal disease and injury, in particular DOD, on Thoroughbred stud farms were high. Further work to identify modifiable risk factors and further understanding of the economic impact of these conditions and long-term consequences for musculoskeletal health and performance is required.

Fast, non-eccentrically loaded exercise worsens tendinopathic healing responses in a murine model.

OBJECTIVE: To advance the understanding of how alterations in exercise speed and grade (flat vs 17° incline or decline) affect the quality of tendon healing, and to determine if a biomarker relationship exists between serum levels of a ColX breakdown product (CXM) and animals exposed to treadmill running protocols. ANIMALS: 35 male mice (C57BL/6J), 8 weeks of age. PROCEDURES: Mice were preconditioned on a treadmill for 14 days. Tendinopathy was then induced by 2 intra-tendinous TGFß1 injections followed by randomization into 7 exercise groups. Exercise capacity and objective gait analysis were measured weekly. Mice were euthanized and histopathologic analysis and evaluation of serum CXM levels were performed. Statistics were conducted using a 2-way ANOVA (exercise capacity), Mixed Effects Model (gait analysis, effect of preconditioning), and 1-way ANOVA (gait analysis, the effect of injury, and rehabilitation normalized to baseline; CXM serum analysis), all with Tukey post hoc tests and significance set to P < .05. RESULTS: Exercise at a fast-flat speed demonstrated inferior tendinopathic healing at the cellular level and impaired stance braking abilities, which were compensated for by increased propulsion. Mice exposed to exercise (at any speed or grade) demonstrated higher systemic levels of CXM than those that were cage rested. However, no ColX immunostaining was observed in the Achilles tendon or calcaneal insertion. CLINICAL RELEVANCE: Exercise at a fast speed and in absence of eccentric loading components (incline or decline) demonstrated inferior tendinopathic healing at the cellular level and impaired braking abilities that were compensated for by increased propulsion.

Regenerative Medicine and Rehabilitation Therapy in the Canine.

Regenerative medicine is used in the canine to optimize tissue healing and treat osteoarthritis and soft tissue injuries. Rehabilitation therapy is also often implemented in the treatment and management of musculoskeletal conditions in the canine. Initial experimental studies have shown that regenerative medicine and rehabilitation therapy may work safely and synergistically to enhance tissue healing. Although additional study is required to define optional rehabilitation therapy protocols after regenerative medicine therapy in the canine, certain fundamental principles of rehabilitation therapy still apply to patients treated with regenerative medicine.

Equine shock wave therapy - where are we now?

Over the past three decades, electrohydraulic extracorporeal shock wave therapy (ESWT) as a treatment modality for equine orthopaedic disorders has sparked exponential interest among practitioners, but its clinical applications are quickly evolving and a current review highlighting modernised equine clinical use is lacking. The objective of this review is to summarise the most current ESWT technology, evidence for its use, proposed mechanisms of action and clinical applications in horses while also highlighting the areas requiring further investigation. The three ways to generate a shock wave are through electrohydraulic, electromagnetic or piezoelectric mechanisms, but over the last decade, electrohydraulic systems have predominated due to the ability to focus and control a therapeutic waveform. Shock waves' primary physical effect is believed to be via mechanotransduction leading to cellular activation and downstream signalling. Experimentally, ESWT's effects on osseous, connective tissue and wound healing via various mechanisms of action have been reported both in the human and veterinary literature. Clinical trials have investigated ESWT's orthopaedic application including osteoarthritis, thoracolumbar pain, navicular syndrome, tendinopathy and proximal suspensory desmopathy, with its concomitant use with biologics representing an area of active research. Direct ESWT protocol comparisons in terms of long-term efficacy with variables of energy, depth and exposed tissue types are still lacking with evidence-based recommendations being largely anecdotal. Technical advancements to facilitate the safe and judicious use of ESWT include human and equine hearing protection, light sedation and/or patient restraint. Efforts to ensure the safe and judicious use of ESWT and its analgesic effects are ongoing.

