OBJECTIVE To determine which method (lateral fabellotibial suture LFS, tibial plateau leveling osteotomy TPLO, tibial tuberosity advancement TTA, or tightrope-like braided multifilament suture ...secured with metallic buttons TR) Veterinary Orthopedic Society (VOS) members preferred for treating cranial cruciate ligament rupture (CCLR) in dogs weighing > 15 kg (33 lb), identify factors associated with this preference, and assess concerns related to surgical implant material used. DESIGN Cross-sectional study. SAMPLE 187 VOS members. PROCEDURES All registered VOS members received an online survey from June to July 2016. Responses were compiled and evaluated for associations with method preferences and perceived complications. RESULTS Overall response rate was 38.4% (221/575). Respondents had graduated from veterinary school a mean of 23 years prior to survey completion, and collectively they performed approximately 30,000 CCLR surgeries annually. The most commonly preferred method was TPLO (147 78.6%), followed by TTA (26 13.9%), the LFS procedure (11 5.9%), and the TR procedure (3 1.6%). The preference for TPLO was independent of board certification or college of training (American, European, or other College of Veterinary Surgeons). Non-board-certified surgeons, including general practitioners, also favored TPLO. The most common perceptions were that titanium implants (used for TTA) were associated with the lowest incidence of major complications, whereas braided multifilament suture (used for the TR procedure) was associated with the highest incidence of major complications. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that TPLO was preferred for treating CCLR in dogs weighing > 15 kg and that the TR procedure was perceived as having the highest complication rate. With results of this survey in mind, use of the TR procedure should be considered cautiously when treating CCLR.
To compare motor effects and analgesic efficacy following an ultrasound-guided lateral approach to lumbar plexus blockade at L7 and sciatic nerve blockade (LPSNB) against epidural injection in dogs ...undergoing tibial plateau leveling osteotomy (TPLO).
Prospective, randomized, blinded clinical trial.
A total of 27 healthy adult dogs undergoing unilateral TPLO surgery.
Dogs were allocated to either LPSNB (bupivacaine 2 mg kg
, 0.75%) or epidural (morphine PF 0.1 mg kg
and bupivacaine 0.5 mg kg
, 0.75%). Other aspects of clinical management were identical, including anesthetic drug protocol, area of presurgical clipping and bladder care. Time to perform the block, response to surgical stimuli, pain scores, rescue analgesia, time to stand and walk, motor score and time to first urination were recorded. One evaluator, unaware of treatment status, performed all evaluations. Student's t-test or Mann-Whitney U test was used to compare continuous variables between groups, and Fisher's exact test for categorical variables.
Median (range) times to stand and walk were shorter for LPSNB 60 (40-120) minutes and 90 (60-150) minutes, respectively, p = 0.003 than for epidural 150 (120-240) minutes and 180 (120-360) minutes, respectively, p = 0.006. Four dogs required rescue intraoperatively (three in epidural group, one in LPSNB group, p = 0.438). Pain scores over the 24 hour evaluation period were similar, and not significantly different, for each group. Time to spontaneous urination LPSNB, 330 (240-360) minutes; epidural, 300 (120-1440) minutes, p = 1.0 did not differ between groups.
An ultrasound-guided lateral paravertebral approach to the lumbar plexus within the psoas compartment at L7, combined with sciatic nerve blockade, allows faster return to normal motor function, with similar pain control and impact on urination when compared with epidural in dogs after TPLO surgery.
Objective
To describe and prospectively report outcomes associated with a novel minimally invasive percutaneous osteosynthesis (MIPO) technique for the treatment of humeral fractures in dogs and ...cats.
Study design
Prospective clinical case series.
Animals
Eleven dogs and 4 cats with traumatic nonarticular humeral fractures.
Methods
Dogs and cats that presented with traumatic humeral fractures were enrolled in the study. After closed reduction, the fracture was stabilized by using a plate‐rod combination applied via remote medial incisions. Postoperative alignment in the frontal and sagittal planes was statistically compared with the contralateral limbs. Time to clinical union and complications were also recorded.
Results
Eleven dogs and 4 cats were included in this study. Body weight ranged from 4.5 to 33.6 kg in dogs and from 2.2 to 3.6 kg in cats. A veterinary cuttable plate (6/11 dogs and 3/4 cats) or locking compression plate was used in a plate‐rod configuration (11/11 dogs and 2/4 cats) or alone (2/4 cats). Rod‐to‐medullary‐cavity ratio was 30%. Plate‐span ratio was 5.8 (range, 2‐13.5). No significant differences were found in frontal or sagittal plane alignment. Healing time in cases that completed on‐time follow‐up (12/15) was 36 ± 14 days (range, 20‐69). No major complications were recorded.
Conclusion
The reported technique was associated with good outcomes in a large variety of fracture configurations and animal sizes, with no complications.
