Osteochondral autograft transfer for treatment of osteochondritis dissecans of the caudocentral humeral head in dogs

Randomized, Blinded, Controlled Clinical Trial of Polylactide-Collagen Scaffold in Treatment of Shoulder Osteochondritis Dissecans in Dogs

OBJECTIVE

 The aim of our study was to investigate a degradable polylactide-collagen scaffold (COPLA) in the treatment of shoulder osteochondritis dissecans (OCD) in dogs.

STUDY DESIGN

 The study was a controlled, randomized, blinded clinical trial with a parallel group design with a 1.5-year follow-up. Twenty dogs with uni- or bilateral shoulder OCD (29 shoulders) were randomized to receive a COPLA or arthroscopic debridement only (Control). The outcome of treatment was assessed with gait and stance analysis, passive range of motion measurement, pain and lameness evaluation, Helsinki Chronic Pain Index, and computed tomography (CT).

RESULTS

 Eighteen dogs (25 shoulders) completed the study. The clinical outcome variables improved significantly from baseline in COPLA and Control groups after treatment but no significant differences emerged between groups. Significantly fewer COPLA than Control shoulders had osteoarthritis (OA) in CT at 6 months (p = 0.019) but the difference was not significant at 1.5 years. At 1.5 years, all dogs were sound and pain-free in joint palpation, but OA was diagnosed in 13/18 dogs (18/25 shoulders) with CT.

CONCLUSION

 The results suggest that COPLA scaffold slowed down the development of OA at 6 months but it did not improve the clinical recovery or prevent OA in dogs with shoulder OCD in long-term follow-up at 1.5 years compared with arthroscopic debridement only. Regardless of the treatment method, clinical recovery was good, but OA developed in the majority of dogs.

Results of the osteochondral autologous transplantation for treatment of osteochondral lesions of the talus with harvesting from the ipsilateral talar articular facets

PURPOSE

There are few studies on the clinical outcomes of osteochondral autologous transplantation (OAT) harvesting from local talar non-weight-bearing articular facets for the treatment of osteochondral lesions of the talus (OLTs). The purpose of this study was to review the short- to midterm outcomes of our patients who were treated with OAT harvesting from ipsilateral talar articular facets for OLTs.

METHODS

Between December 2010 and November 2018, 24 patients were enrolled in this study. There were 16 males and eight females with an average age of 39.1 years and a follow-up period of 50.9 months. The clinical results were evaluated according to the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) score. Pre-operative plain radiographs and magnetic resonance imaging (MRI) scans, post-operative radiographs, and X-ray and computed tomography (CT) scans at the last follow-up were observed.

RESULTS

There was a significant improvement in the AOFAS score from 61.3 ± 19.0 pre-operatively to 84.9 ± 9.2 post-operatively (P < 0.001). The VAS score improved from 6.1 ± 2.3 to 2.0 ± 1.4 at the last follow-up (P < 0.001). Twenty-one patients (87.5%) were satisfied with their clinical results. By the last follow-up CT scan, there was bone cyst formation at the donor sites in three patients, at the recipient sites in five patients and at both sites in five patients. Two patients (8.3%) underwent re-operation with arthroscopic debridement because of medial gutter hypertrophic soft tissue impingement.

CONCLUSION

OAT harvesting from the ipsilateral talar articular facet showed satisfactory results. The mean post-operative VAS score and AOFAS ankle-hindfoot score improved significantly. Post-operative impingement around the osteotomy site was the main complication and reason for re-operation after the index procedure. In addition, bone cysts at the recipient and/or donor site(s) were found with a large percentage under CT. Therefore, longer follow-up is necessary to determine the long-term clinical results for this technique.

A New Generation of Osteochondral Autograft Transfer System for the Treatment of Osteochondritis Dissecans of the Femoral Condyle: Clinical Experience in 18 Dogs

OBJECTIVES

 The aim of this study was to describe the clinical application and outcome of osteochondral autograft transfer using the COR system (COR; DePuy Synthes, Warsaw, Indiana, United States) for the treatment of osteochondritis dissecans (OCD) of the femoral condyle in dogs.

METHODS

 Medical records of dogs that were treated for OCD of the femoral condyle using the COR system between February 2013 and March 2020 were retrospectively reviewed. The results of pre- and postoperative clinical and radiographic examinations were evaluated.