Current use of biologic therapies for musculoskeletal disease: A survey of board-certified equine specialists.

OBJECTIVE: To evaluate the use of mesenchymal stem cells (MSCs), autologous conditioned serum (ACS), platelet-rich plasma (PRP), and autologous protein solution (APS) for the treatment of equine musculoskeletal disease by diplomates of the American College of Veterinary Surgery (ACVS), and American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR). STUDY DESIGN: Cross-sectional study. SAMPLE POPULATION: Diplomates (n = 423). METHODS: An email link was sent to ACVS and ACVMR diplomates. A survey contained 59 questions regarding demographics, as well as indications, frequency, adverse effects, and limitations of use. Responses were analyzed using Fisher's exact test. RESULTS: One hundred and fifty four surveys were analyzed. Years in practice and type of practice were not associated with biologic therapy use. PRP was the most used therapy (120/137; 87.5%). PRP and MSCs were most often administered intralesionally while ACS and APS were most often administered intra-articularly. ACS (50/104; 48.1%) treatment was repeated commonly within 2 weeks of initial injection. MSCs (39/90; 43.3%) and PRP (38/100; 38%) were commonly repeated 1-2 months after initial injection and APS was typically repeated >4 months after initial injection (21/53; 39.6%). Local inflammation and expense were the most common adverse effect and limitation of use. CONCLUSION: Diplomates most commonly utilized PRP and MSC intralesionally for soft-tissue injuries, and ACS and ACP intra-articularly for joint injury. Protocols for repeated administration varied widely. Local inflammation was a clinical concern with the use of biologics. CLINICAL SIGNIFICANCE: Biologic therapies are used commonly by ACVS and ACVSMR diplomates for soft tissue and joint disease.

Use of Negative Pressure Wound Therapy in the Treatment of Limb Wounds: A Case Series of 42 Horses.

Traumatic limb injuries are common in horses. Negative pressure wound therapy (NPWT) has been proven to promote wound healing in human medicine. It has also been described for the treatment of wounds in horses. In this retrospective study, clinical records of 42 (n = 42) animals were assessed. Categories of wounds, duration of NPWT application, frequency of resetting the NPWT device, technical complications, and tolerance to the procedure were recorded. 42 wounds were classified as bony (n = 15; 36 %), articular (n = 14; 33 %), tenosynovial (n = 9; 21%), muscular (n = 2; 5%) and cutaneous (n = 2; 5 %). NPWT was used to help (1) first intention healing by preoperative (n = 3; 7 %) or postoperative (n = 7; 17%) application, (2) second intention healing (n = 31; 74%), and (3) delayed primary closure (n = 1; 2%). Duration of NPWT application ranged from 2 to 36 days (mean 11.5), with the system staying in place for periods ranging from 1 to 7 days (mean 4.5). In 69% (n = 29) of the cases, healing was considered satisfactory at discharge. 26 % (n = 11) of horses were discharged whilst ideally NPWT should have been continued. 2 animals (n = 2; 5%) were euthanized after surgery due to unrelenting pain. The procedure was well tolerated except in 1 horse who showed signs of discomfort at the first application. This study demonstrated that NPWT with long periods of application can be used successfully to manage various types of limb wounds.

Internet-based survey of the frequency and types of orthopedic conditions and injuries experienced by dogs competing in agility.

