FACTORS AFFECTING WIDTH OF THE CANINE FEMOROTIBIAL JOINT SPACE IN NONWEIGHT-BEARING RADIOGRAPHS

Association of meniscal injury to joint space width on standard tibial plateau leveling osteotomy lateral radiographic projections of the canine stifle

Up to 70% of dogs with cranial cruciate ligament tears have concurrent meniscal injury, and these injuries can increase the risk of developing osteoarthritis and persistent lameness. Studies assessing joint space width on knee radiographs in people have indicated associations between joint space width and meniscal injuries. The aim of this prospective analytical study was to determine if there was an association between stifle joint space width on three different radiographic projections (the standard tibial plateau leveling osteotomy projections and a standing lateral projection) and meniscal injuries identified at surgery in dogs. There was a significant association between dogs with a meniscal tear and the corresponding joint space width on standard tibial plateau leveling osteotomy lateral radiographic projections (P-value = .0028). Based on receiver operator characteristic curve analysis, joint space widths measuring less than 3.43 mm may indicate a meniscal tear, with a corresponding 89.5% specificity and 40.5% sensitivity in dogs weighing 31 kg. Joint space narrowing is seen with meniscal tears in dogs, and radiography may be a noninvasive way to identify meniscal tears prior to surgery.

Evaluation of a distractor to increase joint space of the stifle joint in dogs: a cadaveric study

Objective: To evaluate the technical feasibility and efficacy of a joint distraction technique to increase the stifle joint space and assess potential soft tissue damage due to the distraction.

Methods: Twenty stifle joints of twelve canine cadavers without evidence of disease were radiographically evaluated by medio-lateral, cranio-caudal and varus-valgus stressed projections. Joint distraction was applied with loads from 40 N up to 200 N, and the joint space achieved was measured on radiographic images. Distraction plus distension with saline was subsequently applied and measured. Varus-valgus stressed projections were repeated after distraction to evaluate a potential increase in joint laxity.

Results: Distraction produced a significant increase of the joint space for most of the evaluated loads. Distraction plus distension produced a significant increase for most of the loads compared to the distraction alone. No ensuing joint laxity could be inferred from the post-distraction radiographic evaluation.

Clinical significance: Stifle distraction produces an increase of the joint space, which is wider when intra-articular saline is injected. This may be potentially useful for improving joint structure visualization and facilitating arthroscopic procedures, thus reducing the potential for iatrogenic damage to intra articular structures. No soft tissue damage could be inferred by radiographic pre- and post-procedure comparison. Further clinical studies are required to evaluate potential neurovascular complications.

Systematic review of the prevalence, risk factors, diagnosis and management of meniscal injury in dogs: Part 2

OBJECTIVE

To systematically evaluate the evidence reporting the diagnosis and management of meniscal injury in dogs with cranial cruciate ligament failure.

STUDY DESIGN

Systematic literature review.

MATERIALS AND METHODS

Research questions relating to the accuracy of diagnostic techniques for meniscal injury and the effects of meniscal treatment were defined. An electronic database search of PubMed and CAB Abstracts was performed during March 2015. Data were extracted for study participants, design, intervention, outcome measures and results. Studies were evaluated using a validated instrument for assessing methodological quality and assigned a Quality Index score. A level of evidence was then assigned to each study.

RESULTS

Eighty-nine studies were identified. The median Quality Index score was 14 out of a possible 26. Twenty-seven studies were prospective case series, 31 retrospective case series, 16 animal research and 15 cadaveric studies. There were no class I or class II studies, 27 class III and 62 class IV studies.

CONCLUSIONS

Despite a large number of publications the quality of evidence was generally low. No one study or combination of studies provided high quality evidence to support one diagnostic or surgical intervention over another for meniscal injuries in dogs with cranial cruciate ligament failure.

Evaluation of a joint distractor to facilitate arthroscopy of the hip joint in dogs

OBJECTIVE

To evaluate the technical feasibility and efficacy of a hip joint distraction technique, any potential ligamentous damage linked to the procedure, and the effect of joint venting on the maximum distraction achieved.

METHODS

Twenty hip joints from 11 canine cadavers were evaluated radiographically by standard and stressed projections. Joint distraction was applied with loads from 40 up to 200 N, in 40 N increments, and fluoroscopic images were obtained at each load. At 200 N, a needle was inserted into the joint to achieve a venting effect, and the space was measured again. Standard and stressed radiographs were performed to evaluate potential laxity changes.