RESULTS

 Twenty stifles (18 dogs; 15 lateral and 5 medial femoral condyles) met the inclusion criteria. A single graft transfer was done in six stifle joints and mosaicplasty in 14 (2 grafts in 9/14 stifles; 3 grafts in 5/14 stifles). Proper anatomic reconstruction was confirmed intraoperatively and radiographically in all dogs. There were no major and three minor postoperative complications. At 3 months, 15 of 20 stifles (14 of 18 dogs) had no lameness or radiographic signs of inflammation. At 6 months, 12 of 13 dogs had no lameness or discomfort, and four of 13 stifles had radiographic evidence of moderate osteoarthritis.

CLINICAL SIGNIFICANCE

 Treatment of OCD of the femoral condyle using the COR system is feasible in dogs, with low complications and provides a satisfactory short-term outcome.

The Shoulder Joint and Common Abnormalities

The shoulder is a complex joint composed mostly of static and dynamic capsuloligamentous structures and plays an important role in forelimb lameness. Its complex anatomy and biomechanics necessitate thorough examination and diagnostic work-up for accurate diagnosis. This article provides an updated review of common canine shoulder pathologies, including osteochondrosis, bicipital and supraspinatus tendinopathies, infraspinatus contracture, medial shoulder syndrome, and luxation.

Spontaneous dog osteoarthritis - a One Medicine vision

Osteoarthritis (OA) is a global disease that, despite extensive research, has limited treatment options. Pet dogs share both an environment and lifestyle attributes with their owners, and a growing awareness is developing in the public and among researchers that One Medicine, the mutual co-study of animals and humans, could be beneficial for both humans and dogs. To that end, this Review highlights research opportunities afforded by studying dogs with spontaneous OA, with a view to sharing this active area of veterinary research with new audiences. Similarities and differences between dog and human OA are examined, and the proposition is made that suitably aligned studies of spontaneous OA in dogs and humans, in particular hip and knee OA, could highlight new avenues of discovery. Developing cross-species collaborations will provide a wealth of research material and knowledge that is relevant to human OA and that cannot currently be obtained from rodent models or experimentally induced dog models of OA. Ultimately, this Review aims to raise awareness of spontaneous dog OA and to stimulate discussion regarding its exploration under the One Medicine initiative to improve the health and well-being of both species.

Osteoarthritis occurs spontaneously in pet dogs, which often share environmental and lifestyle risk-factors with their owners. This Review aims to stimulate cooperation between medical and veterinary research under the One Medicine initiative to improve the welfare of dogs and humans.

Dogs have many analogous spontaneous diseases that result in end-stage osteoarthritis (OA).

Inbreeding and the predisposition of certain dog breeds for OA enable easier identification of candidate genetic associations than in outbred humans.

Dog OA subtypes offer a potential stratification rationale for aetiological differences and alignment to analogous human OA phenotypes.

The relatively compressed time course of spontaneous dog OA offers longitudinal research opportunities.

Collaboration with veterinary researchers can provide tissue samples from early-stage OA and opportunities to evaluate new therapeutics in a spontaneous disease model.

Awareness of the limitations and benefits of using clinical veterinary patients in research is important.

Preliminary evaluation of an osteochondral autograft, a prosthetic implant, and a biphasic absorbable implant for osteochondral reconstruction in a sheep model

OBJECTIVE

To determine the ability of three implants to enhance the healing of osteochondral defects: (1) a biphasic construct composed of calcium phosphate (CaP) and chitosan/cellulosic polymer, (2) a titanium-polyurethane implant, and (3) an osteochondral autograft.

STUDY DESIGN

Experimental study.

ANIMALS

Ten adult female sheep.

METHODS

In five sheep, an 8-mm diameter osteochondral defect was created on the medial femoral condyle of a stifle and filled with a synthetic titanium-polyurethane implant. In five sheep, a similar defect was filled with an osteochondral autograft, and the donor site was filled with a biphasic construct combining CaP granules and a chitosan/cellulosic polymer. Sheep were monitored daily for lameness. Stifle radiographs and MRI were evaluated at 20 weeks, prior to animals being humanely killed. Surgical sites were evaluated with histology, microcomputed tomography, and scanning electron microscopy.

