Effect of intra-articular platelet-rich plasma or hyaluronic acid on limb function recovery in dogs with TPLO for cranial cruciate ligament rupture: a randomised controlled trial.

OBJECTIVES: This study aimed to investigate the recovery of limb function following a single intra-articular injection of platelet-rich plasma or hyaluronic acid in dogs with cranial cruciate ligament rupture treated with tibial plateau levelling osteotomy compared to dogs receiving no injection intraoperatively. MATERIALS AND METHODS: Sixty-two dogs with cranial cruciate ligament rupture, body weights of 20 to 40 kg, and no other orthopaedic conditions were enrolled in this prospective, randomised, double-blind, controlled study at the small animal clinic at LMU Munich. All dogs underwent tibial plateau levelling osteotomy. Based on random allocation, they received either a single intra-articular injection of platelet-rich plasma, hyaluronic acid or no injection intraoperatively. Gait analysis, clinical examinations, radiography of the stifle joint for osteoarthritis progression and two validated owner questionnaires were compared among groups at three timepoints postoperatively (6 weeks, 3 and 6 months). Limb function was primarily assessed by measuring the ground reaction forces. RESULTS: At all times postoperatively, no differences were observed among groups regarding clinical examinations, osteoarthritis score values, ground reaction forces or owner questionnaires. All dogs showed significant improvement in limb function clinically, in all ground reaction forces and in the validated questionnaires. Osteoarthritis progressed minimally during rechecks in all dogs regardless of the additional injection or not. CLINICAL SIGNIFICANCE: All dogs treated with tibial plateau levelling osteotomy for cranial cruciate ligament rupture showed improvements in limb function. No additive effect on faster recovery was demonstrated with the additional intra-articular injection of platelet-rich plasma or hyaluronic acid. Addition of platelet-rich plasma/hyaluronic acid injections during tibial plateau levelling osteotomy is unnecessary considering the lack of benefit observed up to 6 months postoperatively.

Repeat ablation for paroxysmal atrial fibrillation - Does adenosine play a role in predicting pulmonary vein reconnection patterns?

BACKGROUND: Pulmonary vein (PV) reconduction after PV isolation (PVI) unmasked by adenosine is associated with a higher risk for paroxysmal atrial fibrillation (PAF) recurrence. It is unknown if the reconnected PVs after adenosine testing and immediate re-ablation can predict reconnection and reconnection patterns of PVs at repeat procedures. We assessed reconnection of PVs with and without dormant-conduction (DC) during the first and the repeat procedure. METHODS: We included 67 patients undergoing PVI for PAF and a second procedure for PAF recurrence. DC during adenosine administration at first procedure was seen in 31 patients (46%). 264 PVs were tested with adenosine; DC was found in 48 PVs (18%) and re-ablated during first procedure. During the second procedure, all PVs where checked for reconnection. RESULTS: Fifty-eight patients (87%) showed PV reconnection during the second procedure. Reconnection was found in 152/264 PVs (58%). Of 216 PVs without reconnection during adenosine testing at the first ablation, 116 PVs (53.7%) showed reconnection at the repeat procedure. Overall, 14.9% of patients showed the same PV reconnection pattern in the first and second procedure, expected statistical probability of encountering the same reconnection pattern was only 6.6%(p = 0.012). CONCLUSIONS: In repeat procedures PVs showed significantly more often the same reconnection pattern as during first procedure than statistically expected. More than 50% of initial isolated PVs without reconnection during adenosine testing showed a reconnection during repeat ablation. Techniques to detect susceptibility for PV re-connection like prolonged waiting-period should be applied. Elimination of DC should be expanded from segmental to circumferential re-isolation or vaster RF application.

Catheter Ablation for "Lone" Atrial Fibrillation: Efficacy and Predictors of Recurrence.

BACKGROUND: Atrial fibrillation in otherwise healthy young patients has been termed "lone" atrial fibrillation (AF). The best treatment choice is still under discussion. The aim of this study was to report on efficacy and safety of catheter ablation. METHODS: Among 855 patients referred to our center between 2011 and 2013, 76 (9%) met the diagnostic criteria for lone AF (mean age 45 ± 8 years; mean LA diameter 37 ± 4 mm; paroxysmal AF 82%; persistent AF 18%). The primary endpoint was freedom from any atrial tachycardia after the first ablation; the secondary endpoint was freedom from any atrial tachycardia after the last ablation procedure without antiarrhythmic drugs. RESULTS: The primary endpoint occurred in 56 patients (74%) after a mean follow-up time of 444 ± 344 days. The secondary endpoint occurred in 73 patients (96%) after a mean of 1.3 ablations/patient during a follow-up time of 459 ± 366 days. The risk of AF recurrence was not influenced by AF duration or by the type of AF (paroxysmal versus persistent). In a multivariate regression analysis smoking (P = 0.001), first degree atrioventricular block (P = 0.001), and early (< 3 months) AF recurrence (P = 0.001) were independently associated with a higher risk of AF recurrence. Major peri-procedural adverse events did not occur. CONCLUSIONS: Catheter ablation in young healthy patients is highly effective and safe. The outcomes are maintained during long-term follow-up irrespective of preoperative AF duration. Patients with AF recurrence were more likely to smoke, have first degree AV block and early AF recurrence.

Medullary cavity diameter of metacarpal and metatarsal bones in cats. A cadaveric radiographic and computed tomographic analysis.

