Outcome in 12 Dogs with Chronic Radiographic Cranial Tibial Subluxation after Tibial Plateau Leveling Osteotomy (2019-2021)

Objective

The objective of this study was to examine outcomes in dogs with cruciate ligament rupture (CR) that had chronic radiographic cranial tibial subluxation at the time of osteotomy healing after tibial plateau leveling osteotomy (TPLO). Study Design. Retrospective case analysis of 12 dogs with prospective follow-up. Four of the 12 dogs were prospectively studied 12-24 months after surgery to assess long-term radiographic and clinical outcomes.

Results

Three of the 4 dogs showed improvement in radiographic cranial tibial subluxation at long-term follow-up. In the other dog, minimally improved cranial tibial subluxation was associated with severe lameness. At long-term follow-up, gait analysis in 3 dogs with improved subluxation showed the symmetry of weight-bearing within 10% for peak vertical force, and no clinically lameness. Preoperative tibial plateau angle (TPA) and radiographic osteoarthritis in dogs with prospective follow-up and all dogs treated with TPLO surgery in the study period were not significantly different.

Conclusion

Dogs with chronic radiographic cranial tibial subluxation are acceptable candidates for TPLO. Radiographic improvement in stifle reduction may take more than 10 weeks. The dog with long-term persistent subluxation also had a higher TPA over time, suggestive of ineffective surgical correction with TPLO and treatment failure.

Retrospective evaluation and review of approaches for nonspecific lameness in dogs presented to an emergency service (2013-2014): 134 cases

OBJECTIVE

This retrospective study aimed to characterize and evaluate the emergency approach, diagnosis, management, treatment, and follow-up of nonspecific canine lameness cases.

DESIGN

Retrospective case series from September 25, 2013 to September 25, 2014.

SETTING

The study was conducted at an urban university teaching hospital.

ANIMALS

A consecutive sample of dogs presenting to the emergency service with nonspecific lameness in the designated timeframe was used to identify 134 cases. Owners were contacted to participate in the follow-up survey; dogs that died prior to data collection were excluded from the survey. Medical records were reviewed for lameness localization, etiology of lameness, diagnostics obtained, medications prescribed, and owner recommendations.

INTERVENTIONS

Based on review of the medical records, the lameness localization, presumptive source of lameness (joint, soft tissue, neurological, or bone), diagnostics obtained, medications prescribed, and owner recommendations were recorded. Survey data included duration of lameness, perceived response to treatment, and activity level.

MEASUREMENTS AND MAIN RESULTS

Definitive diagnoses were not assigned in 88.8% of lameness cases. A presumptive diagnosis of soft tissue injury was assigned in 45.3% of cases. Single limb lameness was more prevalent than multiple limb lameness. Owners whose dogs were treated with medication were significantly more likely to report that the lameness resolved (P = 0.049). Dogs with injury localized to ≥1 of the joints were significantly less likely to have resolution of lameness (P = 0.037). Treatment recommendations were predominantly pain control and activity restriction.

CONCLUSIONS

Nonspecific lameness represents approximately 4% of canine urban emergency cases. Highlighting the points of clinical care considerations in understanding the etiology of lameness in dogs represents an opportunity for improved patient care and growth in emergency referral and follow-up.

Psychometric Testing and Validation of the Italian Version of the Helsinki Chronic Pain Index (I-HCPI) in Dogs with Pain Related to Osteoarthritis

Pain assessment is of paramount importance for properly managing dogs with osteoarthritis (OA) pain. The aim of the present study was to develop and psychometrically validate the Italian version of the Helsinki Chronic Pain Index (I-HCPI). Owners of OA painful (n = 87) and healthy dogs (n = 40) were administered the I-HCPI once or twice after an eight-week meloxicam treatment. Sixty-nine owners of healthy and OA dogs also completed the Italian version of the Canine Brief Pain Inventory (I-CBPI). Pain on palpation on a 0-4 scale was assessed on all recruited dogs. Construct validity was tested both with hypothesis testing and principal component analysis, confirming the I-HCPI accurately measured chronic pain. Good convergent and criterion validity were shown through correlations with I-CBPI subscores and distribution among pain on palpation scores (p < 0.0001). The significant difference between the pre- and post-treatment I-HCPI scores (p < 0.0001) and Cohen's effect size (2.27) indicated excellent responsiveness. The I-HCPI was shown to be reliable through communalities (range 0.47-0.90) and Cronbach α (≥0.95). Discriminative ability and cut-off point, as tested through Receiver Operating Characteristic analysis, showed excellent diagnostic accuracy with a threshold value of 11 (specificity 0.98 and sensitivity 0.94). The I-HCPI was confirmed to be a valid, sensitive, reliable, and accurate tool to discriminate between dogs with and without pain.