OBJECTIVE: To describe the frequency and types of injuries experienced by dogs competing and training in agility and identify breed and geographic differences in frequency and types of injuries. SAMPLE: Surveys completed by owners of 4,701 dogs. PROCEDURES: The study involved an internet-based survey. Participants were asked whether their dog had ever had an injury that kept it from participating in agility for > 1 week and, if so, to identify the location and type of injury. RESULTS: Owners of 1,958 (41.7%) dogs reported that their dogs had experienced an injury. The most common injury locations were the shoulder region (n = 589 [30.1% of all dogs with an injury]) and iliopsoas muscle (380 [19.4%]). The percentage of Border Collies sustaining an injury (549/1,052 [51.9%]) was significantly higher than percentages of other breeds. Percentage of dogs that sustained an injury varied by country, with the highest percentage reported in Australia (93/174 [53.4%]) and lowest percentage reported in the US (1,149/2,889 [39.8%]). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that, among dogs competing and training in agility, injuries to the shoulder region were substantially more common than injuries in other anatomic locations, with iliopsoas muscle injuries second most common. The frequency and types of injuries varied among breeds and geographic regions. Findings may help guide clinical evaluations when agility dogs are seen in clinical practice for performance issues or lameness. Further studies regarding regional differences in injury rates are required.

The Role of Mesenchymal Stem Cells (MSCs) in Veterinary Medicine and Their Use in Musculoskeletal Disorders.

Regenerative medicine is a dynamically developing field of human and veterinary medicine. The animal model was most commonly used for mesenchymal stem cells (MSCs) treatment in experimental and preclinical studies with a satisfactory therapeutic effect. Year by year, the need for alternative treatments in veterinary medicine is increasing, and other applications for promising MSCs and their biological derivatives are constantly being sought. There is also an increase in demand for other methods of treating disease states, of which the classical treatment methods did not bring the desired results. Cell therapy can be a realistic option for treating human and animal diseases in the near future and therefore additional research is needed to optimize cell origins, numbers, or application methods in order to standardize the treatment process and assess its effects. The aim of the following work was to summarize available knowledge about stem cells in veterinary medicine and their possible application in the treatment of chosen musculoskeletal disorders in dogs and horses.

Clinical safety of robenacoxib in cats with chronic musculoskeletal disease.

BACKGROUND: Evaluate the clinical safety of robenacoxib in cats with chronic musculoskeletal disease (CMSD). ANIMALS: Four hundred forty-nine client-owned cats with CMSD. METHODS: Pooled analysis of safety variables from 4 prospective randomized blinded clinical trials of robenacoxib (n = 222) versus placebo (n = 227), administered orally once daily for 4 to 12 weeks. Safety was evaluated from reported adverse events (AEs) and abnormalities detected on hematology and serum and urine chemistry analyses. RESULTS: The number of cats with at least 1 AE was not significantly different (P = .15) with robenacoxib (n = 106, 47.8%) compared to placebo (n = 93, 41.0%). The relative risk of at least 1 AE (incidence robenacoxib/placebo) was 1.15 (95% confidence interval 0.93-1.43). There was no significant difference between groups in the number of clinical signs (range, 0-9) per cat (P = .23). Serum creatinine concentrations were higher during robenacoxib administration compared to placebo (+4.36 µmol/L, 95% confidence interval 0.21-8.50), but no related adverse clinical effects were detected. In the subgroup of 126 cats with evidence of chronic kidney disease, the relative risk of at least 1 AE (robenacoxib/placebo) was 1.09 (95% confidence interval 0.78-1.52, P = .61). CONCLUSIONS AND CLINICAL IMPORTANCE: Robenacoxib was not associated with increased risk of AEs compared to placebo when administered for 4 to 12 weeks to cats with CMSD. The generalizability of the results to general practice is limited by the fact that cases with severe and uncontrolled concomitant diseases were not included.

Clinical application of mesenchymal stem cells therapy in musculoskeletal injuries in dogs-a review of the scientific literature.

