Determinants of passive hip range of motion in adult Greyhounds

Examination of Proximodistal Patellar Position in Dogs with the Stifle at Full Extension

OBJECTIVE

 The aim of this study was to determine the factors related to functional patella alta, with which the proximodistal patellar position exceeds the reference range of healthy small dogs proximally when the stifle is at full extension.

STUDY DESIGN

 Mediolateral-view radiographs of dogs weighing less than 15 kg were obtained and classified into the medial patellar luxation (MPL) and control groups. The reference range of the proximodistal patellar position was determined from the control group. In both groups, a patellar position exceeding this reference range proximally was considered functional patella alta. Multiple logistic regression analysis was performed to examine the factors related to functional patella alta. A receiver operating characteristic (ROC) curve was made for each factor.

RESULTS

 Overall, radiographs of 127 stifles of 75 dogs were obtained. Eleven stifles in the MPL group and one stifle in the control group were determined to be functional patella alta. The factors associated with functional patella alta included a greater full extension angle of the stifle joint, longer patellar ligament, and shorter femoral trochlear length. The full extension angle of the stifle joint had the biggest area under the ROC curve.

CONCLUSION

 Mediolateral radiographs of the stifle joint in full extension are clinically important in dogs with MPL because some dogs might have a proximally positioned patella that is recognizable only when the stifles are extended.

Effect of Femoral Head and Neck Osteotomy on Canines’ Functional Pelvic Position and Locomotion

The long-term effect of femoral head and neck osteotomy (FHO) on the locomotory system of dogs was evaluated. The study comprised an owner questionnaire and an orthopaedic examination, anatomical measurements, and pressure-sensitive walkway analysis for dogs. Linear mixed effect models were used for statistical analysis. Ten dogs with a median of 2.5 years since their unilateral FHO were included. According to the questionnaire results, nine dogs had returned to a normal physical activity level. Muscle atrophy (p = 0.005), less extension in the coxofemoral joint (p = 0.003), and less static weight bearing on the FHO limb (p = 0.003) were observed. No consistent pattern regarding tilt or position of the pelvis was noted when measuring height of the tuber ischii (p = 0.39). Five of the dogs tilted away from, and five towards the FHO side when measured from the tuber sacrale with a Myrin goniometer. No differences regarding stance time, swing time, or peak pressure between the FHO and non-FHO limb were seen in trot (p = 0.70, p = 0.26, and p = 0.91, respectively). Over the long term, the FHO limb has muscle atrophy, decreased coxofemoral extension, and decreased static weight bearing. However, this does not seem to affect the trot of the dogs. Dog owners considered the outcome of surgery to be good or excellent.

Effect of sedation or general anesthesia on elbow goniometry and thoracic limb circumference measurements in dogs with naturally occurring elbow osteoarthritis

OBJECTIVE

To evaluate the effect of sedation or general anesthesia (GA) on elbow goniometry and thoracic limb circumference (TLC) measurements in dogs with elbow osteoarthritis (OA).

STUDY DESIGN

Prospective study.

ANIMALS

Twenty-four client-owned dogs with radiographically confirmed elbow OA.

METHODS

Elbow goniometry and TLC measurements were made before and after either sedation or GA by using a hand-held goniometer and spring tension measuring tape, respectively. Observers were not allowed to review their pre-sedation or pre-GA measurements at the time of obtaining measurements on dogs under sedation or GA. Mixed analysis of variance models were used to compare elbow goniometry and TLC measurements before and after sedation or GA.

RESULTS

Eleven and thirteen dogs were included in the sedation and GA groups, respectively. Mean elbow flexion decreased by 5° and 3° and mean elbow extension increased by 6° and 2° under sedation and GA, respectively. Total range of motion increased by 11° under sedation and by 5° under GA. Each of these changes was statistically significant (P < .05) except elbow extension under GA (P = .129). Sedation and GA did not influence TLC measurements (P > .05).

CONCLUSION

Sedation or GA led to slight and similar increase in elbow flexion and extension but did not influence TLC measurements in dogs with elbow OA.

CLINICAL SIGNIFICANCE

Sedation or GA can cause slight alterations to goniometric measurements in canine elbows with OA. The protocols used in this study for sedation and GA seem interchangeably acceptable for goniometry and TLC measurements in dogs with elbow OA.

