Physical Rehabilitation for the Management of Canine Hip Dysplasia: 2021 Update.

Hip dysplasia is one of the most common orthopedic conditions affecting dogs. Initially, laxity of the femur leads to subluxation, and subluxation can lead to an abnormal development or to progressive degeneration of the femoral head and dorsal acetabular rim. Osteoarthritis and its clinical impact progress over time. Changes to the femoral head and neck and the acetabulum and the impact on joint motion and pain vary widely among dogs. The rehabilitation of dogs with hip dysplasia includes rehabilitation therapy in dogs managed conservatively and the rehabilitation of dogs managed with surgery.

Combined center of rotation of angulation-based leveling osteotomy and tibial tuberosity transposition: An ex vivo mechanical study.

OBJECTIVE: To describe the technique of combined center of rotation of angulation (CORA)-based leveling osteotomy (CBLO) with tibial tuberosity transposition (TTT) and to compare the load to failure between CBLO combined with TTT and CBLO or TTT alone. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Twelve pairs of cadaveric pelvic limbs. METHODS: Six pairs of cadaveric tibia were tested in each group (CBLO-TTT versus CBLO) and (CBLO-TTT versus TTT) with each limb randomly assigned to a treatment group. Construct stability was determined by applying a tensile force to each patellar tendon until failure occurred. Load at failure and mode of failure were recorded for each specimen. RESULTS: No difference in mean load to failure was identified between CBLO-TTT (897 N) and CBLO alone (943 N) (P = .81). There was also no difference in the mean load to failure between the CBLO-TTT (928 N) and TTT alone (1046 N) (P = .12). CONCLUSION: Performing a TTT in combination with a CBLO does not weaken the construct failure to load when compared with each procedure performed alone. CLINICAL SIGNIFICANCE: A combined CBLO and TTT could be considered a viable option for concurrent management of a cranial cruciate ligament deficient stifle and medial patella luxation.

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In collaboration with the American College of Veterinary Radiology.

Ex vivo biomechanical comparison of four Center of Rotation Angulation Based Leveling Osteotomy fixation methods.

OBJECTIVE: To compare the strength of four constructs used to secure an osteotomy in a Center of Rotation Angulation (CORA)-Based Leveling Osteotomy (CBLO) in an ex vivo model. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Thirty-two canine tibiae from 17 skeletally mature cadavers weighing between 18 and 33.2 kg. METHODS: Thirty-two paired tibiae with patella and patellar tendon were collected. Each tibia was randomly allocated to a construct group: plate and pin (Plate), plate with countersink compression screw (HCS), plate with tension band (TB), or plate with HCS and TB (HCSTB). Samples were loaded by distraction until failure. The stiffness, yield load, and ultimate load were compared between each fixation method. RESULTS: No difference in stiffness of the constructs was detected between groups (p = .6937). Yield load for the HCSTB group (1211.06 N) was greater than the TB group (1016.41 N), the HCS group (907.20 N), and the Plate group (787.73 N) (p = .0069). The ultimate load for the HCSTB group (1387.82 N) was greater than the TB group (1076.36 N), HCS group (926.62 N), and the Plate group (774.35 N) (p = .0004). CONCLUSIONS: CBLO fixation augmented with a TB and HCS provided a stronger construct that withstood a greater yield load and ultimate load than either augmentation strategy alone. CLINICAL SIGNIFICANCE: Augmenting a CBLO fixation with a TB and a HCS can provide increased construct strength.

Timing of and risk factors for deep surgical site infection requiring implant removal following canine tibial plateau leveling osteotomy.

