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Yeap PM, Robinson P, Grainger AJ. Magnetic resonance imaging of the shoulder in symptomatic professional rugby players: a retrospective analysis. Skeletal Radiol 2024:10.1007/s00256-024-04803-3. [PMID: 39322816 DOI: 10.1007/s00256-024-04803-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 09/07/2024] [Accepted: 09/09/2024] [Indexed: 09/27/2024]
Abstract
OBJECTIVE Shoulder injuries in rugby players are common due to frequent high-impact collisions and tackles. This study aimed to describe the spectrum and pattern of shoulder MRI findings in professional rugby players. METHODS Single-center retrospective study of shoulder MRI was carried out between 2012 and 2016 in symptomatic professional male rugby league and rugby union players. One hundred ten shoulder MRIs were scored for rotator cuff and long head of biceps tendons, labral, bursal, joint, and osseous abnormalities. MRI features were compared using the chi-square or Fisher's exact tests for categorical variables. RESULTS There were a total of one hundred ten professional male rugby players (80 rugby league and 30 rugby union), with a mean age of 24.6 (range 17-38) and 23.7 (range 17-33) years old, respectively. Rotator cuff or long head biceps abnormality was found in 36 (33%) players, of which 22 (20%) were either partial or full-thickness tears. Glenoid labral tears were present in 63 (57%) players. There was no significant difference (p > 0.05) in the frequency of tears of the superior (24%), anterior inferior (25%), posterior superior (25%), and posterior inferior (32%) labrum. Forty-seven percent of players presented with two or more abnormalities of the rotator cuff tendons and glenoid labrum. There were significantly more osseous abnormalities in backs compared to forwards (48% vs. 21%; p = 0.01). CONCLUSIONS There is a wide spectrum of shoulder abnormalities on MRI in professional rugby players, and many have two or more abnormalities. In common with other contact sports, posterior labral injury was a common finding and may relate to sub-clinical trauma, without an association with instability.
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Affiliation(s)
- Phey Ming Yeap
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK.
- Department of Radiology, Sengkang General Hospital, Singapore, Singapore.
| | - Philip Robinson
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew J Grainger
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK
- Department of Radiology, Cambridge University Hospitals Trust, Cambridge, UK
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2
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Xu G, Wang Q, Li Z, Wu T. Computed tomography Osteoabsorptiometry: Review of bone density, mechanical strength of material and clinical application. Front Bioeng Biotechnol 2023; 11:1066709. [PMID: 37051272 PMCID: PMC10083511 DOI: 10.3389/fbioe.2023.1066709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023] Open
Abstract
Computed Tomography (CT) imaging is an effective non-invasive examination. It is widely used in the diagnosis of fractures, arthritis, tumor, and some anatomical characteristics of patients. The density value (Hounsfield unit, HU) of a material in computed tomography can be the same for materials with varying elemental compositions. This value depends on the mass density of the material and the degree of X-ray attenuation. Computed Tomography Osteoabsorptiometry (CTOAM) imaging technology is developed on the basis of CT imaging technology. By applying pseudo-color image processing to the articular surface, it is used to analyze the distribution of bone mineralization under the articular cartilage, evaluate the position of prosthesis implantation, track the progression of osteoarthritis, and determine the joint injury prognosis. Furthermore, this technique was combined with indentation testing to discuss the relationship between the high bone density area of the articular surface, the mechanical strength of the bone, and the anchorage stability of the implant, in addition to the study of the relationship between mechanical strength and bone density. This narrative study discusses the pre- and postoperative evaluation of medical device implantation position, orthopedic surgery, and the clinical treatment of bone injury and degeneration. It also discusses the research status of CTOAM technology in image post-processing engineering and the relationship between bone material and mechanical strength.
