A study of osteochondritis dissecans of the canine humeral head using histological, OTC bone labelling, microradiographic and microangiographic methods

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.

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

OBJECTIVE

To establish whether osteochondral autograft transfer (OAT) procedures for osteochondritis dissecans (OCD) of the canine caudocentral humeral head would restore articular contour, resurface osteochondral defects, and resolve lameness in dogs with OCD.

STUDY DESIGN

Case series.

ANIMALS

Dogs (n=14) with caudocentral humeral head OCD (16 shoulders).

METHODS

After arthroscopic assessment, the humeral head was exposed by arthrotomy. The OCD lesion was debrided and OATS(™) instrumentation used for resurfacing the defect with osteochondral core grafts collected from the stifle. Recipient sockets were created to maximally resurface articular lesions. Outcomes measures included clinical, radiographic, and arthroscopic examination at 12-18 weeks and clinical examination at 12-46 months (mean, 30.8 months) postoperatively.

RESULTS

Resurfacing of the humeral head was achieved in all dogs. Subjectively, lameness resolved in 9 of 16 limbs by 5-6 weeks postoperatively, and in 13 limbs by 12-18 weeks. Radiographically, all autografts were maintained. On second-look arthroscopy, the grafted section was intact, resilient on probing, satisfactorily conformed to the adjacent articular contour, and grossly appeared consistent with hyaline or fibrocartilage depending on the graft source. Of 12 limbs available for 12-46 months reevaluation, none were considered lame and mild discomfort on shoulder manipulation was recorded for only 1 joint.

CONCLUSIONS

OAT procedures are technically feasible in the caudocentral aspect of the canine humeral head. Articular contour reconstruction, resurfacing of osteochondral defects, and amelioration or resolution of short-term lameness may be achieved.

Evaluation of chondrocyte death in canine osteochondral explants exposed to a 0.5% solution of bupivacaine

OBJECTIVE

To evaluate chondrocyte death in canine articular cartilage exposed in vitro to bupivacaine with and without methylparaben and to compare viability for cartilage with intact or mechanically debrided surfaces.

SAMPLE POPULATION

Both glenohumeral joints from 10 adult canine cadavers.

PROCEDURES

10 osteochondral cores were harvested from each of the 20 humeral heads; synovium and 1 core from each joint were examined to verify joint health, and the other 9 cores were exposed to canine chondrocyte culture medium (CCCM), a 0.5% solution of bupivacaine, or 0.5% solution of bupivacaine with methylparaben for 5, 15, or 30 minutes.

RESULTS

For the superficial zone of surface-intact chondrocytes, bupivacaine with methylparaben caused a significantly higher percentage of chondrocyte death at 5 minutes (47.7%) than did bupivacaine (23.6%) or CCCM (25.4%). Bupivacaine (53.8%) and bupivacaine with methylparaben (62.5%) caused a significantly higher percentage of chondrocyte death at 30 minutes than did CCCM (20.0%). For the superficial zone of chondrocytes with debrided surfaces, bupivacaine with methylparaben caused a significantly higher percentage of chondrocyte death at 30 minutes (59%) than it did at 5 minutes (37.7%). Bupivacaine with methylparaben caused a significantly higher percentage of chondrocyte death at 30 minutes (59.0%) than did CCCM (28.9%). For middle and deep zones of chondrocytes, treatment solution and surface debridement had minimal effects on percentage of chondrocyte death.

CONCLUSIONS AND CLINICAL RELEVANCE

Bupivacaine and bupivacaine with methylparaben were cytotoxic to canine articular chondrocytes in vitro. Intra-articular administration of bupivacaine is not recommended for clinical use until additional studies are conducted.

Osteochondritis dissecans of the humeral head in two small-breed dogs

Shoulder pathology consistent with osteochondritis dissecans of the humeral head was diagnosed in two small-breed dogs. In both cases, the diagnosis was made tentatively on the basis of radiography and confirmed by arthroscopy of the affected shoulder joint. Both dogs were successfully treated by surgical removal of a flap of cartilage from the affected area. Clinical and radiographic follow-up was available in both cases. The excised cartilage flaps were examined histopathologically and showed the same characteristics as cartilage flaps from dogs of large breeds prone to developing osteochondritis dissecans of the shoulder.