Long-term outcome in dogs with cranial cruciate ligament disease evaluated using the canine orthopaedic index

BACKGROUND

Cranial cruciate ligament disease (CCLD) is common in dogs, but studies on the long-term treatment outcome are scarce.

METHODS

The long-term outcome in a cohort of 71 dogs with CCLD treated with tibial plateau levelling osteotomy (TPLO, n = 18), tibial tuberosity advancement (TTA, n = 23) or lateral fabellotibial suture (LFS, n = 30) was evaluated using the canine orthopaedic index.

RESULTS

The risk of stiffness and lameness was increased in dogs treated with TPLO (stiffness: incidence rate ratio [IRR] 1.33, p = 0.015; lameness: IRR 1.34, p = 0.020) or TTA (stiffness: IRR 1.26, p = 0.035; lameness: IRR 1.31, p = 0.026) when compared to LFS at a median follow-up time of 4.6 years.

LIMITATIONS

No follow-up veterinary examination was performed. Data were collected from only two university animal hospitals, and thus, a referral bias towards more complicated cases is possible, which may limit the generalisability of the results.

CONCLUSION

Clinicians can use the results to inform dog owners about the expected long-term outcome in dogs with CCLD.

Effect of Rehabilitation in a Dog with Delayed Recovery following TPLO: A Case Report

A 7-year-old neutered Maltese dog weighing 5.1 kg was presented, with a tibial plateau-leveling osteotomy (TPLO) on the right hindlimb 42 days prior. The patient's right hind limb showed lameness, intermittent limping, and atrophy, and the patient had not experienced rehabilitation since TPLO surgery. The patient showed a pain reaction at the end of the stifle extension, and an increased body temperature was identified on the medial side of the right hindlimb when compared with the left hindlimb using a digital thermal imaging device. In addition, a type of lameness, only partial weight bearing in the right hindlimb, was also identified during the gait analysis. The pain was relieved by applying a cold pack and transcutaneous electrical nerve stimulation, and the patient's weak muscles were strengthened through treadmill exercises. In this study, physical therapy and rehabilitation exercises controlled pain and induced rapid recovery, indicating that rehabilitative intervention is required after TPLO surgery.

Surgical Treatment of Nonmineralized Supraspinatus Tendinopathy in Dogs: A Retrospective Long-Term Follow-Up

(1) Background: two forms of supraspinatus tendinopathy (ST) have been reported in dogs: mineralized and non-mineralized. Surgical treatment consists of longitudinal incisions (splitting) in the tendon of insertion of the supraspinatus muscle. The purpose of this retrospective study is to describe the diagnostic workout, the surgical procedure and the short and long term follow up of dogs treated for non-mineralized ST. (2) Methods: medical records (2010-2017) of dogs diagnosed with non-mineralized ST that underwent surgical treatment were reviewed. Data retrieved were: signalment, history, clinical signs, orthopaedic examination findings, diagnostic imaging findings, surgical treatment, histopathologic diagnosis and clinical outcome. (3) Results: A total of 27 dogs met the inclusion criteria. The most consistent clinical findings were intermittent lameness accompanied by pain on palpation of the insertion of the supraspinatus. Magnetic resonance imaging (MRI) of 27 shoulders distended sheaths of the biceps tendon (10/27), compression of the biceps brachii tendon sheaths (5/27) and enlargement of the supraspinatus tendon (3/27) were observed. The most prominent histologic finding was severe myxomatous degeneration in all 27 samples. Resolution of lameness was achieved in 80% of the cases surgically treated without any further lameness episodes in the long-term follow-up. (4) Conclusions: the surgical splitting of the non-mineralized supraspinatus tendon is an effective procedure with no intra-operative complications and a low incidence of minor (18%) and major (4%) complications.

Arthroscopic Treatment of Chronic Cruciate Ligament Rupture in the Dog without Stifle Stabilization: 13 Cases (2001-2020)

Objective

The objective was to study clinical outcomes in dogs with chronic cruciate ligament rupture (CR) treated with palliative arthroscopy as the sole surgical treatment.

Methods

Thirteen client-owned dogs with CR underwent physical examination, stifle radiography, and arthroscopy with resection of damaged meniscal tissue. Records were evaluated, and orthopaedic examination, radiographs, and arthroscopy images were assessed. Long-term clinical outcome was also assessed by use of an owner questionnaire.

