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Quadflieg I, Ordobazari J, Lüpke M, Freise F, Volk HA, Metje B. Development and Validation of an Examination Protocol for Arthroscopic Evaluation of the Temporomandibular Joint in Dogs. Animals (Basel) 2024; 14:1338. [PMID: 38731342 PMCID: PMC11083697 DOI: 10.3390/ani14091338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/17/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Due to the previously limited intra-articular diagnostic possibilities of the canine temporomandibular joint, an examination protocol for the canine temporomandibular joint (TMJ) was developed and tested in this study using a needle arthroscope. In total, the discotemporal (DTJ) and discomandibular (DMJ) joint compartments of 32 animals (64 TMJs) were examined arthroscopically. During the examinations, 15 anatomical landmarks per joint side were evaluated in regard to their visibility and accessibility. All arthroscopies were performed by the same examiner and the same assistant to ensure standard methods were applied. The examination procedure which was developed here proved to be a reliable tool for examining this joint. The 15 anatomical landmarks that were to be examined could be reliably visualised and assessed in all TMJs with a certainty of 86% to 100% by both observers. This tool provides clinicians with a reliable examination aid for everyday practice and ensures the comparability of results. In the future, this could provide an opportunity to better diagnose and treat TMJ pathologies.
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Affiliation(s)
- Ina Quadflieg
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; (I.Q.); (J.O.); (H.A.V.)
| | - Jasmin Ordobazari
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; (I.Q.); (J.O.); (H.A.V.)
| | - Matthias Lüpke
- Department of General Radiology and Medical Physics, University of Veterinary Medicine Hannover, 30173 Hannover, Germany;
| | - Fritjof Freise
- Department of Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover, 30559 Hannover, Germany;
| | - Holger A. Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; (I.Q.); (J.O.); (H.A.V.)
| | - Benjamin Metje
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; (I.Q.); (J.O.); (H.A.V.)
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Evers JS, Kim SE, Johnson MD, Lazarus MA. Accuracy of needle arthroscopy for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture. Vet Surg 2023; 52:820-826. [PMID: 35560359 DOI: 10.1111/vsu.13828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/25/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the accuracy of needle arthroscopy (NA) for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture (CCLR). STUDY DESIGN Prospective clinical trial. ANIMALS Twenty-six client-owned dogs. METHODS Dogs with CCLR and scheduled to undergo tibial plateau leveling osteotomy were recruited for the study. Needle arthroscopy was performed by an experienced surgeon; the same dog subsequently underwent standard arthroscopy (SA) by another experienced surgeon who was blinded to the NA findings. The SA arthroscopy findings were used as the gold standard. Arthroscopy time, visibility of the menisci, ability to probe the menisci, and the presence of meniscal tears were recorded for both arthroscopies. The degree of lameness before and after NA was subjectively quantified. RESULTS The sensitivity and specificity to diagnose medial meniscal tears with NA was 95% and 100%, respectively. Visibility of the menisci was lower (P < .01), probing of the lateral meniscus was harder (P = .0017), and procedure time was shorter (P = .073) with NA when compared to SA. The lameness scores did not differ before and after NA (P = .25). CONCLUSION Needle arthroscopy could be performed rapidly with low morbidity, and had high accuracy for detecting medial meniscal tears in dogs with CCLR. CLINICAL SIGNIFICANCE Needle arthroscopy is a promising minimally invasive technique for diagnosing medial meniscal tears in dogs with CCLR.
