Prevalence of computed tomographic subchondral bone lesions in the scapulohumeral joint of 32 immature dogs with thoracic limb lameness

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.

Fast field echo resembling a CT using restricted echo-spacing (FRACTURE) sequence for shoulder joint in normal dogs

Shoulder disease is a common cause of forelimb lameness in dogs. Determining the precise underlying cause of shoulder lameness can be challenging, especially in veterinary practice. Computerized tomography (CT) is often the preferred imaging modality for bone evaluation; however, it uses ionizing radiation and provides limited soft tissue contrast. Conversely, magnetic resonance imaging (MRI) offers excellent soft tissue contrast but has limitations in bone imaging. This study aimed to introduce a new technical innovation that enhances cortical and trabecular bone contrast on MRI, which we refer to as Fast Field Echo Resembling a CT Using Restricted Echo-Spacing (FRACTURE). In this prospective pilot study, we aimed to evaluate the use of FRACTURE, CT, and conventional MRI sequences in assessing the normal canine shoulder using a 3.0 Tesla MRI scanner. Five research beagle dogs were included, and the following pulse sequences were acquired for each dog (1): three-dimensional (3D) FRACTURE, (2) T2-weighted (T2W) images using 3D turbo spin echo (TSE), (3) T1-weighted (T1W) images using 3D TSE, (4) PD-weighted (PDW) images using 3D TSE, and (5) CT. Various parameters, including the delineation of cortical bone (intertubercular groove, greater tubercle, and lesser tubercle), conspicuity of the trabecular bone, shoulder joint visualization, and image quality, were measured for each dog and sequence. In all sequences, the shoulder joint was successfully visualized in all planes with mild motion artifacts. The intertubercular groove was best visualized on CT and FRACTURE. Both the greater and lesser tubercles were easily identified on the CT, FRACTURE, and PDW images. The trabecular pattern scored significantly higher in the CT and FRACTURE images compared to the T1W, T2W, and PDW images. Overall, the visualization of the shoulder joint was excellent in all sequences except for T1W. The use of FRACTURE in combination with conventional MRI sequences holds promise for facilitating not only soft tissue evaluation but also cortical and trabecular bone assessment. The findings from this study in normal dogs can serve as a foundation for further FRACTURE studies in dogs with shoulder diseases.

Detection of fragment migration into the biceps tendon sheath originating from a humeral osteochondrosis lesion - A case report and review of the literature

The purpose of this report is to demonstrate that radiographic evaluation of the canine shoulder joint alone is not sensitive enough to detect migrated osteochondral fragments within the biceps tendon sheath, as a sequela to osteochondrosis dissecans of the caudal humeral head. A 6-months-old, male, 35 kg Hovawart was referred due to chronic intermittent lameness on the left forelimb. Survey radiographs revealed a semilunar radiolucency surrounded by a moderately sclerotic rim at the caudal aspect of the left humeral head, referred to as osteochondrosis dissecans. However, only computed tomography combined with ultrasonography could clearly confirm a dislodged osteochondral fragment within the left biceps tendon sheath and a consequent tenosynovitis. Arthroscopic treatment on the clinically affected left forelimb followed by an additional approach over the left biceps tendon sheath to remove the migrated fragment resulted in a complete remission of the lameness until the last follow-up one year after surgery. In our opinion, computed tomography should be applied in the medical work up of canine shoulder osteochondrosis (OC) as standard. Combined with ultrasonography, it can further aid in complete evaluation of the shoulder joint and reliable exclusion of displaced osteochondral fragments, which might also be missed during arthroscopy when located too far distally.

Computed tomographic arthrography is a useful adjunct to survey computed tomography and arthroscopic evaluation of the canine shoulder joint

The aim of this retrospective, methods comparison study was to assess the diagnostic utility of computed tomographic arthrography in the assessment of various intraarticular shoulder pathologies in dogs in comparison with survey computed tomography (CT), using arthroscopic examination as the reference standard. Computed tomography, computed tomographic arthrography, and arthroscopic findings of 46 scapulohumeral joints of dogs with forelimb lameness were reviewed retrospectively. Predefined sites were assessed for the presence or absence of disease. If a lesion was present, a prespecified pathology was designated. Computed tomographic arthrography was found to be a safe technique which provided a superior diagnostic efficacy relative to survey CT for the assessment of the biceps tendon and biceps tendon sheath (sensitivity 71%, specificity 75%, positive likelihood ratio 2.9, negative likelihood ratio 0.38) and humeral head cartilage (sensitivity 65%, specificity 97%, positive likelihood ratio 19, negative likelihood ratio 0.37). Computed tomography and computed tomographic arthrography provided additional diagnostic information to arthroscopy in regard to osteophytosis, subchondral defects, and joint mice. Computed tomographic arthrography alone was of limited diagnostic value for assessment of the medial and lateral glenohumeral ligaments (sensitivity 13% and 0%, specificity 1% and 78%, positive likelihood ratios unmeasurable and 0, negative likelihood ratios 0.88 and 1.29, respectively) and the subscapularis tendon (sensitivity 14%, specificity 98%, positive likelihood ratio 5.7, negative likelihood ratio 0.88). Computed tomographic arthrography is therefore a useful adjunct to survey CT and arthroscopic evaluation of the canine shoulder joint, however, is not a replacement for these techniques.

Arthroscopic Management of Osteochondrosis of the Glenoid Cavity in a Dog

A 5 mo old English setter dog was presented with mild left forelimb lameness. Physical examination revealed pain upon shoulder palpation and extension. Mediolateral radiographs of both shoulders showed a subchondral bone defect in the mid-portion of the glenoid cavity. Computed tomography arthrography and arthroscopy revealed a cartilage flap, suggesting osteochondritis dissecans of the glenoid cavity. Subchondral bone cysts of the glenoid cavity and incomplete fusion of the supraglenoid tubercle were also observed. Arthroscopic removal of the fragment led to a favorable outcome.