RESULTS

Clinical outcomes were satisfactory regardless of the tested biomaterials. All implants appeared in place on imaging studies. Osteointegration of prosthetic implants varied between sites, with limited ingrowth of new bone into the titanium structure. Autografts and biphasic constructs were consistently well integrated in subchondral bone. All autografts except one contained a cartilage surface, and all biphasic constructs except one partially restored hyaline cartilage surface.

CONCLUSION

Biphasic constructs supported hyaline cartilage and subchondral bone regeneration, although restoration of the articular cartilage was incomplete.

CLINICAL IMPACT

Biphasic constructs may provide an alternative treatment for osteochondral defects, offering a less invasive approach compared with autologous grafts and eliminating the requirement for a prosthetic implant.

Beyond Cartilage Repair: The Role of the Osteochondral Unit in Joint Health and Disease

Once believed to be limited to articular cartilage, osteoarthritis is now considered to be an organ disease of the “whole joint.” Damage to the articular surface can lead to, be caused by, or occur in parallel with, damage to other tissues in the joint. The relationship between cartilage and the underlying subchondral bone has particular importance when assessing joint health and determining treatment strategies. The articular cartilage is anchored to the subchondral bone through an interface of calcified cartilage, which as a whole makes up the osteochondral unit. This unit functions primarily by transferring load-bearing weight over the joint to allow for normal joint articulation and movement. Unfortunately, irreversible damage and degeneration of the osteochondral unit can severely limit joint function. Our understanding of joint pain, the primary complaint of patients, is poorly understood and past efforts toward structural cartilage restoration have often not been associated with a reduction in pain. Continued research focusing on the contribution of subchondral bone and restoration of the entire osteochondral unit are therefore needed, with the hope that this will lead to curative, and not merely palliative, treatment options. The purpose of this narrative review is to investigate the role of the osteochondral unit in joint health and disease. Topics of discussion include the crosstalk between cartilage and bone, the efficacy of diagnostic procedures, the origins of joint pain, current and emerging treatment paradigms, and suitable preclinical animal models for safety and efficacy assessment of novel osteochondral therapies. The goal of the review is to facilitate an appreciation of the important role played by the subchondral bone in joint pain and why the osteochondral unit as a whole should be considered in many cases of joint restoration strategies.

Synthetic osteochondral resurfacing for treatment of large caudocentral osteochondritis dissecans lesions of the humeral head in 24 dogs

OBJECTIVE

To report the outcome of dogs with large, caudocentral, osteochondritis dissecans (OCD) lesions of the humeral head treated with synthetic osteochondral resurfacing (SOR) implants.

STUDY DESIGN

Retrospective case series.

ANIMALS

Twenty-four client-owned large breed or giant dogs.

METHODS

The medical records of all dogs treated with first generation (G1) and second generation (G2) SOR implants were reviewed. All dogs were assessed with clinical examination and imaging 12 weeks after surgery. Assessment of outcome was based on subjective assessment of lameness, scoring of postoperative radiographs, and the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire.

RESULTS

Osteochondral resurfacing was performed with a G1 implant in 13 dogs (15 shoulders) and a G2 implant in 11 dogs (13 shoulders). Lameness resolved in all dogs treated with G1 implants and in 10 dogs treated with G2 implants by 12 weeks after surgery. One dog treated with a G2 implant was found to have an implant-associated infection, requiring implant removal. No recurrence of lameness was reported in 9 limbs treated with G1 implants and 10 limbs treated with G2 implants that were available for clinical review at a median time of 387 and 365 days, respectively, after surgery. Mean postoperative LOAD scores were 4.2 of 52 and 5.2 of 52 in dogs treated with a G1 or a G2 implant, respectively.

CONCLUSION

Synthetic resurfacing was technically feasible in all joints of this study and resulted in good clinical results.

CLINICAL SIGNIFICANCE

The use of SOR implants seems viable to treat large caudocentral OCD lesions of the humeral head in dogs and warrants prospective comparison with conventional arthroscopic treatment.