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Affiliation(s)
- Johanna S Evers
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Stanley E Kim
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Matthew D Johnson
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Matthew A Lazarus
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
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Barnes HKS, Sinovich M, Baldwin CM, Gillen A, Stack JD. Ex vivo pilot study evaluating needle tenoscopy of the digital flexor tendon sheath and its suitability to assist palmar annular ligament transection. EQUINE VET EDUC 2023. [DOI: 10.1111/eve.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Harriet K. S. Barnes
- Department of Equine Clinical Studies, The Philip Leverhulme Equine Hospital University of Liverpool Neston UK
| | | | - Christopher M. Baldwin
- Department of Equine Clinical Studies, The Philip Leverhulme Equine Hospital University of Liverpool Neston UK
| | - Alexandra Gillen
- Department of Equine Clinical Studies, The Philip Leverhulme Equine Hospital University of Liverpool Neston UK
| | - John David Stack
- Department of Equine Clinical Studies, The Philip Leverhulme Equine Hospital University of Liverpool Neston UK
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Auffret V, Bonilla AG. Standing Surgical Management of Splint Bone Fractures in 13 Horses: A Comparison to Management Under General Anaesthesia. Vet Comp Orthop Traumatol 2023; 36:148-156. [PMID: 36758616 DOI: 10.1055/s-0043-1761241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE The aim of this article was to describe the technique and outcomes of standing surgical management of splint bone fractures and to compare outcome variables and hospitalization cost to a group with similar fractures treated under general anaesthesia. STUDY DESIGN It is a single-institution retrospective study. Surgical technique, surgical time, hospitalization cost and complications were retrieved from the medical records of horses treated surgically for splint bone fractures (2008-2020). Owner telephone follow-up provided data about athletic outcome, client satisfaction and cosmetic appearance. RESULTS Forty-nine horses (13 standing, 36 under general anaesthesia) with 57 fractures (18 contaminated and 39 non-contaminated) were included. Seven fractures were in the proximal third (4 standing, 3 under general anaesthesia), 18 in the middle third (5 standing, 13 under general anaesthesia) and 30 were distal (4 standing, 26 under general anaesthesia). No significant difference between groups in surgical time was found (p= 0.8). Average total cost was 522 CAN$ lower for the standing group for non-contaminated fractures (p= 0.02). Three horses of the general anaesthesia group demonstrated postoperative colic signs and one case of the standing group was re-operated due to sequestration. Based on follow-up information (range: 3.8-151.2 months), no significant differences in cosmetic and athletic outcomes were found between groups. CONCLUSION Surgical management of splint bone fractures in the standing horse is a valuable alternative for horses selected based on behaviour. When compared to general anaesthesia, standing management of splint bone fractures did not alter the surgical time or outcome variables and avoided general anaesthesia-associated risks.
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Affiliation(s)
- Vincent Auffret
- Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Alvaro G Bonilla
- Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada
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Garnier P, Decambron A, Manassero M, Viateau V. Needle arthroscopy for exploration of the elbow joint: a case series of six dogs with preliminary cadaveric study. N Z Vet J 2022; 70:287-296. [PMID: 35703056 DOI: 10.1080/00480169.2022.2090457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
CASE HISTORY Dogs (n = 6) suffering from elbow-associated lameness for a median of 3.5 (min 2, max 12) months duration requiring arthroscopic exploration according to imaging results were prospectively included in this study. CLINICAL FINDINGS Dogs that met the inclusion criteria were of various breeds with a median body weight of 18 (min 13.2, max 34.5) kg and median age at presentation of 11 (min 6, max 96) months. RESULTS of imaging modalities (radiographs and/or CT) were consistent with developmental elbow disease in all of the dogs. ARTHROSCOPIC FINDINGS Feasibility of the needle arthroscopy procedure was first assessed in a preliminary cadaveric study. Disease-free cadaveric forelimbs (n = 12) were collected from adult dogs (n = 6) euthanised for reasons unrelated to the present study. Elbow exploration was performed, beginning with needle arthroscopy (1 mm, 0° angle scope) followed by standard arthroscopy (2.4 mm, 30° angle scope) through a medial approach. The ease of introduction, range of motion and the quality of visualisation were assessed subjectively and presence of iatrogenic introduction lesions and extent of field of vision (assessed by the number of anatomical structures visualised) were scored and statistically compared. Needle arthroscopy allowed inspection of all structures at risk for medial/caudal compartment disease in all joints considering the occasional need for multiple portals. In the clinical setting, elbow exploration was found to be similar to that in cadaver joints in 4/6 dogs. The lower quality of vision provided by needle arthroscopy was a limitation of the technique, and 2/6 clinical cases required conversion to standard arthroscopy for full visualisation of the joint. No introduction lesions were noted with needle arthroscopy in either the cadaveric or clinical studies. CONCLUSIONS AND CLINICAL RELEVANCE Needle arthroscopy allowed safe visualisation of all the structures of the medial and caudal compartment in disease-free cadaveric elbows, suggesting that needle arthroscopy is an appropriate technique for diagnosis and assessment of lesions of developmental elbow disease. However, the low quality of vision provided by the 1 mm scope, and the small diameter of the sleeve, which limited fluid inflow, combined with fragility of the device were major drawbacks that prevented consistent full exploration of the joint and detailed lesion assessment in clinical situations. Improvement of the device is thus necessary before use of the technique in clinical practice can be recommended.