Results

Thirteen dogs that underwent arthroscopy at the UW Veterinary Care between 2001 and 2020 were included. Long-term follow-up was available for 7 of 13 dogs. Lameness was static to improved in all dogs in which arthroscopy was performed. Subsequent stifle stabilization was performed after arthroscopy in only 1 of 7 dogs with follow-up data.

Conclusion

Palliative arthroscopy and resection of damaged meniscal tissue in combination with medical management of osteoarthritis can be considered in dogs with chronic CR and cranial tibial subluxation with little passive laxity during examination. Revision surgery with TPLO is uncommon after arthroscopy based on this study.

Efficacy of a dietary supplement in dogs with osteoarthritis: A randomized placebo-controlled, double-blind clinical trial

This study is a randomized, placebo-controlled, double-blinded trial performed to investigate the effects of a dietary supplement containing a mixture of Boswellia serrata Roxb., chlorophyll, green tea extract, glucosamine, chondroitin sulfate, hyaluronic acid, and further in the manuscript: non-hydrolised type II collagen in dogs with osteoarthritis (OA). A total of 40 dogs were enrolled in the study, they were randomly divided in control (CTR) and treatment (TRT) groups. The TRT group received the dietary supplement for 60 days. The CTR group received a placebo for the same number of days. All the subjects had veterinary evaluations during the trial and owners were requested to fill in questionnaires on chronic pain using the Helsinki Chronic Pain Index. The product was easy to administer and no side effects were reported. Combining results from veterinarian and owner evaluations, the tested product proved to be significantly beneficial in alleviating pain and in reducing the clinical signs in dogs with OA.

Long-term clinical and goniometric follow-up of lateral suture surgery in dogs with cranial cruciate ligament rupture

The aim of this study was to evaluate the complications and the short-, medium-, and long-term outcomes following treatment of cranial cruciate ligament (CCL) rupture in dogs using the lateral fabello-tibial suture technique. The patients were ten dogs of various breeds, 62.5 ± 18.8 months of age, weighing 30.2 ± 3.3 kg, with unilateral CCL rupture. At 2, 6, 12, 24, and 52 weeks after surgery, the dogs were re-evaluated with clinical examination, gait and pain analysis, and radiography. A major complication was identified in one dog (10%), requiring second surgery due to implant failure and destabilisation of stifle joint. Minor complications occurred in two dogs postoperatively (one late meniscal injury and one case of seroma formation). The short-term outcome at two and six weeks postoperatively was considered good in six dogs and satisfactory in four dogs, while the mid-term outcome (between 12 and 24 weeks) was good to excellent in eight dogs and satisfactory in two dogs. All ten dogs had a good to excellent outcome 52 weeks after surgery. The lateral suture technique is generally safe and given the major benefits, such as lower costs, lower technical difficulty, and minimal requirement for specialised equipment, will probably remain a popular and alternative method for treatment of CCL insufficiency in dogs with good degree of owner satisfaction.

Biomechanical evaluation of bovine stifles stabilized with an innovative braided superelastic nitinol prosthesis after transection of the cranial cruciate ligament

OBJECTIVE

To determine the stability bovine stifles stabilized with nylon or nitinol superelastic prostheses after transection of the cranial cruciate ligament (CCL).

STUDY DESIGN

Ex vivo study.

SAMPLE POPULATION

Stifles (n = 15) harvested from adult bovine cadavers.

METHODS

The stifles were randomly assigned pairwise to a ligament reconstruction technique (n = 5): (1) and (2) Hamilton's technique using a prosthesis made of 24 nitinol strands (0.39 mm) braided at 40°or single 600-lb test nylon implant, and (3) nitinol prosthesis placed in femoral and tibial bone tunnels (bone-to-bone). Craniocaudal tibial translation at ±2000 N was applied to the tibia, and mediolateral angular displacement via measured under torsional tibial loading at ±60 Nm on three occasions: intact CCL, transected, and stabilized. Outcomes were evaluated with a mixed effect linear model for repeated measures.

RESULTS

Bone-to-bone using nitinol was the only repair that decreased tibial translation after CCL transection (p = .001) with a 23% change magnitude compared with intact CCL. Hamilton was the only stabilization reestablishing angular displacement, similar to intact CCL (p = .109 and .134 for nitinol and nylon). Bone-to-bone nitinol stabilization decreased angular displacement after CCL-transection with an 8% change magnitude (p = .040) without returning to normal values.

CONCLUSION

CCL replacement with nylon did restore joint stability. Nitinol prostheses passed through single femoral and tibial bone tunnels (bone-to-bone) were the only techniques reducing tibial translation.