Clinical significance
This report provides evidence that MIPO is a compelling alternative to open reduction and internal fixation in the treatment of various humeral fractures.
To determine its efficacy in stimulating the regeneration of a rotator cuff tendon, an implant of 10-ply porcine small intestinal submucosa was used to replace a completely resected infraspinatus ...tendon in 21 adult mongrel dogs. The contralateral infraspinatus tendon was elevated and then reattached to the greater tubercle with sutures to mimic conventional repair (sham operation). Mechanical evaluations were performed at 0, 3, and 6 months (five specimens at each time period). Histologic comparisons were made at 3 and 6 months (three specimens). At both times, the gross appearance, histologic continuity, and failure mode of the constructs mimicked those of sham-operated and native infraspinatus tendons, thus suggesting host tissue ingrowth and implant remodeling with solid integration of the regenerated tissue to muscular and bony interfaces. Tissue ingrowth occurred without histologic evidence of foreign body or immune-mediated reactions or adhesions to peripheral tissues. Sham operations simulated tendon mobilization and reimplantation procedures routinely performed to treat chronic rotator cuff tendon injuries. Although the ultimate strength of small intestinal submucosa-regenerated tendons was significantly less than that of native infraspinatus tendons (P<0.001), it was similar to that of reimplanted tendons at 3 (P<0.05) and 6 months (P<0.05).
Introduction:
Critical-sized long bone defects represent a major therapeutic challenge and current treatment strategies are not without complication. Tissue engineering holds much promise for these ...debilitating injuries; however, these strategies often fail to successfully translate from rodent studies to the clinical setting. The dog represents a strong model for translational orthopedic studies, however such studies should be optimized in pursuit of the Principle of the 3R’s of animal research (replace, reduce, refine). The objective of this study was to refine a canine critical-sized femoral defect model using an angle-stable interlocking nail (AS-ILN) and reduce total animal numbers by performing imaging, biomechanics, and histology on the same cohort of dogs.
Methods:
Six skeletally mature hounds underwent a 4 cm mid-diaphyseal femoral ostectomy followed by stabilization with an AS-ILN. Dogs were assigned to autograft (
n
= 3) or negative control (
n
= 3) treatment groups. At 6, 12, and 18 weeks, healing was quantified by ordinal radiographic scoring and quantified CT. After euthanasia, femurs from the autograft group were mechanically evaluated using an established torsional loading protocol. Femurs were subsequently assessed histologically.
Results:
Surgery was performed without complication and the AS-ILN provided appropriate fixation for the duration of the study. Dogs assigned to the autograft group achieved radiographic union by 12 weeks, whereas the negative control group experienced non-union. At 18 weeks, median bone and soft tissue callus volume were 9,001 mm
3
(range: 4,939–10,061) for the autograft group and 3,469 mm
3
(range: 3,085–3,854) for the negative control group. Median torsional stiffness for the operated, autograft treatment group was 0.19 Nm/° (range: 0.19–1.67) and torque at failure was 12.0 Nm (range: 1.7–14.0). Histologically, callus formation and associated endochondral ossification were identified in the autograft treatment group, whereas fibrovascular tissue occupied the critical-sized defect in negative controls.
Conclusion:
In a canine critical-sized defect model, the AS-ILN and described outcome measures allowed refinement and reduction consistent with the Principle of the 3R’s of ethical animal research. This model is well-suited for future canine translational bone tissue engineering studies.
Post-traumatic osteoarthritis (PTOA) is a debilitating disease that is a result of a breakdown of knee joint tissues following traumatic impact. The interplay of how these tissues influence each ...other has received little attention because of complex interactions. This study was designed to correlate the degeneration of the menisci, cartilage and subchondral bone following an acute traumatic event that resulted in anterior cruciate ligament (ACL) and medial meniscus tears. We used a well-defined impact injury animal model that ruptures the ACL and tears the menisci. Subsequently, the knee joints underwent ACL reconstruction and morphological analyses were performed on the menisci, cartilage and subchondral bone at 1-, 3- and 6-months following injury. The results showed that the morphological scores of the medial and lateral menisci worsened with time, as did the tibial plateau and femoral condyle articular cartilage scores. The medial meniscus was significantly correlated to the medial tibial subchondral bone at 1 month (
= 0.01), and to the medial tibial cartilage at 3 months (
= 0.04). There was only one significant correlation in the lateral hemijoint, i.e., the lateral tibial cartilage to the lateral tibial subchondral bone at 6 months (
= 0.05). These data may suggest that, following trauma, the observed medial meniscal damage should be treated acutely by means other than a full or partial meniscectomy, since that procedure may have been the primary cause of degenerative changes in the underlying cartilage and subchondral bone. In addition to potentially treating meniscal damage differently, improvements could be made in optimizing treatment of acute knee trauma.