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Affiliation(s)
- P Garnier
- Department of Small Animal Surgery, Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Université Paris Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - A Decambron
- Department of Small Animal Surgery, Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Université Paris Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - M Manassero
- Department of Small Animal Surgery, Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Université Paris Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - V Viateau
- Department of Small Animal Surgery, Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Université Paris Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
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Carmalt JL, Pimentel KL. The Equine Temporomandibular Joint: Comparisons Between Standard and Needle Arthroscopic Examination of Cadaver Specimens and Standing Horses. Front Vet Sci 2022; 9:876041. [PMID: 35558885 PMCID: PMC9087581 DOI: 10.3389/fvets.2022.876041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Definitive diagnosis of equine temporomandibular joint osteoarthritis (TMJ-OA) may require advanced diagnostic imaging. Arthroscopy is a modern, minimally invasive, diagnostic, and treatment modality. Standing arthroscopic treatment of joint disease is a relatively recent advance in equine surgery, despite which there are few published comparisons between the available arthroscopic systems. Objective To compare and contrast two arthroscopic systems for assessing the equine temporomandibular joint compartments in cadavers and standing horses. Study design Experimental study. Methods Phase I involved the assessment of the discotemporal joint (DTJ) and discomandibular (DMJ) joint compartments of both temporomandibular joints (TMJ) of 14 cadaveric equine heads using a caudally placed arthroscopy portal. Joints were initially examined using the needle arthroscope and the results compared to the findings of examination using a 2.5 mm 30° arthroscope system (standard). Three healthy horses were subsequently examined to determine the validity of the procedure in live animals in Phase II. Results Needle and standard arthroscopy, in combination with mandibular manipulation, allowed evaluation of the caudal aspects of both joint compartments of the TMJ in Phase I. However, the extreme margins of the joint were more commonly visualized using standard arthroscopy. Live horses in phase II were restrained in stocks and both the rostral and caudal aspects of the DTJ and DMJ compartments of both TMJs were examined successfully understanding sedation and local analgesia. The use of a modified Guenther speculum allowed the mandible to be manipulated and offset, which facilitated a complete examination of the joint compartments. Despite adverse behavior encountered during the procedure in one horse, no surgical complications ensued. Main Limitations Not blinded-bias; learning curve. Conclusions The needle arthroscope system is a relatively inexpensive diagnostic tool, which can be used to evaluate the TMJ in the absence of advanced diagnostic imaging such as computed tomography or magnetic resonance imaging. However, if arthroscopic treatment is required after advanced imaging and pre-operative diagnosis, superior image quality and ease of manipulation may favor the use of the standard equipment.