Developing a testing battery for measuring dogs' stifle functionality: the Finnish Canine Stifle Index (FCSI)

This study aimed at developing a quantitative testing battery for dogs’ stifle functionality, as, unlike in human medicine, currently none is available in the veterinary field. Forty-three dogs with surgically treated unilateral cranial cruciate ligament rupture and 21 dogs with no known musculoskeletal problems were included. Eight previously studied tests: compensation in sitting and lying positions, symmetry of thrust in hindlimbs when rising from lying and sitting, static weight bearing, stifle flexion and extension and muscle mass symmetry, were summed into the Finnish Canine Stifle Index (FCSI). Sensitivities and specificities of the dichotomised FCSI score were calculated against orthopaedic examination, radiological and force platform analysis and a conclusive assessment (combination of previous). One-way analysis of variance (ANOVA)was used to evaluate FCSI score differences between the groups. Cronbach’s alpha for internal consistency was calculated. The range of the index score was 0–263, with a proposed cut-off value of 60 between ‘adequate’ and ‘compromised’ functional performance. In comparison to the conclusive assessment, the sensitivity and specificity of the FCSI were 90 per cent and 90.5 per cent, respectively. Cronbach’s alpha for internal reliability of the FCSI score was 0.727. An estimate of the surgically treated and control dogs’ FCSI scores were 105 (95 per cent CI 93 to 116) and 20 (95 per cent CI 4 to 37), respectively. The difference between the groups was significant (P<0.001).

Comparison of goniometric measurements of the stifle joint in seven breeds of normal dogs

Objective: To compare the goniometric measurements of the stifle joint in seven dog breeds, and to determine the relationship among goniometric measurements, age, body weight, tibial plateau angle, crus and thigh circumferences, and widths of quadriceps, hamstring, and gastrocnemius muscles in healthy dogs.

Methods: We used a total of 126 dogs from seven different breeds, and recorded the angle of the stifle joint at standing, extension, and flexion together with the range of motion (ROM). The circumferences of the thigh and crus were also measured. Medio -lateral radiographic projections of the tibia and the femur were obtained from the dogs, and the tibial plateau angles, as well as the widths of quadriceps, hamstring, and gas -trocnemius muscles, were measured from these images.

Results: Neither the sex of the dog nor the differences in the side measured affected the goniometric measurements of the stifle joint. The standing, extension, flexion, and ROM angles were different among the breeds. The standard deviations of the standing and extension angles were small relative to their means, but the standard deviations of the flexion angle were large relative to their means in all breeds. Body weight and muscular measurements were the most influential factors on the stifle flexion angle and ROM.

Clinical significance: Breed differences, body weights, and muscle mass should be taken into consideration during assessment of the stifle function using goniometric measurements.

NBD delivery improves the disease phenotype of the golden retriever model of Duchenne muscular dystrophy

Background

Duchenne muscular dystrophy (DMD) is caused by mutations in the dystrophin gene and afflicts skeletal and cardiac muscles. Previous studies showed that DMD is associated with constitutive activation of NF-κB, and in dystrophin-deficient mdx and utrophin/dystrophin (utrn^-/-;mdx) double knock out (dko) mouse models, inhibition of NF-κB with the Nemo Binding Domain (NBD) peptide led to significant improvements in both diaphragm and cardiac muscle function.

Methods

A trial in golden retriever muscular dystrophy (GRMD) canine model of DMD was initiated with four primary outcomes: skeletal muscle function, MRI of pelvic limb muscles, histopathologic features of skeletal muscles, and safety. GRMD and wild type dogs at 2 months of age were treated for 4 months with NBD by intravenous infusions. Results were compared with those collected from untreated GRMD and wild type dogs through a separate, natural history study.

Results

Results showed that intravenous delivery of NBD in GRMD dogs led to a recovery of pelvic limb muscle force and improvement of histopathologic lesions. In addition, NBD-treated GRMD dogs had normalized postural changes and a trend towards lower tissue injury on magnetic resonance imaging. Despite this phenotypic improvement, NBD administration over time led to infusion reactions and an immune response in both treated GRMD and wild type dogs.

Conclusions

This GRMD trial was beneficial both in providing evidence that NBD is efficacious in a large animal DMD model and in identifying potential safety concerns that will be informative moving forward with human trials.