Osteochondrosis dissecans of the tarsus in Labrador Retrievers: Clinical signs, radiological data and force plate gait evaluation after surgical treatment

Objectives: To report the outcome of unilateral surgery, by a plantaromedial approach, in 15 Labrador Retrievers with osteochondrosis dissecans (OCD) of the medial trochlear ridge of the talus. To evaluate the influence on outcome of age at surgery, bilateral involvement, periarticular soft tissue increase (PSI), osteophyte size (OS), decrease of range of joint motion and follow-up. To assess the extent of tarsal hyperextension in the standing dog.

Methods: A retrospective clinical and radiographic study was conducted and the posttreatment gait was analysed using a force plate. Ground reaction force (GRF) data were compared with data derived from 24 healthy Labrador Retrievers (control group).

Results: Six dogs had an excellent or good clinical result. Significant differences were found between the patients and the control group for many GRF data. Propulsive and vertical forces significantly decreased in the operated limb and increased in the contralateral pelvic and ipsilateral or both thoracic limbs. The lameness was significantly correlated to the OS postoperatively, the range-of-motion, the PSI, the length of the follow-up period, and the vertical ground force. No hyperextension in stance was recorded.

Clinical significance: Although most dogs improved, the prognosis remains guarded. This seems to be independent of age, bilateral involvement, or preoperative OS in these dogs. No relation between medial talar OCD and tarsal hyperextension in stance was found in these dogs.

Transferência de autoenxerto osteocondral para tratamento de osteocondrite dissecante em côndilo femoral de cão

RESUMO Na osteocondrite dissecante (OCD), a articulação do ombro é mais comumente afetada, mas o joelho é ocasionalmente lesionado, o que, muitas vezes, passa desapercebido. O tratamento cirúrgico precoce é indicado para remover cartilagem solta, aliviar a dor e minimizar a artrose. Benefícios putativos da transferência de autoenxerto osteocondral em relação às técnicas convencionais incluem a reconstrução exata do contorno subcondral e articular, recobrimento da superfície com cartilagem hialina e criação de uma barreira imediata entre o líquido sinovial e o osso subcondral. O objetivo deste trabalho é relatar a técnica de transferência de autoenxerto osteocondral para o tratamento da osteocondrite do côndilo femoral. Um cão da raça Bull Terrier foi tratado cirurgicamente por meio da técnica de transferência de autoenxerto osteocondral, após ter sido diagnosticado com OCD do côndilo femoral, apresentando melhora clínica significativa e completa recuperação aos 30 dias de pós-operatório.

Shoulder joint hemiarthroplasty for treatment of a severe osteochondritis dissecans lesion in a dog

INTRODUCTION

Partial resurfacing of the humeral head has been reported in humans to treat humeral osteochondritis dissecans. The aim is to describe a custom-made humeral resurfacing prosthesis for treatment of severe humeral head osteochondritis disse-cans in a dog.

CASE REPORT

A seven-month-old female entire St. Bernard dog was presented with a 10 week history of severe left thoracic limb lameness. Radiography, arthroscopy and magnetic resonance imaging confirmed an extensive osteochondritis dissecans lesion affecting the caudal, medial and central regions of the humeral head. A prosthesis designed from computed tomography (CT) images was manufactured in polished stainless steel alloy with a hydroxyapatite coated base and central finned humeral stem for cementless insertion. A standard caudal approach to the shoulder was used to place the prosthesis following reaming of the caudal humeral head.

RESULTS

Radiography and CT imaging revealed appropriate topographical placement on the humerus. Force plate analysis demonstrated initial reduction in ground reaction force at six weeks, followed by gradual improvement at three months. There was no radiographic evidence of implant loosening and the range of shoulder joint motion was comparable to the contralateral joint at three months; these findings were maintained to final follow-up at 24 months.

CLINICAL SIGNIFICANCE

Placement of a humeral head resurfacing prosthesis was an effective technique for the management of severe osteochondritis dissecans-related shoulder lameness. To the authors' knowledge, this is the first report of the clinical use of shoulder hemiarthroplasty in a dog.

Effect of lateral meniscectomy and osteochondral grafting of a lateral femoral condylar defect on contact mechanics: a cadaveric study in dogs

Background

Osteochondral autograft transfer (OAT) aims at restoring normal articular cartilage surface geometry and articular contact mechanics. To date, no studies have evaluated the contact mechanics of the canine stifle following OAT. Additionally, there are no studies that evaluated the role of the meniscus in contact mechanics following OAT in human or canine femorotibial joints. The objective of this study was to measure the changes in femorotibial contact areas (CA), mean contact pressure (MCP) and peak contact pressure (PCP) before and after osteochondral autograft transplantation (OAT) of a simulated lateral femoral condylar cartilage defect with an intact lateral meniscus and following lateral meniscectomy.