CLINICAL SIGNIFICANCE/IMPACT

Bone-to-bone stabilization with a nitinol prosthesis may be considered as an alternative to nylon for CCL replacement in cattle. These results provide evidence to justify clinical evaluation in cattle undergoing CCL replacement.

The epidemiology of cruciate ligament rupture in an insured Swedish dog population

Cruciate ligament rupture (CLR) is a common orthopedic disorder in dogs. The study objectives were to evaluate incidence rate (IR), cause-specific mortality rate (CSMR) and risk factors for CLR in insured dogs. A single cohort study of dogs insured in Agria Pet Insurance in Sweden (2011–2016) was performed. Age at diagnosis, IR, CSMR and relative risk (RR) for CLR was calculated overall and per breed. The cohort included just over 600,000 dogs. The IR of CLR was 23.8 (95% confidence interval, 23.1–24.6) cases per 10,000 DYAR. The breeds with highest RR of CLR were Boerboel and Dogo Canario, while the breeds with lowest RR were Standard Dachshund and Miniature Pinscher. Dogue de Bordeaux had highest RR of euthanasia due to CLR. The median age at veterinary care claim for CLR was 7.1 (range 0.3–16.0) years and 6.6 (0.3–12) years at life insurance settlement. Large and giant breeds were generally diagnosed and euthanized due to CLR at a younger age compared to smaller breeds. The majority of the breeds with increased RR of CLR diagnosis and CLR-related euthanasia were large or giant. A pattern of increasing size and decreasing age at diagnosis/CLR-related euthanasia was observed.

Risk factors for severe postoperative complications in dogs with cranial cruciate ligament disease - A survival analysis

OBJECTIVE

To analyze the effect of surgical technique and other risk factors on severe postoperative complications in dogs with cranial cruciate ligament disease (CCLD).

MATERIALS AND METHODS

A cohort study of 255 dogs (287 stifles) surgically treated for CCLD at two veterinary university hospitals (2011-2016) was performed. The electronic medical records were reviewed and dog owners and referring veterinarians contacted for additional information. The complications were classified as minor, major and catastrophic, where major and catastrophic were considered severe. A multivariable Cox proportional hazards model was applied to assess risk factors for severe postoperative complications.

RESULTS

Three surgical techniques were used; lateral fabellotibial suture (LFS, 141 stifles), tibial plateau leveling osteotomy (TPLO, 77 stifles) and tibial tuberosity advancement (TTA, 69 stifles). The most common severe postoperative complications were surgical site infections or complications related to the surgical implant. Severe postoperative complications occurred in 31 % of the stifles treated with TPLO, 22 % of the stifles treated with LFS and 25 % of the stifles treated with TTA. The multivariable Cox proportional hazards model identified surgical technique (p = 0.0258) as a risk factor for severe postoperative complications; TPLO had a significantly lower hazard than LFS (hazard ratio (HR) = 0.37, p = 0.007) when controlling for body weight and age, which also were identified as risk factors (HR = 1.05, p < 0.001 and HR = 0.91, p = 0.047, respectively).

CONCLUSION AND CLINICAL RELEVANCE

Although TPLO procedures had the highest occurrence of severe postoperative complications, the hazard was lower than for LFS after adjusting for body weight and age. This implies that it is important to consider potential effect-modifiers when comparing postoperative complications after CCLD surgery.

The epidemiology of stifle joint disease in an insured Swedish dog population

BACKGROUND

Stifle joint diseases (SJD) are common in dogs and include a variety of diagnoses. The objective of the study was to provide an overview of the epidemiology of SJD in insured dogs.

METHODS

An historical single cohort study of dogs insured in Agria Pet Insurance (2011-2016) in Sweden was performed. Incidence and relative risk (RR) of SJD was calculated for the whole dog population and for subgroups divided by breed, breed group and sex.

RESULTS

The study population included almost 600,000 insured dogs (>1.7 million dog-years). Ninety-three different stifle joint diagnoses were reported in 9624 dogs, and the most common were cruciate ligament rupture and patellar luxation. The incidence of SJD was 55.4 cases per 10,000 dog-years at risk. Bulldog and boerboel had the highest RR of SJD. The breeds that accounted for the highest proportion of all SJD claimed dogs were mixed breed and Labrador retriever. Female dogs had a slightly increased RR compared with male dogs (RR 1.06, p = 0.006). The incidence increased yearly during the observation period.

CONCLUSION

The study demonstrates breed-specific differences in incidence of SJD in dogs, which may be of importance for breeders, dog owners and veterinarians.