Micro-computed tomography of early lesions of osteochondrosis in the tarsus of foals

INTRODUCTION

Osteochondrosis (OC) is an important developmental orthopedic disease of human and equine patients. The disease is defined as a focal disturbance in enchondral ossification. In horses, the disturbance can occur secondary to failure of the blood supply to growth cartilage. Diagnosis of the early, subclinical stages that can clarify the etiology is currently confined to cross-sectional histological examination. The potential for micro-computed tomography (micro-CT) with angiography to detect early lesions of OC has not yet been investigated.

MATERIALS AND METHODS

Nine Standardbred foals bred from parents with OC of the tarso-crural joint were sacrificed at weekly intervals from birth to 7 weeks of age. Permanent barium angiograms were created within one hind limb post mortem, and samples collected from two predilection sites for OC within the tarso-crural joint of the perfused hind limb. The resulting 18 sample blocks were scanned with a custom-built micro-CT equipment set-up, and analyzed as 2D slices and 3D volume rendered models before sectioning for conventional histological examination.

RESULTS

Histological examination identified eight early lesions in seven locations within six joints from the nine foals. Micro-CT with angiography was able to detect seven lesions in the same sites as histological examination. Lesions consisted of non-perfused foci within growth cartilage. No perfused vessels exited from subchondral bone deep to any lesion. Six of the seven lesions were associated with focal defects in the subchondral bone plate. Evidence of ongoing ossification was seen in three out of the seven lesions and included one separate center of ossification.

CONCLUSION

Micro-CT was a useful technique for examination of early lesions of OC. The results of micro-CT were compatible with failure of cartilage canal vessels at the point where they cross the ossification front. Resultant areas of ischemic chondronecrosis were associated with focal delay in enchondral ossification as visualized in 3D volume rendered models. Micro-CT combined with histology clarified the role of different forms of ossification in the secondary repair responses to lesions.

Bilateral Stifle Osteochondritis Dissecans in a Cat

A 9-month-old, castrated male, domestic shorthaired cat was presented for progressive right hind-limb lameness. A diagnosis of osteochondritis dissecans of the lateral femoral condyle was made based on radiographs and physical examination, and was confirmed by right lateral stifle arthrotomy. The cartilage flap was removed, and the underlying bone was curetted. Seven months later, the cat was sound on the right leg but developed a left hind-limb lameness. A similar lesion was found in the left leg and was treated identically. Fourteen months after presentation, the cat was sound on both hind limbs.

Biochemical characterization of cartilage affected by osteochondritis dissecans in the humeral head of dogs

OBJECTIVE

To determine glycosaminoglycan (GAG) concentration and immunohistochemical staining characteristics of type-I, -II, and -X collagen from cartilage affected by osteochondritis dissecans (OCD) in dogs.

ANIMALS

31 dogs with OCD and 11 clinically normal purpose-bred dogs.

PROCEDURE

Cartilage samples were evaluated microscopically, and GAG content was determined. Immunohistochemical staining was performed for type-I, -II, and -X collagen. Sections were subjectively evaluated for location and intensity of staining.

RESULTS

Cartilage affected by OCD had a variety of pathologic changes and significantly lower GAG concentrations than did normal cartilage. Normal cartilage had no detectable type-I collagen. For dogs < 9 months of age, cartilage affected by OCD had significantly more type-I collagen but significantly less type-X collagen than did control cartilage. For dogs > 12 months of age, cartilage affected by OCD contained significantly more type-I collagen than did control cartilage. There was a significant negative correlation between immunoreactivity of type-I collagen and that of type-II and -X collagen. A significant positive correlation was found between immunoreactivity of type-II and -X collagen.

CONCLUSIONS AND CLINICAL RELEVANCE

Cartilage affected by OCD contains less GAG, more type-I collagen, and less type-X collagen, compared with normal cartilage. A direct correlation between these changes and the etiopathogenesis of OCD was not established.

Hip dysplasia in the cat: a report of three cases

Hip dysplasia was diagnosed in three cats. Two were presented with a history of hindlimb lameness and the other had a history of constipation. All were confined for two weeks and showed considerable clinical improvement. At follow-up examination the cats were free of clinical signs despite the deterioration in the radiological appearance of their hips. Luxation or subluxation of the hips, insufficient development of the craniolateral acetabular edges, loss of the arched shape of the cranial subchondral acetabular bones, shallow acetabula and secondary degenerative changes on the femoral heads and necks were the main radiological findings in the affected cats.