Background Injury patterns of the meniscus following impact trauma resulting in anterior cruciate ligament (ACL) rupture are not well understood. This study explored the spatial and temporal ...distribution of meniscal tears in a novel in vivo lapine model. Methods Skeletally mature Flemish Giant rabbits were subjected to either tibiofemoral impaction resulting in ACL rupture or surgical ACL transection. Meniscal damage was assessed acutely and after 12 wk for traumatically torn, and after 12 wk in ACL transected animals. Morphological grading was assessed using previously established criteria, and descriptions of meniscal damage were diagnosed by a Board certified orthopedist. Histological assessment was also made on 12 wk traumatically torn and ACL transected animals using Fast-Green/Safranin-O staining. Results Traumatic ACL rupture resulted in acute tears predominately in the lateral menisci. Animals subjected to both surgical transection and traumatic ACL rupture experienced degradation of the lateral and medial menisci 12 wk after injury. However, traumatic ACL rupture resulted in acute lateral damage and chronic degradation of the menisci, as well as more severe degradation of the menisci 12 wk after injury. Conclusions This study showed that unconstrained high-intensity impacts on the tibiofemoral joint lead to meniscal damage in conjunction with ACL ruptures. Both acute and chronic changes to the menisci following traumatic impaction were observed. This research has implications for the future use of lapine models for osteoarthritis, as it incorporates traumatic loading as a more realistic mode contributing to the progression of osteoarthritis (OA) compared to surgically transected models.
Objectives— To investigate the effect of tibial plateau leveling (TPL) on tibial subluxation and tibial axial rotation; to determine the minimal tibial plateau rotation (MinTPR) angle that provides ...stifle stability; and to evaluate caudal cruciate ligament (CaCL) strain following tibial plateau rotation in cranial cruciate ligament (CrCL)‐deficient stifles.
Animals— Fifteen canine cadaver hind limbs.
Methods— Tibial subluxation was measured from lateral radiographs in intact, loaded stifles and after sequential CrCL transection, MinTPR, TPL, and CaCL transection. The MinTPR angle was determined using a custom‐made hinge plate and compared with the TPL angle. Tibial axial rotation was evaluated in CrCL‐deficient stifles before and after TPL. Finally, CaCL strain was recorded in intact, loaded stifles, and following MinTPR, TPL, and tibial plateau over‐rotation (MaxTPR) using a force probe.
Results— Cranial tibial subluxation in CrCL‐deficient stifles was eliminated with TPL. Tibial plateau rotation, however, induced caudal tibial subluxation, which significantly increased from MinTPR to TPL before and after CaCL transection. The MinTPR angle was 6.5°± 0.9° less than the TPL angle (P < .05). Tibial internal rotation decreased significantly after TPL in CrCL‐deficient stifles. Finally, CaCL strain increased with increasing tibial plateau rotation.
Conclusions— This study suggests that, during stance phase, TPL transforms cranial tibial thrust into caudal tibial thrust, thereby stabilizing the stifle in the cranio‐caudal plane via the constraint of the CaCL. The increase in CaCL stress, which results from tibial plateau rotation, could predispose the CaCL to fatigue failure and therefore would caution against tibial plateau over‐rotation.
Pancarpal canine arthrodesis (PCA) sets immobilization of all three carpal joints
dorsal plating to result in bony fusion. Whereas the first version of the plate uses a round hole (RH) for the ...radiocarpal (RC) screw region, its modification into an oval hole (OH) in a later version improves versatility in surgical application. The aim of this study was to mechanically investigate the fatigue life of the PCA plate types implementing these two features-PCA-RH and PCA-OH. Ten PCA-RH and 20 PCA-OH stainless steel (316LVM) plates were assigned to three study groups (n = 10). All plates were pre-bent at 20° and fixed to a canine forelimb model with simulated radius, RC bone and third metacarpal bone. The OH plates were fixed with an RC screw inserted either most proximal (OH-P) or most distal (OH-D). All specimens were cyclically tested at 8 Hz under 320 N loading until failure. Fatigue life outcome measures were cycles to failure and failure mode. Cycles to failure were higher for RH plate fixation (695,264 ± 344,023)
both OH-P (447,900 ± 176,208) and OH-D (391,822 ± 165,116) plate configurations, being significantly different between RH and OH-D,
= 0.03. No significant difference was detected between OH-P and OH-D configurations,
= 0.09. Despite potential surgical advantages, the shorter fatigue life of the PCA-OH plate design may mitigate its benefits compared to the plate design with a round radiocarpal screw hole. Moreover, the failure risk of plates with an oval hole is increased regardless from the screw position in this hole. Based on these findings, the PCA plate with the current oval radiocarpal screw hole configuration cannot be recommended for clinical use.