The influence of the choice of preemptive analgesia on long-term postsurgical pain after tibial plateau leveling osteotomy in dogs

OBJECTIVE

To evaluate the prevalence of chronic postsurgical pain (CPSP) after tibial plateau leveling osteotomy (TPLO) in dogs and to determine the influence of preemptive locoregional analgesia on CPSP.

STUDY DESIGN

Retrospective study.

ANIMALS

One hundred twenty client-owned dogs.

METHODS

Medical records of dogs that underwent TPLO between 2012 and 2016 were reviewed for demographic information and type of preemptive analgesia. Owners were contacted to retrospectively assess the quality of life of their dogs by using the Helsinki Chronic Pain Index (HCPI) before and 6 months after surgery and at the time of questioning. An HCPI score > 12 was considered indicative of CPSP. Medical records were reviewed for demographic information and type of preemptive analgesia. A cumulative logit model was used to assess correlation of type of perioperative analgesia, HCPI, and demographic data.

RESULTS

The HCPI score was consistent with CPSP in 41 of 101 dogs with long-term follow-up (2.9 ± 1.5 years after surgery). Chronic postsurgical pain was documented in 11 of 32 and 13 of 28 dogs that received a spinal or epidural injection, respectively, or in 28 of 80 and 25 of 67 dogs with sciatic-femoral block at 6 months or with long-term follow-up after TPLO, respectively (P > .05). A negative correlation was found between HCPI and both weight and age 6 months after surgery. Only weight remained negatively correlated 2.9 years after surgery.

CONCLUSION

Forty-one percent of dogs that were evaluated exhibited HCPI values compatible with CPSP long-term after TPLO, regardless of the type of preemptive analgesia. Increased body weight was a negative prognostic factor for CPSP development.

CLINICAL SIGNIFICANCE

Additional studies are required to evaluate CPSP development after TPLO.

Comparative Analysis of Vertical Forces in Dogs Affected with Cranial Cruciate Ligament Disease and Tibial Plateau Angles Greater or Less than 25 Degrees

OBJECTIVE

 Our objective was to compare the peak vertical force (PVF) and vertical impulse (VI) between dogs with cranial cruciate ligament disease and a tibial plateau angle (TPA) greater or less than 25 degrees.

METHODS

 A retrospective study was performed in 18 dogs with cranial cruciate ligament disease in which kinetic gait data were obtained with a pressure walkway system. Dogs were distributed in two groups: dogs with a TPA ≤ 25 degrees (n = 8) and dogs with a TPA > 25 degrees (n = 10). Mean PVF and VI in per cent of body weight (%BW) were compared between groups with an unpaired t-test (p < 0.05).

RESULTS

 Mean PVF and VI for the cranial cruciate ligament disease limb were 14.39%BW and 3.57%BWs for dogs with a TPA >25 degrees and 14.44%BW and 3.47%BWs for dogs with a TPA ≤ 25 degrees. There was no significant difference in mean PVF and VI between the groups.

CONCLUSION

 The results suggest that there is no difference in kinetic data between dogs with cranial cruciate ligament disease and a TPA greater or less than 25 degrees. Other factors such as body weight, time of injury or meniscal lesion could be more related to the magnitude of cranial cruciate ligament disease lameness.

Disease-related and overall survival in dogs with cranial cruciate ligament disease, a historical cohort study

OBJECTIVE

To analyse the effect of treatment method and other risk factors on survival in dogs with cranial cruciate ligament disease (CCLD).

METHODS

A historical cohort study of 333 dogs presenting with CCLD at two University Hospitals (2011-2016) was performed. Signalment, history, treatment and follow-up details were retrieved from medical records, dog owners and referring veterinarians. Treatment groups were defined; conservative or surgical with either lateral fabellotibial suture (LFS) or osteotomy procedures. Multivariable Cox proportional hazards models were applied to evaluate risk factors for disease-related and overall survival.

RESULTS

Sixty-five dogs were conservatively managed, 125 treated with LFS and 143 with osteotomy techniques. At follow-up (autumn 2018), 164 dogs (49.3 %) were alive and 169 (50.7 %) were dead. Both final Cox proportional hazards models included variables for treatment, age, weight and hospital. In addition, the final disease-related model included a variable for orthopaedic comorbidity, while non-orthopaedic comorbidities and a time-varying effect for age on a linear scale were included in the overall survival model. Treatment method was found to have an effect on both disease-related and overall survival and surgical treatment was associated with a lower hazard than conservative treatment.