OBJECTIVE: To identify demographic risk factors for deep surgical site infection (SSI) requiring tibial plateau leveling osteotomy (TPLO) implant removal and time to implant removal. ANIMALS: Four hundred and thirty-three dogs that underwent a TPLO (144 that developed a deep SSI and required implant removal, 289 that did not). STUDY DESIGN: Retrospective case-control study. METHODS: Records of dogs undergoing implant removal due to a deep SSI after TPLO between 2006 and 2018 at two referral centers were reviewed. These records were frequency-matched by date to dogs undergoing TPLO that did not require implant removal. Multivariable analyses tested associations between demographics and implant removal as well as timing of implant removal. RESULTS: Deep SSI and implant removal occurred in 144 of 4813 (3.0%; 95% CI: 2.5, 3.5) dogs treated with TPLO. Implant removal was performed at a median of 279 days (range 49-2394 days) postoperatively. Male dogs (OR 1.8; 95% CI: 1.2, 2.7) and German Shepherd dogs (GSDs) (OR 7.4; 95% CI: 2.6, 20.5) were associated with plate removal. Earlier TPLO plate removal was associated with GSDs only (HR 2.4; 95% CI: 1.4, 4.1). CONCLUSION: Implant removal due to SSI after TPLO was uncommon, although male dogs and GSDs seemed predisposed to this complication. SIGNIFICANCE: These demographic risk factors can be used to educate owners regarding perioperative management.

Average Tibial Plateau Angle of 3,922 Stifles Undergoing Surgical Stabilization for Cranial Cruciate Ligament Rupture.

OBJECTIVE: The aim of this study was to report the average tibial plateau angle (TPA) from a large sample of dogs and to determine if breed or gonadectomy had a significant association with abnormal TPA. STUDY DESIGN: This was a retrospective case study. MATERIALS AND METHODS: Medical records from 2006 to 2015 were reviewed for dogs that were diagnosed with cranial cruciate ligament (CrCL) rupture and underwent dynamic surgical stabilization. Signalment, examination findings, preoperative TPA and surgical report were reviewed. RESULTS: A total of 3,249 dogs underwent CrCL stabilization surgery from 2006 to 2015. Of the 3,249 dogs, 3,054 dogs met the inclusion criteria for a total of 3,922 stifles to be evaluated. The average preoperative TPA was 29° ± 3.7°. Average breed-specific preoperative TPA ranged from 27° to 35.1°, with four breeds having significantly lesser TPA and four breeds significantly greater TPA than the overall mean of dogs. Neutered dogs had a higher TPA of 28.87° ± 3.8° than non-neutered dogs with an average TPA of 26.88° ± 4.0°, p < 0.001. There was not a significant difference in average TPA between females and males, regardless of the neuter status. CONCLUSION AND CLINICAL RELEVANCE: Our reported preoperative TPA in a large sample of dogs is higher than what has been previously published. In reviewing 3,922 stifles, the average preoperative TPA was 29°. We report the average preoperative TPA in specific breeds and report that neutered dogs have a significantly higher TPA than intact dogs. This updated information may guide clinicians in management decisions regarding treatment for CrCL rupture.

Sensitivity and Specificity of a Weight Distribution Platform for the Detection of Objective Lameness and Orthopaedic Disease.

INTRODUCTION: Weight distribution and off-loading at the stance are commonly used subjective assessments during the orthopaedic examination. The clinical relevance, sensitivity and specificity of limb off-loading have not yet been established. The aim of the study was to assess off-loading on a weight distribution platform (WDP) and determine the sensitivity and specificity at various cut-off points for the detection of objective lameness (OL) and orthopaedic disease (OD). MATERIALS AND METHODS: The total pressure index was used to determine OL on a pressure-sensitive walkway (PSW). Normal weight distribution on both the PSW and WDP was considered 30/30/20/20. A total pressure index standard deviation of 2 was used. The sensitivity and specificity of the WDP for the identification of OL and OD was determined at cut-off points 1 to 6 below normal weight distribution values. RESULTS: All patients in the study (n = 50) had confirmed OD. The PSW identified 36/50 (74%) patients as OL; these were deemed to be OL for sensitivity and specificity analysis of WDP data. At cut-off point 1, the WDP had the highest sensitivity for OD (84%) and OL (97%). At cut-off point 6, the WDP had the highest specificity for OD (98%) and OL (98%). The highest combination of sensitivity and specificity for both OD (1.65) and OL (1.80) was at cut-off point 2. DISCUSSION/CONCLUSION: The WDP provided the highest combined sensitivity and specificity at cut-off point 2 below the normal value for the detection of both OL and OD.

Physical Rehabilitation for the Management of Canine Hip Dysplasia.