Progression of femoropatellar osteochondrosis in nine young horses. Clinical, radiographic and arthroscopic findings

The clinical and radiographic progression, and arthroscopic findings for nine young horses (< 1 year of age) with femoropatellar osteochondrosis (OCD) are presented. Horses had a 2 to 12 week history of bilateral (8 horses) or unilateral (1 horse) hindlimb lameness. The most consistent clinical signs included femoropatellar joint distention and bilateral hindlimb lameness. At the onset of clinical signs, radiographic lesions were not present (4 horses) or subtle (5 horses), but were easily identified on radiographs taken 4 to 24 weeks later. Arthroscopic surgery was delayed until radiographic changes became obvious. Surgical findings in 20 femoropatellar joints were most commonly osteochondral "flaps" located on the proximal lateral trochlear ridge of the femur and were larger than had been indicated by the radiographs. Eight horses were being used for their intended purpose, which was racing (3 horses were racing and 3 were in race training), dressage (1 horse) or pleasure riding (1 horse). One horse required a second surgery when similar lesions developed on the opposite stifle, and was euthanatized 2 months later because of persistent lameness. One clinical signs are observed, osteochondrosis lesions of the distal femur can progress in foals younger than 9 months of age and the full extent of the radiographic lesion may take several weeks to develop.

Ischemic necrosis of cartilage in spontaneous and experimental lesions of osteochondrosis

This study was designed to examine the association of spontaneous lesions of osteochondrosis with vascular supply to epiphyseal cartilage, and to determine whether similar lesions could be experimentally reproduced by selective interruption of cartilage canal blood supply. The vascular supply to the articular-epiphyseal cartilage complex of the distal end of the femur was studied in 27 microfil- or barium-injected and cleared specimens and 24 serially sectioned microangiographic specimens from 27 clinically normal female swine (3.6 to 71.0 kg). Blood vessels supplying the articular-epiphyseal cartilage complex were consistently restricted to the epiphyseal region and the number of vessels decreased as the pigs increased in weight (p less than 0.001). Spontaneous lesions of osteochondrosis (i.e., cartilage necrosis) were initially seen in the first areas of epiphyseal cartilage to become avascular and were associated with necrotic blood vessels. The number and size of foci of necrotic cartilage increased as the pigs increased in weight (p less than 0.001). Blood supply to epiphyseal cartilage from cartilage canal vessels was surgically interrupted in a highly vascular area of the medial femoral condyle in eight additional 23-kg female swine. This procedure resulted in necrosis of blood vessels within cartilage canals followed by necrosis of surrounding cartilage, lesions that appeared to be identical to early spontaneous lesions of osteochondrosis. These results suggest that the viability of epiphyseal cartilage in the articular-epiphyseal cartilage complex is highly dependent on an adequate blood supply from cartilage canal vessels, and strongly implicates a defect in blood supply in the pathogenesis of osteochondrosis.

Osteochondrosis dissecans in turkeys

The lesions in 3 turkeys with articular cartilage flap formation and associated osteoarthrosis are described. Since cartilage flap formation was accompanied by a disturbance in endochondral ossification, the diagnosis of osteochondrosis dissecans could be made. The site of lesions in 2 of the cases demonstrated that an adjacent ossific nucleus is not a necessary prerequisite for animal osteochondrosis dissecans. In addition, the site of the lesion in these 2 cases support the suggestion that the junctions of contact and non-contact areas of an articular surface are predisposed to pathological change.

Osteochondritis dissecans in the dog

The diagnosis, aetiology, pathogenesis and treatment of osteochondritis dissecans in the shoulder, elbow, stifle and hock joints of the dog is reviewed. A technique of surgically exploring the shoulder joint with minimal exposure is described. Recommendations for preventing the development of osteochondritis dissecans are made.

Etiological factors in osteochondritis dissecans. An experimental study into the etiological factors in osteochondritis dissecans in the canine humeral head using overloading with and without somatotropin and thyrotropin hormone treatment and mechanical trauma

The overloaded humeral heads of the six growing Labrador retrievers treated with somatotropin and thyrotropin hormone showed the most pronounced changes of the articular cartilage and subchondral home, resembling changes in the early stage of spontaneous osteochondritis dissecans. The overloading alone used in 16 dogs without hormone treatment produced no changes, except that two Labrador retrievers showed increased radiodensity subchondrally during the first 4-6 weeks of the observation period. The mechanical traumas of the articular cartilage and the epiphyseal bone regenerated and did not result in changes resembling those of spontaneous osteochondritis dissecans.