CONCLUSION

Survival in dogs with CCLD is influenced by treatment strategy, comorbidities, age and weight.

Cranial cruciate ligament disease in cats: an epidemiological retrospective study of 50 cats (2011-2016)

OBJECTIVES

The aim of this study was to describe the characteristics and long-term outcome of surgically and conservatively treated cats with cranial cruciate ligament disease (CCLD).

METHODS

A retrospective cohort study of cats with CCLD, diagnosed at two university animal hospitals between January 2011 and December 2016, was performed. Signalment, history, treatment and follow-up information were retrieved. Cat owners were contacted for additional long-term follow-up information. The cases were divided into two groups: one conservatively managed and one surgically treated with the lateral fabellotibial suture technique. A quality of life questionnaire, the Feline Musculoskeletal Pain Index (FMPI), was distributed to the owners of cats alive at follow-up for assessment of chronic pain as a long-term outcome. Univariable statistical methods were used to evaluate the data.

RESULTS

Fifty cats were identified and were followed for a median of 41 months after diagnosis of CCLD. Seven cats (14%) developed bilateral CCLD. Twenty-eight cats (56%) were treated conservatively and 22 (44%) surgically. All surgically treated cats in which arthrotomy was performed (19/22) had total cranial cruciate ligament rupture and 9/19 (47%) had meniscal injuries. Postoperative surgical complications were recorded in 6/22 cats (27%). Owners of 24/29 (83%) cats still alive at follow-up completed the FMPI questionnaire. The conservatively treated cats had a lower FMPI score, indicating less chronic pain, than those cats treated surgically (P = 0.017).

CONCLUSIONS AND RELEVANCE

Conservatively treated cats with CCLD experienced less chronic pain at long-term follow-up than surgically treated cats. Bilateral disease is not uncommon in cats with CCLD.

Investigating the Probability of Response Bias in Owner-Perceived Pain Assessment in Dogs With Osteoarthritis

Owners' ability to recognize signs of chronic pain in dogs undergoing pharmacologic and nonpharmacologic pain interventions during a period of physical rehabilitation is not known. This study aimed to compare dogs with and without chronic pain, and to assess the relationship between explanatory factors, including the probability of owners' response bias induced by pharmacologic and nonpharmacologic pain intervention, and chronic pain in dogs with osteoarthritis (OA). Seventy-one dogs with OA were included in this observational study. Owner-perceived pain interference was measured by Canine Brief Pain Inventory (CBPI) and owner-perceived pain behavior was assessed using Helsinki Chronic Pain Index. A dichotomous variable of Helsinki Chronic Pain Index was used in regression analysis to investigate the association between chronic pain and explanatory factors (body condition, anti-inflammatory medication, animal physiotherapy consultation once or more and owners' perception of pain interfering). Seventy-five percent of the dogs had ongoing anti-inflammatory medication, 51% of were overweight and 45% had a physiotherapy consultation. Higher levels of overt pain behaviors were reported in items addressing activities. Body condition, physiotherapy consultation and medication were not associated with chronic pain. Odds ratio (OR) and 95% confidence intervals of OR for the CBPI were 1.74 (1.23-2.47) and significantly associated with chronic pain. The adjusted OR of the CBPI did not differ from the crude OR. Owner-perceived pain behavior was not confounded by the dogs' medication. Results indicated that CBPI was not mediated by the medication. The CBPI pain interference score was not associated with response bias and may be used as clinical outcome measure of chronic pain and pain-related disability in dogs with OA along a period of physical rehabilitation comprising pharmacologic and nonpharmacologic pain interventions.

Prospective clinical assessment of tibial tuberosity advancement for the treatment of cranial cruciate ligament rupture in dogs

PURPOSE

To evaluate clinically dogs that underwent tibial tuberosity advancement (TTA) six months previously.

METHODS

Dogs of various breeds, gender, weight, and age that had CCL rupture and underwent TTA for treatment were included in this study. Parapatellar arthrotomy was performed in all patients to assess the joint for a ruptured ligament and meniscal injury before the TTA. The appropriate cage for the TTA was chosen with planning surgery. The surgical procedure was performed according to the literature, using a modified Maquet technique. Six months after surgery, lameness during walking; muscular atrophy; crepitation, cranial drawer and tibial compression tests and quality of life based on owner's evaluation were assessed.

RESULTS

Postoperative complications were observed in only one knee (4.76%), with a surgical site seroma. The mean lameness score at walking was 0.29 (± 0.64). The mean score regarding muscular atrophy was 0.95 (± 1.56). The mean score of the cranial drawer test, in a range from 0 to 5, was 1.52 (± 1.54). The owners rated the dog's quality of life as excellent in 44%, good in 30%, and moderate in 17%.