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Affiliation(s)
- Guanghua Xu
- Orthopedic Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Institute of Sport and Exercise Medicine, North University of China, Taiyuan, China
| | - Qiuyuan Wang
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Zhiqiang Li
- School of Physical Education, North University of China, Taiyuan, China
| | - Tingrui Wu
- Orthopedic Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- *Correspondence: Tingrui Wu,
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Momma D, Iwamoto W, Endo K, Sato K, Iwasaki N. Stress Distribution Patterns Across the Shoulder Joint in Gymnasts: A Computed Tomography Osteoabsorptiometry Study. Orthop J Sports Med 2020; 8:2325967120962103. [PMID: 33244475 PMCID: PMC7678403 DOI: 10.1177/2325967120962103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/26/2020] [Indexed: 12/22/2022] Open
Abstract
Background: The distribution pattern of subchondral bone density is an indicator of stress distribution over a joint surface under long-term physiologic loading. The biomechanical characteristics of the articular surfaces of the shoulder joint in gymnasts can be determined by measuring this distribution pattern. Purpose: To evaluate the distribution of subchondral bone density across the shoulder joint in male collegiate gymnasts and to determine the effects of gymnastic activities on its articular surfaces under long-term loading conditions using computed tomography osteoabsorptiometry (CTOAM). Study Design: Descriptive laboratory study. Methods: CT image data were obtained from both shoulders of 12 asymptomatic male collegiate gymnasts (gymnast group; mean age, 19.4 years; range, 18-22 years) and 10 male collegiate volunteers (control group; mean age, 20.2 years; range, 18-22 years). The distribution pattern of subchondral bone density across the articular surfaces of each shoulder joint was assessed by CTOAM. Quantitative analysis was performed of the locations and percentages of high-density areas on the articular surface. Results: Stress distribution patterns over the articular surfaces differed between the gymnasts and the controls. In the gymnasts, high-density areas were detected on the posterosuperior articular surface of the humeral head and the anterosuperior and/or posterosuperior articular surface of the glenoid. Mean bone density was greater in the gymnasts than in the controls (P < .0001). Conclusion: Stress distribution over the articular surfaces of the shoulder joint was affected by gymnastic activities. Stress was concentrated over the superior part of the glenohumeral joint in male collegiate gymnasts. Clinical Relevance: The present findings suggest that gymnastic activities increase stress to the articular surfaces of the superior glenohumeral joint. This supports the notion that mechanical conditions play a crucial role in the origin of disorders particular to gymnastic activities.
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Affiliation(s)
- Daisuke Momma
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Wataru Iwamoto
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Endo
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Norimasa Iwasaki
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
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Anderson PA, Morgan SL, Krueger D, Zapalowski C, Tanner B, Jeray KJ, Krohn KD, Lane JP, Yeap SS, Shuhart CR, Shepherd J. Use of Bone Health Evaluation in Orthopedic Surgery: 2019 ISCD Official Position. J Clin Densitom 2019; 22:517-543. [PMID: 31519473 DOI: 10.1016/j.jocd.2019.07.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 02/07/2023]
Abstract
This position development conference (PDC) Task Force examined the assessment of bone status in orthopedic surgery patients. Key questions included which orthopedic surgery patients should be evaluated for poor bone health prior to surgery and which subsets of patients are at high risk for poor bone health and adverse outcomes. Second, the reliability and validity of using bone densitometry techniques and measurement of specific geometries around the hip and knee before and after arthroplasty was determined. Finally, the use of computed tomography (CT) attenuation coefficients (Hounsfield units) to estimate bone quality at anatomic locations where orthopedic surgery is performed including femur, tibia, shoulder, wrist, and ankle were reviewed. The literature review identified 665 articles of which 198 met inclusion exclusion criteria and were selected based on reporting of methodology, reliability, or validity results. We recommend that the orthopedic surgeon be aware of established ISCD guidelines for determining who should have additional screening for osteoporosis. Patients with inflammatory arthritis, chronic corticosteroid use, chronic renal disease, and those with history of fracture after age 50 are at high risk of osteoporosis and adverse events from surgery and should have dual energy X-ray absorptiometry (DXA) screening before surgery. In addition to standard DXA, bone mineral density (BMD) measurement along the femur and proximal tibia is reliable and valid around implants and can provide valuable information regarding bone remodeling and identification of loosening. Attention to positioning, selection of regions of interest, and use of special techniques and software is required. Plain radiographs and CT provide simple, reliable methods to classify the shape of the proximal femur and to predict osteoporosis; these include the Dorr Classification, Cortical Index, and critical thickness. Correlation of these indices to central BMD is moderate to good. Many patients undergoing orthopedic surgery have had preoperative CT which can be utilized to assess regional quality of bone. The simplest method available on most picture archiving and communications systems is to simply measure a regions of interest and determine the mean Hounsfield units. This method has excellent reliability throughout the skeleton and has moderate correlation to DXA based on BMD. The prediction of outcome and correlation to mechanical strength of fixation of a screw or implant is unknown.