Principles and application of range of motion and stretching in companion animals

Optimal function after injury, surgery, or in patients with chronic conditions requires adequate motion in joints, muscles, tendon, fascia, and skin. Range of motion and stretching exercises are commonly used in companion animal rehabilitation programs to maintain or improve motion of musculoskeletal tissues. Range of motion exercises and stretching prevent adhesions from forming, help scar tissue remodeling, may improve muscle tone, and prevent future injury from occurring. Stretching is used to avoid loss of motion or to regain lost joint motion. Stretching is done manually, using external coaptation, or using therapeutic exercises. Careful documentation of range of motion is necessary.

Evaluation of ranges of motion of a new constrained acetabular prosthesis for canine total hip replacement

Background

Total hip replacement (THR) is considered to be the most effective treatment option for advanced osteoarthritis of the hip in large breed dogs. However, a proportion of post-THR patients suffer prosthesis dislocation for various reasons, which may be addressed by a constrained acetabular prosthesis design. The study proposed a new THR with constrained acetabular component that aimed to decrease the incidence of postoperative dislocation while maintaining the necessary range of motion (ROM); and, through computer-simulated implantations, evaluated the ROM of the THR with and without malpositioning of the acetabular component.

Methods

A new THR with a constrained acetabular component that had an inward eccentric lining and a 60° cut-out on the dorsal side was designed, and its computer-aided design models were implanted into the pelvic and femoral models reconstructed from the computed tomography data of six healthy Labrador Retriever dogs. The allowable and functional ROM of the implanted THR were determined via computer simulations. The contact patterns between the bone or the prosthetic components at extreme positions of the THR were analyzed. Influence of malpositioning of the acetabular component on the ROM was assessed.

Results

The means (SD) of the functional ranges for flexion, extension, adduction, abduction, internal rotation and external rotation were 51.8° (6.6°), 163.3° (7.3°), 33.5° (5.7°), 74.0° (3.7°), 41.5° (8.3°) and 65.2° (9.9°), respectively. Malpositioning of the acetabular component by 20° in one direction was found to reduce ROM in other directions (reducing lateral opening: flexion: 12°, adduction: 20°, internal/external rotations: < 20°; increasing lateral opening: extension and abduction: < 16°; reducing retroversion: extension: < 20°, abduction: 15°, external rotation: < 20°; increasing retroversion: flexion: < 20°, abduction, adduction and internal rotation: 20°).

Conclusions

From the computer-aided surgical simulations, the new THR was found to have sufficient functional ranges for flexion, extension, abduction, adduction and external rotation for Labrador Retrievers. Analysis of the malpositioning of the acetabular component suggests that accurate placement of the acetabular component is critical for achieving desirable ROM for daily activities.

Ranking of physiotherapeutic evaluation methods as outcome measures of stifle functionality in dogs

Background

Various physiotherapeutic evaluation methods are used to assess the functionality of dogs with stifle problems. Neither validity nor sensitivity of these methods has been investigated. This study aimed to determine the most valid and sensitive physiotherapeutic evaluation methods for assessing functional capacity in hind limbs of dogs with stifle problems and to serve as a basis for developing an indexed test for these dogs. A group of 43 dogs with unilateral surgically treated cranial cruciate ligament deficiency and osteoarthritic findings was used to test different physiotherapeutic evaluation methods. Twenty-one healthy dogs served as the control group and were used to determine normal variation in static weight bearing and range of motion.

The protocol consisted of 14 different evaluation methods: visual evaluation of lameness, visual evaluation of diagonal movement, visual evaluation of functional active range of motion and difference in thrust of hind limbs via functional tests (sit-to-move and lie-to-move), movement in stairs, evaluation of hind limb muscle atrophy, manual evaluation of hind limb static weight bearing, quantitative measurement of static weight bearing of hind limbs with bathroom scales, and passive range of motion of hind limb stifle (flexion and extension) and tarsal (flexion and extension) joints using a universal goniometer. The results were compared with those from an orthopaedic examination, force plate analysis, radiographic evaluation, and a conclusive assessment. Congruity of the methods was assessed with a combination of three statistical approaches (Fisher’s exact test and two differently calculated proportions of agreeing observations), and the components were ranked from best to worst. Sensitivities of all of the physiotherapeutic evaluation methods against each standard were calculated.