CONCLUSION

This clinical study supports the affirmation that patients who undergo TTA for treatment of CCL rupture have an acceptable response.

Contribution of antirotational pins and an intact fibula to the ex vivo compressive strength of four tibial plateau leveling osteotomy constructs

OBJECTIVE To assess the contribution of antirotational pins (ARPs) and an intact fibula to the compressive strength of 4 tibial plateau leveling osteotomy (TPLO) constructs (bone and implants). SAMPLE 20 hind limbs from 10 canine cadavers. PROCEDURES Each hind limb was assigned to 1 of 4 TPLO constructs (construct in which the ARP was removed, constructs in which 1 or 2 ARPs were left in place, and construct in which the ARP was removed and the fibula was cut). Following TPLO completion, all limbs underwent mechanical testing that included 10,000 cycles of cyclic axial compression followed by testing to failure at a displacement rate of 1 mm/s. Displacement during cyclic testing; load generated at 0.5, 1.0, and 3.0 mm of displacement; ultimate load; and failure type were recorded for each limb. Mean values were compared among the groups. RESULTS None of the specimens failed during cyclic testing. None of the variables assessed during mechanical testing differed significantly among the 4 groups. During testing to failure, the majority (17/20) of specimens failed as the result of a long oblique fracture through the first screw hole in the distal segment. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that the axial compressive strength and stiffness of a TPLO construct were not significantly affected by the addition of 1 or 2 ARPs or the presence of an intact fibula. These findings appear to support removal of ARPs during uncomplicated TPLOs, but further research is warranted to assess the effect of ARP removal on bone healing and complication rates.

Long-term assessment of a modified tibial tuberosity advancement technique in dogs

ABSTRACT The purpose of study was to assess long-term clinical and radiographic aspects of dogs’ stifle joints which had undergone a modified tibial tuberosity advancement technique (mTTA). A total of 15 stifles that had undergone mTTA for CCL disease of 11 patients were included in this study. Assessments involved patient’s gait analysis, cranial drawer and tibial compression tests, stifle goniometry range of articular motion, thigh and leg girth and radiographic evidence of progression of osteoarthrosis. Variables were compared between operated and healthy limbs and among moments (M0) on the early postop; (M1) 120 days postop; and (M2) approximately 5 years following surgery. A questionnaire regarding owner’s perceptions after approximately 5 years of surgery was assessed. Most dogs presented positive response to cranial drawer and tibial compression tests on operated knees. There was also decrease on goniometry and thigh girth and increase in leg girth. Radiographic evidence of progression of osteoarthritis was seen especially on the long-term follow-up (M2). On gait analysis, most animals presented some degree of lameness in different conditions, in contrast to owners’ perceptions. Osteoarthritis still develops in dogs following mTTA surgery for CCL disease. However, owners were overall satisfied with their recovery and would be willing to accept indication of mTTA for dogs with ruptured CCL.

Why Owners Choose an Orthosis Over Stifle Surgery for Canine Cranial Cruciate Ligament Deficiency

The objective of this study was to describe the patient population of dogs with cranial cruciate ligament (CrCL) deficiency that were prescribed a stifle orthosis. A total of 215 client-owned dogs with previously diagnosed CrCL deficiency were prescribed a stifle orthosis at a veterinary pain management and mobility clinic. Patient intake data collected included dog signalment, chief medical complaint, home environment and activity description, medical and surgical history, and diagnosing veterinarian. An orthopedic examination was conducted to assess pelvic limb function and determine pelvic limb morphologic measures. Spayed females (57.2%) were most common in our sample. Median age, body weight, and body condition score were 9.00 ± 3.23 years, 32.98 ± 13.37kg, and 6.00 ± 1.04, respectively. Most common breeds prescribed stifle orthoses included Labrador Retriever, Golden Retriever, and German Shepherd. Right and left limbs were equally affected, and 19.5% of dogs previously had stifle stabilization surgery. Primary reasons for seeking a stifle orthosis consultation were surgical concerns, advanced age, and surgery cost. Most common chief complaints included altered gait, decreased weight bearing, and pain following activity. Reduced stifle extension, increased cranial drawer score, and decreased 3-leg stance time characterized the CrCL-deficient stifle. Stifle orthosis represents an alternative approach to surgical stabilization and management of CrCL deficiency. CrCL-deficient dogs prescribed stifle orthoses were generally large breeds of advanced age with above ideal body condition score. Owners commonly sought a stifle orthosis for CrCL deficiency due to reservations regarding surgical management.