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Affiliation(s)
- Paul A Anderson
- Department of Orthopedics Surgery & Rehabilitation, University of Wisconsin UWMF Centennial Building, Madison, WI, USA.
| | - Sarah L Morgan
- UAB Osteoporosis Prevention and Treatment Clinic, University of Alabama Birmingham, Birmingham, AL, USA
| | - Diane Krueger
- University of Wisconsin, Osteoporosis Clinical Research Program, Madison, WI, USA
| | | | - Bobo Tanner
- Division Rheumatology, Vanderbilt University, Nashville, TN, USA
| | - Kyle J Jeray
- Greenville Health System, Deparment of Orthopaedic Surgery, Greenville, SC, USA
| | | | - Joseph P Lane
- Department of Orthopedic Surgery, Hospital for Special surgery, New York, USA
| | | | | | - John Shepherd
- University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI, USA
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Bone mineralization changes of the glenoid in shoulders with symptomatic rotator cuff tear. INTERNATIONAL ORTHOPAEDICS 2018; 42:2639-2644. [PMID: 29876627 DOI: 10.1007/s00264-018-4004-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Computed tomography osteoabsorptiometry (CTO) is a method to analyze the stress distribution in joints by measuring the subchondral bone density. The purpose of this study was to evaluate the bone mineralization changes of the glenoid in shoulders with rotator cuff tears by CTO and to evaluate whether rotator cuff tears are associated with stress changes in the glenoid. METHODS In total, 32 patients, who were diagnosed with unilateral rotator cuff tears and underwent arthroscopic rotator cuff repair, were enrolled in this study. They underwent CT scanning of both shoulders pre-operatively and the glenoid was evaluated using CTO. Hounsfield units (HU) in seven areas of the glenoid were compared between the affected and unaffected sides. RESULTS The central area of the glenoid on the affected side had significantly lower HU than on the unaffected side among all patients. Focusing on the rotator cuff tear size and the subscapularis tendon, only patients with larger cuff tears or with subscapularis tendon tears showed significantly lower HU in the central area of the affected side. CONCLUSIONS This study showed a decrease in bone mineralization density in the central glenoid in shoulders with rotator cuff tear. This change was observed in the case of larger cuff tears and subscapularis tendon tears. Our results help clarify the changes in stress distribution in the shoulder joint caused by symptomatic rotator cuff tears.
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Patel BA, Romanu JT, Carlson KJ. Subchondral Bone Radiodensity Patterns in the Glenoid Fossa of Ape and Human Scapulae. Anat Rec (Hoboken) 2017; 301:776-785. [PMID: 29281860 DOI: 10.1002/ar.23767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/06/2017] [Accepted: 10/04/2017] [Indexed: 11/07/2022]
Abstract
Regions of denser subchondral bone deep to a joint's articular surface indicate locations where the joint experiences relatively higher or more frequent compressive trans-articular forces than less dense regions. Human clinically focused studies have hypothesized that regional variation of acquired with computed tomography osteoabsorptiomety (CT-OAM), in the scapular glenoid fossa (GF) is specifically related to forces arising from everyday rotator cuff muscle function. We test this hypothesis by investigating the relationship between rotator cuff function and GF HiRD subchondral bone patterns in a broader comparative context. CT-OAM was used on scapulae of chimpanzees, gibbons and humans to visualize HiRD subchondral bone patterns and assess regional (anterior-posterior; superior-inferior) differences in HiRD concentrations within each group. Like patterns observed in humans, ape GFs show HiRD concentrations in anterior, posterior and superior regions. Gibbons exhibit significantly larger concentrations anteriorly, probably serving as a skeletal correlate of increased subscapularis activity during humeral internal rotation during arm-swinging locomotion. Chimpanzees exhibit relatively larger areas posteriorly (though not statistically significant), conceivably serving as a correlate of increased infraspinatus activity during humeral external rotation and retraction during knuckle-walking. All groups show relatively larger HiRD areas superiorly, likely correlating with forceful humeral abduction (rather than adduction) during routine upper limb use across behaviors. Subchondral bone HiRD patterns in the GF appear to correspond with normal and unbalanced rotator cuff activity and force production not only in humans, but also in other primates, thereby corroborating their value in human clinical studies and functional morphology research. Anat Rec, 301:776-785, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Biren A Patel
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California 90033
- Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, California 90089
| | - Joshua T Romanu
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California 90033
| | - Kristian J Carlson
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California 90033
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Terrier A, Obrist R, Becce F, Farron A. Cement stress predictions after anatomic total shoulder arthroplasty are correlated with preoperative glenoid bone quality. J Shoulder Elbow Surg 2017; 26:1644-1652. [PMID: 28412104 DOI: 10.1016/j.jse.2017.02.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We hypothesized that biomechanical parameters typically associated with glenoid implant failure after anatomic total shoulder arthroplasty (aTSA) would be correlated with preoperative glenoid bone quality. METHODS We developed an objective automated method to quantify preoperative glenoid bone quality in different volumes of interest (VOIs): cortical bone, subchondral cortical plate, subchondral bone after reaming, subchondral trabecular bone, and successive layers of trabecular bone. Average computed tomography (CT) numbers (in Hounsfield units [HU]) were measured in each VOI from preoperative CT scans. In parallel, we built patient-specific finite element models of simulated aTSAs to predict cement stress, bone-cement interfacial stress, and bone strain around the glenoid implant. CT measurements and finite element predictions were obtained for 20 patients undergoing aTSA for primary glenohumeral osteoarthritis. We tested all linear correlations between preoperative patient characteristics (age, sex, height, weight, glenoid bone quality) and biomechanical predictions (cement stress, bone-cement interfacial stress, bone strain). RESULTS Average CT numbers gradually decreased from cortical (717 HU) to subchondral and trabecular (362 HU) bone. Peak cement stress (4-10 MPa) was located within the keel hole, above the keel, or behind the glenoid implant backside. Cement stress, bone-cement interfacial stress, and bone strain were strongly negatively correlated with preoperative glenoid bone quality, particularly in VOIs behind the implant backside (subchondral trabecular bone) but also in deeper trabecular VOIs. CONCLUSION Our numerical study suggests that preoperative glenoid bone quality is an important parameter to consider in aTSA, which may be associated with aseptic loosening of the glenoid implant. These initial results should now be confronted with clinical and radiologic outcomes.