Mesenchymal stem cells (MSCs) are multipotent, which is defined by their ability to self-renew while maintaining the capacity to differentiate into a certain number of cells, presumably from their own germinal layer. MSCs therapy is based on their anti-inflammatory, immunomodulatory (immunosuppressive), and regenerative potential. This review aims to provide a clinical overview of the MSCs potential as a therapeutic option for orthopedic diseases in dogs. A total of 25 clinical studies published in the scientific literature in the last 15 years on various diseases will be presented: semitendinosus myopathy, supraspinatus tendinopathy, cruciate ligament rupture, bone fractures and defects, and also osteoarthritis (OA). All articles involved in this study include only diseases that have naturally occurred in canine patients. MSCs therapy in the veterinary orthopedic field has great potential, especially for OA. All studies presented promising results. However, MSCs bone healing capacity did not reveal such favorable outcomes in the long term. Besides, most of these clinical studies did not include immunohistochemistry, immunofluorescence, and histopathology to confirm that MSCs have differentiated and incorporated into the injured tissues. This review summarizes the current knowledge of canine MSCs biology, immunology, and clinical application in canine orthopedic diseases. Despite the positive results in its use, there is still a lack of defined protocols, heterogeneous samples, and concomitant medications used with MSCs therapy compromising therapeutic effects. Further studies are needed in the hope of overcoming its limitation in upcoming trials.

Sports Medicine and Rehabilitation in Working Dogs.

Canine sports medicine and rehabilitation recently have evolved to embody the optimization of performance, injury prevention, and mitigation of musculoskeletal degeneration. This article discusses the diverse factors and considerations of working dog wellness and injury prevention and the importance of recognizing normal and abnormal posture and anatomic structure for performance evaluation and early indication of musculoskeletal injury. The importance of a canine physical fitness program is highlighted and the need for a 4-phase recovery plan to determine if a working dog can safely return to work after injury discussed.

Biomechanical effects of a titanium intervertebral cage as a stand-alone device, and in combination with locking plates in the canine caudal cervical spine.

OBJECTIVE: To evaluate the change in ex vivo biomechanical properties of the canine cervical spine, due to an intervertebral cage, both as a stand-alone device and in combination with plates. STUDY DESIGN: Experimental ex vivo study. ANIMALS: Cervical spinal segments (C5-C7) from eight canine cadavers. METHODS: The range of motion (ROM) and elastic zone stiffness (EZS) of the spines were determined with a four-point bending device in flexion/extension, lateral bending, and axial rotation for four conditions: native, discectomy, cage (at C6-C7), and cage with plates (at C6-C7). The disc height index (DHI) for each condition was determined using radiography. RESULTS: Discectomy resulted in overall increased ROM (p < .01) and EZS (p < .05) and decreased DHI (p < .005) when compared to the native condition. Placement of the cage increased DHI (p < .001) and restored total ROM during flexion/extension, lateral bending and axial rotation, and EZS during flexion/extension to the level of the native spine. Application of the plates further reduced the total ROM during flexion/extension (p < .001) and lateral bending (p < .001), but restored ROM in extension and EZS during lateral bending. No implant failure, subsidence, or significant cage migration occurred during loading. CONCLUSION: An anchorless intervertebral cage used as a stand-alone device was able to restore the disc height and spinal stability to the level of the native cervical spine, whereas the addition of plates further reduced the spinal unit mobility. CLINICAL SIGNIFICANCE: This study implies that the intervertebral cage may be used as a stand-alone device in the spinal unit fixation in the canine cervical spine.

A RETROSPECTIVE REVIEW OF POST-METAMORPHIC MOUNTAIN CHICKEN FROG (LEPTODACTYLUS FALLAX) NECROPSY FINDINGS FROM EUROPEAN ZOOLOGICAL COLLECTIONS, 1998 TO 2018.