Results

With an intact lateral meniscus, creation of an osteochondral defect caused a decrease in MCP and PCP by 11% and 30%, respectively, compared to the intact stifle (p < 0.01). With an intact meniscus, implanting an osteochondral graft restored MCP and PCP to 96% (p = 0.56) and 92% (p = 0.41) of the control values. Lateral meniscectomy with grafting decreased CA by 54% and increased PCP by 79% compared to the intact stifle (p < 0.01).

Conclusions

OAT restored contact pressures in stifles with a simulated lateral condylar defect when the meniscus was intact. The lateral meniscus has a significant role in maintaining normal contact pressures in both stifles with a defect or following OAT. Meniscectomy should be avoided when a femoral condylar defect is present and when performing OAT.

Age-associated cartilage degeneration of the canine humeral head

The goal of this study was to determine if cartilage lesions of the humeral head in adult dogs are the consequence of osteochondrosis dissecans or degenerative joint disease. A gross and histologic survey was performed of humeral head cartilage lesions of 155 dogs ranging in age from 1 week to 19 years. The humeral head and cartilage lesion size were measured for each dog. Cartilage lesions were classified as fibrillation, fissures, erosion, and/or eburnation. The area of each lesion was multiplied by a severity score (fibrillation and fissures 1, erosion 2, and eburnation 3) to create a combined score for each humeral head. Correlations between this combined lesion score and age, humeral head size, body weight, and body condition score were assessed using a Bonferroni-corrected alpha of .01. Twenty-six humeral heads were also evaluated histologically. Of the 155 dogs, 80 (52%) had gross lesions of the articular cartilage. The presence and severity of the articular cartilage lesions were positively correlated with age, humeral head size, body weight, and body condition score. The average age of dogs with cartilage lesions was 8.8 years, and 77/105 (74%) of adult dogs had cartilage lesions. Fifty dogs were 3 years of age or younger; 3 of those had cartilage lesions, 1 of which was osteochondrosis. These data indicate that cartilage erosion of the caudal humeral head in dogs is a common degenerative lesion acquired in adult large breed dogs; osteochondrosis dissecans does not precede the lesion in the vast majority of cases.

Osteochondral autograft transfer for the treatment of osteochondritis dissecans of the medial femoral condyle in dogs

OBJECTIVE

To describe the clinical application of osteochondral autograft transfer procedure for the treatment of osteochondritis dissecans (OCD) of the canine medial femoral condyle and to report clinical and force plate outcomes.

METHODS

Osteochondral autograft transfer (OATS™ Arthrex, Naples FL, USA) instrumentation was employed in six stifle joints of five dogs. Clinical examination was performed preoperatively and at two to three weeks, six to eight weeks, 12-18 weeks and at >22 months postoperatively. Radiography and arthroscopy were performed preoperatively and 12-18 weeks postoperatively. The follow-up examinations performed at 22 to 56 months included radiography, questionnaire completion with the owner, and force plate gait evaluation.

RESULTS

Articular surface reconstruction was radiographically (for 6 stifle joints) and arthroscopically (for 5 stifle joints) maintained at 12-18 weeks. Subjectively-assessed lameness resolved in five out of six stifles by the 12 to 18 week reassessment. Morbidity included lateral patellar luxation at seven weeks and cranial cruciate ligament rupture at 11 months postoperatively. At the >22 month re-evaluation examination, subjectively-assessed lameness and signs of discomfort were minimal. Owner perceptions of outcome were positive; force plate assessment of gait indicated that weight bearing on three out of six OAT implanted limbs was less than the contralateral limb, but these comparisons were not evaluated statistically. A progression in the development of osteophytes was radiographically evident.

CLINICAL SIGNIFICANCE

The OAT procedure can reconstruct medial femoral condyle OCD defects in dogs. Long-term lameness and progressive osteophytosis may occur but can be associated with other pathology such as cruciate ligament insufficiency.