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Affiliation(s)
- Alexandre Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | - Raphaël Obrist
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Alain Farron
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
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Simon P, Gupta A, Pappou I, Hussey MM, Santoni BG, Inoue N, Frankle MA. Glenoid subchondral bone density distribution in male total shoulder arthroplasty subjects with eccentric and concentric wear. J Shoulder Elbow Surg 2015; 24:416-24. [PMID: 25240512 DOI: 10.1016/j.jse.2014.06.054] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/20/2014] [Accepted: 06/27/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid component loosening in total shoulder arthroplasty may be prevented by component placement on a congruent and adequate bony surface. Glenoid subchondral bone density (SBD) variability may be correlated with this concept. This study analyzed the 3-dimensional distribution of glenoid SBD in total shoulder arthroplasty patients with osteoarthritis. MATERIALS AND METHODS Three-dimensional computed tomography osteoabsorptiometry (CT-OAM) was performed in 42 men (21 with eccentric and 21 with concentric wear patterns) with glenohumeral arthritis. Glenoid SBD was measured from the joint surface based on 5 clinically relevant topographic zones. The correlation of the wear pattern with the SBD distribution was investigated. RESULTS The glenoid subarticular layers could be separated into distinct regions: calcified cartilage (≤ 1.5 mm), subchondral plate (2-4.5 mm) and cancellous bone (≥ 5 mm). There were significant differences in SBD among these layers within and between patients with concentric and eccentric wear patterns. In concentric glenoids, the SBD distribution was homogeneous, with greater mineralization in the central zone, 1,749.1 ± 162.3 Hounsfield units (HU) (at 2.5 mm), compared with the posterior, anterior, and superior zones (P < .001). In the eccentric group, the SBD distribution was inhomogeneous. Mineralization was greatest in the posterior zone, 1,739.0 ± 172.6 HU (at 2.5 mm), followed by the inferior zone, 1,722.1 ± 186.6 HU (at 3 mm). CONCLUSION This study represents the first study using CT-OAM to evaluate the 3-dimensional SBD distribution of the glenoid vault for different arthritic wear patterns. The study findings indicate that the SBD distribution is dependent on (1) depth from the articular surface, (2) topographic zone, and (3) wear pattern. CT-OAM may be an effective tool to assist in preoperative planning for shoulder arthroplasty.
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Affiliation(s)
- Peter Simon
- Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Anil Gupta
- Department of Shoulder and Elbow Surgery, Florida Orthopaedic Institute, Tampa, FL, USA
| | - Ioannis Pappou
- Department of Shoulder and Elbow Surgery, Florida Orthopaedic Institute, Tampa, FL, USA
| | - Michael M Hussey
- Department of Shoulder and Elbow Surgery, Florida Orthopaedic Institute, Tampa, FL, USA
| | - Brandon G Santoni
- Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Nozomu Inoue
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mark A Frankle
- Department of Shoulder and Elbow Surgery, Florida Orthopaedic Institute, Tampa, FL, USA.
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Kunst CM, Pease AP, Nelson NC, Habing G, Ballegeer EA. COMPUTED TOMOGRAPHIC IDENTIFICATION OF DYSPLASIA AND PROGRESSION OF OSTEOARTHRITIS IN DOG ELBOWS PREVIOUSLY ASSIGNED OFA GRADES 0 AND 1. Vet Radiol Ultrasound 2014; 55:511-20. [DOI: 10.1111/vru.12171] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 01/15/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Anthony P. Pease
- Department of Small Animal Clinical Sciences
- College of Veterinary Medicine; Michigan State University; East Lansing MI 48823
| | | | - Greg Habing
- Department of Veterinary Preventative Medicine; Ohio State University; Columbus OH 43210
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