Results

Evaluation of asymmetry in a sitting and lying position, assessment of muscle atrophy, manual and measured static weight bearing, and measurement of stifle passive range of motion were the most valid and sensitive physiotherapeutic evaluation methods.

Conclusions

Ranking of the various physiotherapeutic evaluation methods was accomplished. Several of these methods can be considered valid and sensitive when examining the functionality of dogs with stifle problems.

The paradox of muscle hypertrophy in muscular dystrophy

Mutations in the dystrophin gene cause Duchenne and Becker muscular dystrophy in humans and syndromes in mice, dogs, and cats. Affected humans and dogs have progressive disease that leads primarily to muscle atrophy. Mdx mice progress through an initial phase of muscle hypertrophy followed by atrophy. Cats have persistent muscle hypertrophy. Hypertrophy in humans has been attributed to deposition of fat and connective tissue (pseudohypertrophy). Increased muscle mass (true hypertrophy) has been documented in animal models. Muscle hypertrophy can exaggerate postural instability and joint contractures. Deleterious consequences of muscle hypertrophy should be considered when developing treatments for muscular dystrophy.

Canine models of Duchenne muscular dystrophy and their use in therapeutic strategies

Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder in which the loss of dystrophin causes progressive degeneration of skeletal and cardiac muscle. Potential therapies that carry substantial risk, such as gene- and cell-based approaches, must first be tested in animal models, notably the mdx mouse and several dystrophin-deficient breeds of dogs, including golden retriever muscular dystrophy (GRMD). Affected dogs have a more severe phenotype, in keeping with that of DMD, so may better predict disease pathogenesis and treatment efficacy. Various phenotypic tests have been developed to characterize disease progression in the GRMD model. These biomarkers range from measures of strength and joint contractures to magnetic resonance imaging. Some of these tests are routinely used in clinical veterinary practice, while others require specialized equipment and expertise. By comparing serial measurements from treated and untreated groups, one can document improvement or delayed progression of disease. Potential treatments for DMD may be broadly categorized as molecular, cellular, or pharmacologic. The GRMD model has increasingly been used to assess efficacy of a range of these therapies. A number of these studies have provided largely general proof-of-concept for the treatment under study. Others have demonstrated efficacy using the biomarkers discussed. Importantly, just as symptoms in DMD vary among patients, GRMD dogs display remarkable phenotypic variation. Though confounding statistical analysis in preclinical trials, this variation offers insight regarding the role that modifier genes play in disease pathogenesis. By correlating functional and mRNA profiling results, gene targets for therapy development can be identified.

Geometry of the femoral condyles in dogs

The stifle joint is one of the most important joints in dogs from the orthopaedic point of view. The aim of this study was to document the morphometric values of femoral condyles, given the close relationship between the shape and function of an anatomic structure. The left femora of 16 mid-sized dogs were used, and diameter and nine radii as well as cranial and caudal bow lengths from each condyle were measured. The photographs were taken of the distal femora from both sides. All measurements were obtained from these images by using software. Additionally, the rotation angle was calculated from the intercondylar distance and the difference between lateral and medial bow lengths. In addition to the rotation angle, the difference of diameter and nine radii between the lateral and medial condyles was determined. All radii except getting at 90° were significantly different between the medial and lateral condyles. The greatest values were determined in the caudal part of the medial condyle. This results the smaller contact area and a greater pressure on the underlying surface, and therefore the meniscus and articular cartilage of the caudal part of the medial side suggests the possibility of a risk of injury as the stifle joint flexes. The mean rotational angle of the femur was also calculated to be 2.18° laterally and 1.02° medially in the caudal and cranial parts of condyles, respectively. The result of this study showed that the lateral and medial condyles had different shapes in canine femur.

Golden retriever muscular dystrophy (GRMD): Developing and maintaining a colony and physiological functional measurements

Studies of canine models of Duchenne muscular dystrophy (DMD) provide insight regarding disease pathogenesis and treatment efficacy. To take maximal advantage, colonies of affected dogs must be maintained and outcome parameters developed. In this chapter, we review our 25 years of experience with the golden retriever muscular dystrophy (GRMD) model. Key challenges in colony development (breeding, neonatal death, and the risk of inbreeding) and representative functional measurements (tibiotarsal joint angle and torque force; and eccentric contraction decrement) are discussed.