RESULTS

Distraction caused a significant increase in joint space at each load of distraction, although there were some variations. Joint venting produced a significant increase in joint space. A statistically significant difference in joint laxity evaluated radiographically before and after the procedure was recorded.

CLINICAL SIGNIFICANCE

Use of the distraction apparatus resulted in an increase in joint space. This could be useful for clinical situations where a larger joint space is required such as for arthroscopic procedures. However, loads in excess of 200 N may induce significant increases in joint laxity.

Evaluation of a joint distractor to facilitate arthroscopy of the tibio-tarsal joint in dogs

OBJECTIVE

To evaluate the technical feasibility, efficacy and potential soft tissue damage of a joint distraction technique to facilitate arthroscopy of the tibio-tarsal joint and to test the effect of joint venting on the maximum distraction achieved.

METHODS

Twenty hocks were preliminarily evaluated radiographically by standard and stressed projections. Joint distraction was applied with loads from 40 N up to 200 N, in 40 N increments, and radiographic images were obtained at each load. The effect of joint venting by an intra-articular needle was evaluated at the maximum load. Standard and stressed radiographs were repeated to evaluate potential laxity changes.

RESULTS

Joint distraction caused a significant increase in the joint space at each load of distraction except for the 40 to 80 N load increase. Joint venting produced a significant increase in the joint space. No increase of joint laxity could be inferred from the postdistraction radiographic evaluation.

CLINICAL SIGNIFICANCE

Hock distraction can be useful to facilitate arthroscopic procedures, increasing the joint space available for intra-articular manoeuvres. Further clinical studies are required to evaluate potential neurovascular complications.

Diagnostic imaging of the canine stifle: a review

The stifle joint, a common location for lameness in dogs, is a complex arrangement of osseous, articular, fibrocartilaginous, and ligamentous structures. The small size of its component structures, restricted joint space, and its intricate composition make successful diagnostic imaging a challenge. Different tissue types and their superimposition limit successful diagnostic imaging with a single modality. Most modalities exploit the complexity of tissue types found in the canine stifle joint. Improved understanding of the principles of each imaging modality and the properties of the tissues being examined will enhance successful diagnostic imaging.

Radiographic assessment of the femorotibial joint of the CCLT rabbit experimental model of osteoarthritis

Background

The purposes of the study were to determine the relevance and validity of in vivo non-invasive radiographic assessment of the CCLT (Cranial Cruciate Ligament Transection) rabbit model of osteoarthritis (OA) and to estimate the pertinence, reliability and reproducibility of a radiographic OA (ROA) grading scale and associated radiographic atlas.

Methods

In vivo non-invasive extended non weight-bearing radiography of the rabbit femorotibial joint was standardized. Two hundred and fifty radiographs from control and CCLT rabbits up to five months after surgery were reviewed by three readers. They subsequently constructed an original semi-quantitative grading scale as well as an illustrative atlas of individual ROA feature for the medial compartment. To measure agreements, five readers independently scored the same radiographic sample using this atlas and three of them performed a second reading. To evaluate the pertinence of the ROA grading scale, ROA results were compared with gross examination in forty operated and ten control rabbits.

Results

Radiographic osteophytes of medial femoral condyles and medial tibial condyles were scored on a four point scale and dichotomously for osteophytes of medial fabella. Medial joint space width was scored as normal, reduced or absent. Each ROA features was well correlated with gross examination (p < 0.001). ICCs of each ROA features demonstrated excellent agreement between readers and within reading. Global ROA score gave the highest ICCs value for between (ICC 0.93; CI 0.90-0.96) and within (ICC ranged from 0.94 to 0.96) observer agreements. Among all individual ROA features, medial joint space width scoring gave the highest overall reliability and reproducibility and was correlated with both meniscal and cartilage macroscopic lesions (r_s = 0.68 and r_s = 0.58, p < 0.001 respectively). Radiographic osteophytes of the medial femoral condyle gave the lowest agreements while being well correlated with the macroscopic osteophytes (r_s = 0.64, p < 0.001).

Conclusion

Non-invasive in vivo radiography of the rabbit femorotibial joint is feasible, relevant and allows a reproducible grading of experimentally induced OA lesion. The radiographic grading scale and atlas presented could be used as a template for in vivo non invasive grading of ROA in preclinical studies and could allow future comparisons between studies.