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Affiliation(s)
- James L. Carmalt
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Hersh-Boyle RA, Chou PY, Kapatkin AS, Spriet M, Filliquist B, Garcia TC, Marcellin-Little DJ. Comparison of needle arthroscopy, traditional arthroscopy, and computed tomography for the evaluation of medial coronoid disease in the canine elbow. Vet Surg 2021; 50 Suppl 1:O116-O127. [PMID: 33576043 DOI: 10.1111/vsu.13581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the diagnostic value of still images of needle arthroscopy (SNAR), still images of traditional arthroscopy (STAR), and computed tomography (CT) to diagnose medial coronoid process (MCP) pathology. STUDY DESIGN Prospective clinical trial. ANIMALS Dogs (n = 17) presented for evaluation of elbow dysplasia. METHODS For each case, two SNAR and STAR images of the MCP were reviewed independently and in random order by three board-certified surgeons. Computed tomographic images were reviewed by one board-certified radiologist. Reviewers were blinded to surgical and clinical findings. Surgical findings from real-time TAR with palpation were used as the gold standard. Receiver operating characteristic (ROC) curves and concordance statistics tests for the diagnostic accuracy of MCP fissure, MCP fragment, medial compartment condition, and cartilage score were calculated. RESULTS Images of 27 elbows joints were reviewed. For MCP fissure detection, areas under the ROC curves for CT (0.84), STAR (0.73), and SNAR (0.57) did not differ. For the detection of MCP fragment, STAR had a larger area under the ROC curve (0.93) compared with SNAR (0.74, P = .015) and CT (0.54, P < .001). Still images of TAR and SNAR had comparable concordance for cartilage score (0.80 and 0.77, respectively) and medial compartment pathology (0.80 and 0.73, respectively). CONCLUSION Still images of NAR, STAR, and CT had similar diagnostic value to identify MCP fissures. Still images of TAR was superior to SNAR and CT to identify MCP fragments. CLINICAL SIGNIFICANCE The diagnostic accuracy of SNAR varied on the basis of the coronoid lesion being evaluated.
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Affiliation(s)
- Rebecca A Hersh-Boyle
- William R Prichard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California Davis, Davis, California
| | - Po-Yen Chou
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California
| | - Amy S Kapatkin
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California
| | - Mathieu Spriet
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California
| | - Barbro Filliquist
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California
| | - Tanya C Garcia
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California
| | - Denis J Marcellin-Little
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California
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Pouyet M, Bonilla AG. Diagnostic needle arthroscopy of the scapulohumeral joint in standing sedated horses. Vet Surg 2020; 50:29-37. [PMID: 33074573 DOI: 10.1111/vsu.13529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the technique to perform diagnostic standing scapulohumeral joint needle arthroscopy with a 1.2-mm-diameter arthroscope in horses. STUDY DESIGN Experimental study. ANIMALS Eight thoracic limbs in phase 1 and six horses in phase 2. METHODS In phase 1, the feasibility of the technique was evaluated by using a craniolateral arthroscopic approach. An evaluation of the visible structures of the scapulohumeral joint was performed with both a needle arthroscope and a 4-mm-diameter arthroscope. In phase 2, the technique was performed in six healthy sedated horses to validate the technique in live animals and to report any complications or limitations. RESULTS In phase 1, joint evaluation was similar between arthroscopes and allowed complete evaluation of approximately the lateral half of the humeral head and the lateral glenoid rim. In phase 2, all joints were successfully accessed, and fluid extravasation was mild. Arthroscopic visualization was complete for the centrolateral aspect of the joint in all horses and either complete (3/6) or partial (3/6) for the craniolateral and caudolateral structures, respectively. The procedure was rapidly performed and well tolerated, and no postoperative complications occurred. CONCLUSION The described technique was simple and allowed direct inspection of the scapulohumeral joint. Nonetheless, the standing nature of the technique prevents evaluation of the medial aspect of the humeral head and most of the glenoid cavity. CLINICAL SIGNIFICANCE Needle arthroscopy of the scapulohumeral joint is feasible in horses and offers a diagnostic technique that may improve the surgeon's diagnostic ability for certain shoulder pathologies.
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Affiliation(s)
- Morgane Pouyet
- Department of Clinical Sciences, College of Veterinary Medicine, Université de Montréal, Québec, Canada
| | - Alvaro G Bonilla
- Department of Clinical Sciences, College of Veterinary Medicine, Université de Montréal, Québec, Canada
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