The mountain chicken frog (Leptodactylus fallax) is the largest endemic amphibian species in the Western Hemisphere. Since 1998, this critically endangered species has been maintained as a European Endangered Species Programme, but low breeding success and a high mortality rate threaten the sustainability of the captive frog population. In the current study, we analyzed gross and histopathologic postmortem information from 212 mountain chicken frogs that died in European zoological collections from 1998 to 2018. Thin body condition was the most commonly reported finding across all submissions, observed in 125 frogs. The gastrointestinal and urinary systems were reported to have the highest prevalence of pathologic findings on gross and histopathologic examination. Inflammatory disease was the most frequent diagnosis after histopathologic examination of relevant tissues, with intestinal inflammatory disease (n = 76) followed by tubulointerstitial nephritis (n = 26) being the most commonly reported. Neoplasia was reported in 42 of 212 (19.8%) frogs, all of which were adults. A defined cause of death, or reason for euthanasia, was proposed for 164 of 212 (77.4%) frogs, with inflammatory diseases processes (74 of 212; 34.9%) most commonly implicated. Intestinal adenocarcinoma, seemingly restricted to the colon, caused the deaths of 31 adult frogs. Further investigations to determine factors contributing to the high incidence of inflammatory disease processes and neoplasia are advocated to improve the health and sustainability of the captive mountain chicken frog population.

Feline musculoskeletal ageing: How are we diagnosing and treating musculoskeletal impairment?

PRACTICAL RELEVANCE: An understanding of the process of musculoskeletal ageing - which all senior and geriatric cats will experience - is vital to maintaining the health and welfare of our ageing cat population. CLINICAL CHALLENGES: Assessment of the feline musculoskeletal system is not always straightforward. Diagnosis of impairment relies on input from owners and veterinarians in terms of visual observation, and clinical and orthopaedic examination, in addition to diagnostic imaging. AUDIENCE: This review is written for the primary care veterinary team. AIMS: The goals are to raise awareness and improve clinical diagnosis of musculoskeletal impairment as a result of ageing. The article also reviews therapeutic options and considers the evidence available for the prevention/deceleration of musculoskeletal ageing and impairment. EVIDENCE BASE: There is good evidence of a high prevalence of osteoarthritis (OA) and degenerative joint disease (DJD) in older cats. There is also good evidence to indicate that functional impairment and chronic pain are sequelae of musculoskeletal disease. However, there is a paucity of information for what is best practice for the management and treatment of musculoskeletal impairment in a clinical situation. There is also a lack of evidence on how prevention of central stimulation of the nervous system caused by musculoskeletal impairment and, in turn the development of chronic pain, can be avoided.

Risk factors associated with work-preventing musculoskeletal discomfort in the upper extremities of bovine practitioners.

OBJECTIVE: To identify risk factors associated with work-preventing musculoskeletal discomfort (MSKD) in the upper extremities (defined as neck, shoulders, upper back, arms, elbows, wrists, and hands) of bovine practitioners. SAMPLE: 116 members of the Western Canadian Association of Bovine Practitioners. PROCEDURES: Data from a previously described cross-sectional survey of western Canadian bovine practitioners underwent further analysis. The survey, developed to glean information about MSKD in bovine practitioners, was a modified standardized Nordic questionnaire that included questions regarding personal and work characteristics and incidence and location of MSKD during the preceding 12 months along with perceptions about most physically demanding tasks. Logistic regression was used to identify factors associated with work-preventing upper extremity MSKD. RESULTS: 18 of 116 (15.5%) respondents indicated they had experienced work-preventing upper extremity MSKD during the preceding 12 months. The final multivariable regression model indicated that practice type (mixed animal vs primarily [> 50%] bovine; OR, 3.20; 95% CI, 0.96 to 10.67), practitioner height (OR, 0.93; 95% CI, 0.87 to 0.99), and number of veterinarians in the practice (OR, 1.32; 95% CI, 1.05 to 1.66) were significantly associated with the odds of work-preventing upper extremity MSKD. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that reproductive examination of cattle was not a significant risk factor for upper extremity MSKD in bovine practitioners. Further research into the effects of biomechanical, organizational, and psychosocial workplace factors on the development of MSKD in bovine practitioners is necessary to help inform prevention strategies to foster career longevity in this increasingly diverse practitioner group.