OBJECTIVES: To compare radiography and computed tomography (CT) for the evaluation of medullary cavity diameters of metacarpal and metatarsal bones in cats and to analyse their correlation with intramedullary pin size. METHODS: Radiography and CT were performed in cadavers (n = 12). The mid-diaphysis was determined and the medullary cavity diameter was measured by two observers. Each bone was osteotomized at the mid-diaphysis, Kirschner wires were inserted, and pin size was documented. Intra- and interobserver variability was evaluated (hierarchical analysis of variance). Radiography and CT were compared (correlation analysis, a t-test for dependent samples, a Bland-Altman analysis) and pin size, radiography and CT were compared (regression and correlation analysis). RESULTS: Intra-observer variability was low for radiographs and CT, with an estimated median variation of 0.10 mm for radiographs and 0.12 mm for CT. Inter-observer variability was low, with a median variation of 0.03 mm for radiographs and 0.21 mm for CT. There was a high correlation between radiography and CT for the assessment of the medullary cavity diameter. A high correlation was found between pin size and measurement on radiographs, and between pin size and measurements on CT. In two cats, pin insertion was difficult or impossible. CLINICAL SIGNIFICANCE: Mid-diaphyseal measurements are applicable methods for the assessment of the medullary cavity diameter in feline metacarpal and metatarsal bones regarding intramedullary pins. In some cats the medullary cavity diameter may be too small for intramedullary pinning techniques, which can be identified preoperatively on radiographs.

Long-term prognosis of metacarpal and metatarsal fractures in dogs. A retrospective analysis of medical histories in 100 re-evaluated patients.

OBJECTIVES: Lameness after metacarpal and metatarsal fractures in dogs is reported to occur with an incidence of 18% to 70%. On the basis of long-term results, the prognosis of these injuries was re-evaluated retrospectively. METHODS: Medical records of 100 dogs with complete clinical and radiographic follow-up examinations after an average of four years (4 months - 14 years) were evaluated. According to their treatment, patients were allocated to three groups (Group 1=conservative, Group 2=surgical, Group 3=combined). Assessment included complications during the healing period and the final radiographic and functional outcome, which was statistically compared for differences between groups (Fisher exact test, exact Wilcoxon-Mann-Whitney test). Further, risk factors for each bone were analyzed (stepwise, multiple logistic regression model). In 15 dogs, kinetic data (relative stance phase, peak vertical force and impulse) were investigated by computed gait analysis. RESULTS: Complications were observed in 11 of 67 (16%) conservatively, in three of 25 (12%) surgically, and in three of eight (37%) conservatively and surgically treated dogs. Overall frequency of lameness evaluated by visual clinical assessment was three percent. Frequency of osteoarthritis and nonunion was also low, accounting for three percent and one percent respectively, although healing of mainly single-bone fractures resulted in malunions in 14% radiographically. Synostoses were found in 19% of patients, and significantly more frequent in surgically treated dogs. A higher risk of complications was identified for metatarsal compared to metacarpal fractures. Further, an increased risk for complications was detected for a higher degree of displacement and instability. CLINICAL SIGNIFICANCE: According to the long-term results found in this study, the prognosis for metacarpal and metatarsal fractures is better than reported in the literature to date. With the reservation that more severe injuries are generally treated surgically, and these fractures more frequently developed synostosis, no significant difference could be detected between conservative and surgical treatment.

Spinal fracture in a dog with diffuse idiopathic skeletal hyperostosis.

A six-year-old, spayed female Weimaraner dog was first presented with the complaint of hindlimb paresis and then hindlimb paralysis two years later after colliding with a tree. Radiographs and computed tomography revealed spinal fractures at lumbar vertebrae (L)2-3 and at L4-5. In addition, the spinal column was affected by new bone formation along the vertebral bodies, bridging the disc spaces, as seen in diffuse idiopathic skeletal hyperostosis (DISH). Open reduction and internal fixation was achieved with standard vertebral body plating. This is the first report of DISH-associated spinal fractures after minor trauma in a dog. Surgery resulted in return of the full function after the first, and in improvement of neurologic function after the second incident.

Dowel pinning for feline metacarpal and metatarsal fractures.

The goal of this retrospective study was to describe dowel pinning, and to compare the results of osteosynthesis and external coaptation of metacarpal and metatarsal fractures in cats. Evaluation of the medical records of 351 cats yielded 63 cats treated with dowel pinning, 35 cats treated with external coaptation and 14 cats treated with both methods within the same limb. All of the cats had been re-evaluated at an average of 2.8 years (six months - 15 years) postoperatively. Dowel pinning was superior to external coaptation when all fractured bones of a limb could be pinned. When internal fixation of multiple fractures was not feasible in all fractured bones due to comminution or fragments that were too short to pin, the outcome was not significantly different from cases treated with external coaptation alone. Malunion was seen in 16% of fractured bones in cats treated with external coaptation and occurred secondary to implant bending in 3% of fractured bones treated with dowel pinning. The latter refers to one operated cat, which had four metacarpal fractures in the same limb. Radiographs taken at re-evaluation showed implant migration within the medullary canal in two cats, although neither showed any signs of non-union or lameness. Non-union was seen in one operated cat, in which the fracture (MC IV) could not be completely reduced with a K-wire. Osteomyelitis did not occur. Dowel pinning is an easy, inexpensive and effective technique for repair of metacarpal and metatarsal fractures in cats.