Hip dysplasia is among the most common orthopedic conditions affecting dogs. Joint laxity is responsible for abnormal development of the femoral head and acetabulum, leading to excessive wear of the articular cartilage. Wear leads to secondary osteoarthritis. Rehabilitation is either conservative or after surgical management. Conservative rehabilitation therapies are directed at decreasing pain, improving hip range of motion (ROM), and building or maintaining muscle mass. Postoperatively, rehabilitation focuses on decreasing postoperative pain and inflammation, improving comfort and limb use, and protecting the surgical site. Once the patient has healed, rehabilitation is directed at improving ROM and promoting muscle mass.

Adhesive Capsulitis in Eight Dogs: Diagnosis and Management.

OBJECTIVE: To describe clinical and diagnostic findings as well as management of adhesive capsulitis in dogs. BACKGROUND: Adhesive capsulitis, also known as frozen shoulder, is a syndrome defined by loss of range of motion of the shoulder and may be the end-stage manifestation of several primary conditions. EVIDENTIARY VALUE: This is a case series report of eight dogs with chronic forelimb lameness diagnosed with adhesive capsulitis. METHODS: Medical records (June 1, 2010-September 1, 2015) including, physical examination findings, radiographic findings, magnetic resonance imaging (MRI) findings, arthroscopy findings, and treatment plans were reviewed. RESULTS: All dogs presented with a chronic, grade III-VI/VI forelimb lameness. On orthopedic examination, all dogs had moderate to significant discomfort on shoulder extension and flexion and severe restriction of range of motion. Six of the eight dogs had evidence of bone remodeling and sclerosis in the affected shoulder on radiographs. Six of the dogs had an initial diagnostic ultrasound performed, which revealed evidence of fibrous scar tissue. Five dogs had MRI performed that revealed moderate shoulder effusion and enhancement of the synovial lining of the shoulder. Arthroscopy was performed in five of the eight patients. Three were noted to have significant contracture, adhesions, and fibrous scar tissue of the joint capsule. Severe inflammation was noted throughout the synovium of two patients. All eight patients tried conservative management consisting of oral medications and rehabilitation therapy. Five of the eight patients received extracorporeal shockwave therapy. Three patients received regenerative medicine treatment in the affected supraspinatus and shoulder. Regardless of the treatment elected, none of the dogs were reported to have significant improvement. CONCLUSION: Adhesive capsulitis is an uncommon cause of chronic forelimb lameness. Further investigation is needed to describe the etiology and pathogenesis of adhesive capsulitis in dogs to evaluate the effectiveness of both non-surgical and surgical treatment modalities, establish treatment protocols, and evaluate short- and long-term clinical outcome of patients. APPLICATION: Adhesive capsulitis should be considered in patients with chronic forelimb lameness and moderate to significant discomfort and restriction on shoulder range of motion.

Traumatic fracture of the medial coronoid process in 24 dogs.

OBJECTIVE: To describe traumatic fracture of the medial coronoid process in dogs as a clinically distinct disease unrelated to congenital elbow dysplasia. METHODS: Clinical records of dogs with acute, traumatic, unilateral lameness attributable to medial coronoid process disease were reviewed retrospectively. Clinical interpretation included findings on physical examination, orthopaedic examination, and subjective gait analysis. Radiographs of the affected and contralateral elbows were obtained and reviewed for pathology. Arthroscopy of the elbow joints was performed by one of three surgeons and findings were compared to preoperative diagnostics. Postoperative follow-up was continued for 16 weeks. RESULTS: Twenty-four dogs were included in this study. All dogs in this study were free of radiographic evidence of medial coronoid pathology. All dogs were diagnosed with a single, large, displaced or non-displaced fracture of the medial coronoid process, with no other joint pathology. Dogs generally had an excellent short-term outcome following arthroscopic treatment of the fractured medial coronoid process. CLINICAL SIGNIFICANCE: Traumatic fracture of the medial coronoid process should be considered a clinical disease distinct from dysplasia-related fragmentation and should be considered as a differential diagnosis in dogs that are presented with the complaint of acute unilateral elbow discomfort or lameness, especially after concussive activities involving the forelimb. .

In-vitro comparison of 3 knotting techniques for lateral fabellotibial suture stabilization.

This study evaluated the biomechanical characteristics of a single self-locking knot (sSLK) and a double self-locking knot (dSLK) compared with the square knot (SQ) for stabilization of cranial cruciate ligament rupture. Each knot underwent monotonic tensile and cyclical loading. Starting tension, elongation, stiffness, and load to failure were all evaluated. A value of P < 0.05 was considered significant. Starting tension, overall stiffness, and load to failure were all significantly greater in both the sSLK and dSLK compared with the SQ. There was no difference in elongation among the knots. There were no significant differences in starting tension, elongation, stiffness, and load to failure between the sSLK and the dSLK. The self-locking knots were stronger and stiffer than the SQ; there is no biomechanical advantage in using the dSLK compared with the sSLK.

Comparaison in vitro de 3 techniques de nœuds pour la stabilisation des sutures fabello-tibiales latérales. Cette étude a évalué les caractéristiques d'un nœud auto-serrant unique (NASu) et d'un nœud auto-serrant double (NASd) comparativement à un nœud plat (NP) pour la stabilisation d'une rupture d'un ligament croisé crânial. Chaque nœud a subi un effort de tension monotonique et cyclique. La tension de départ, l'élongation, la rigidité et la charge avant la rupture ont toutes été évaluées. Une valeur de P < 0,05 était considérée significative. La tension de départ, la rigidité générale et la charge avant la rupture ont toutes été de beaucoup supérieures avec NASu et NASd comparativement à NP. Il n'y avait pas de différence au niveau de l'élongation parmi les nœuds. Il n'y avait pas de différences importantes dans la tension de départ, l'élongation, la rigidité et la charge avant rupture entre NASu et NASd. Les nœuds auto-serrants étaient plus forts et plus rigides que le NP; il n'y avait pas d'avantage biomécanique à utiliser le NASd comparativement au NASu.(Traduit par Isabelle Vallières).

Modulation of inflammation and oxidative stress in canine chondrocytes.

OBJECTIVE: To determine whether oxidative stress could be induced in canine chondrocytes in vitro. SAMPLE: Chondrocytes obtained from healthy adult mixed-breed dogs. PROCEDURES: Harvested chondrocytes were maintained at 37°C with 5% CO2 for 24 hours. To assess induction of oxidative stress, 2 stimuli were used: hydrogen peroxide and a combination of interleukin-1ß (IL-1ß) and tumor necrosis factor-α (TNF-α). To determine the effect of hydrogen peroxide, a set of chondrocyte-seeded plates was incubated with control medium alone or hydrogen peroxide (100, 200, or 300µM) for 24 hours. For inhibition of oxidative stress, cells were incubated for 24 hours with N-acetylcysteine (NAC; 10mM) before exposure to hydrogen peroxide. Another set of chondrocyte-seeded plates was incubated with control medium alone or with IL-1ß (10 ng/mL) and TNF-α (1 ng/mL) for 24 hours. Supernatants were obtained for measurement of prostaglandin E2 production, and cell lysates were used for measurement of superoxide dismutase (SOD) activity and reduced-glutathione (GSH) concentration. RESULTS: Chondrocytes responded to the oxidative stressor hydrogen peroxide with a decrease in SOD activity and GSH concentration. Exposure to the antioxidant NAC caused an increase in SOD activity in hydrogen peroxide-stressed chondrocytes to a degree comparable with that in chondrocytes not exposed to hydrogen peroxide. Similarly, NAC exposure induced significant increases in GSH concentration. Activation with IL-1ß and TNF-α also led to a decrease in SOD activity and increase in prostaglandin E2 production. CONCLUSIONS AND CLINICAL RELEVANCE: Canine chondrocytes responded to the oxidative stress caused by exposure to hydrogen peroxide and cytokines. Exposure to oxidative stress inducers could result in perturbation of chondrocyte and cartilage homeostasis and could contribute to the pathophysiology of osteoarthritis. Use of antioxidants, on the other hand, may be helpful in the treatment of arthritic dogs.