Owner assessment of chronic pain intensity and results of gait analysis of dogs with hip dysplasia treated with acupuncture

OBJECTIVE To evaluate pain intensity and kinetic variables in dogs with hip dysplasia (HD) treated with acupuncture, carprofen, or a placebo. DESIGN Randomized, controlled clinical study. ANIMALS 54 HD-affected dogs and 16 healthy dogs. PROCEDURES Seven HD-affected dogs were removed from the study. Dogs with HD were treated in a blinded manner for 30 days with acupuncture (once weekly for 5 sessions; n = 15), carprofen (4.4 mg/kg [2.0 mg/lb], PO, q 24 h; n = 16), or placebo capsules containing lactose (1 mg/kg [0.45 mg/lb], PO, q 24 h; n = 16). Dogs were evaluated 2 weeks and immediately before (baseline) and 2, 4, and 6 weeks after the onset of treatment. Owners evaluated the dogs' pain intensity with 2 validated questionnaires and a visual analogue scale (VAS) for pain and evaluated degree of lameness with a VAS for locomotion. Kinetics of the hind limbs were also evaluated. Sixteen HD-free dogs were used to assess the evaluation protocol. RESULTS Owners' assessments revealed that outcomes of the 3 treatments did not differ significantly. The Canine Brief Pain Inventory and VAS pain intensity assessments were decreased from baseline at weeks 4 and 6, respectively, but only in acupuncture-treated dogs. The locomotion VAS values were decreased at week 4 in acupuncture-treated and carprofen-treated dogs. Kinetic evaluation findings did not differ among the groups or over time. CONCLUSIONS AND CLINICAL RELEVANCE Neither acupuncture nor carprofen was significantly different from placebo. Acupuncture and carprofen reduced the degree of subjectively evaluated lameness, and acupuncture was associated with a decrease in validated chronic pain scores.

Psychometric evaluation of the canine brief pain inventory in a Swedish sample of dogs with pain related to osteoarthritis

BACKGROUND

To evaluate intervention, implement evidence-based practice and enhance the welfare of dogs with naturally occurring osteoarthritis (OA), access to valid, reliable and clinically relevant outcome measures is crucial for researchers, veterinarians and rehabilitation practitioners. The objectives of the present study were to translate and evaluate psychometric properties, in terms of internal consistency and construct validity, of the owner-reported measure canine brief pain inventory (CBPI) in a Swedish sample of dogs with pain related to OA.

RESULTS

Twenty-one owners of clinically sound dogs and 58 owners of dogs with pain related to OA were included in this observational and cross-sectional study. After being translated according to the guidelines for patient-reported outcome measures, the CBPI was completed by the canine owners. Construct validity was assessed by confirmatory factor analysis, by repeating the principal component analysis and by assessing for differences between clinically sound dogs and dogs with pain related to OA. Internal consistency was estimated by Cronbach's α. Confirmatory factor analysis was not able to confirm the factor-structure models tested in our sample. Principal component analysis showed a two-component structure, pain severity and pain interference of function. Two components accounted for 76.8% of the total variance, suggesting an acceptable fit of a two-component structure. The ratings from the clinically sound dogs differed from OA dogs and showed significantly lower CBPI total sum. Cronbach's α was 0.94 for the total CBPI, 0.91 for the pain severity and 0.91 for the pain interference of function.

CONCLUSIONS

The results indicate that the translated version of the CBPI is valid for use in the Swedish language. The findings suggest satisfying psychometric properties in terms of high internal consistencies and ability to discriminate clinically sound dogs from OA dogs. However, based on the confirmatory factor analysis, the original factor structure in the CBPI is not ideally suited to measure pain related to OA in our sample and the hypothesis of the presented two-factor structure was rejected. Further research needs to be conducted to determine whether the original psychometric results from CBPI can be replicated across different target groups and particularly with larger sample size.

Biomechanics of an orthosis-managed cranial cruciate ligament-deficient canine stifle joint predicted by use of a computer model

OBJECTIVE To evaluate effects of an orthosis on biomechanics of a cranial cruciate ligament (CrCL)-deficient canine stifle joint by use of a 3-D quasistatic rigid-body pelvic limb computer model simulating the stance phase of gait and to investigate influences of orthosis hinge stiffness (durometer). SAMPLE A previously developed computer simulation model for a healthy 33-kg 5-year-old neutered Golden Retriever. PROCEDURES A custom stifle joint orthosis was implemented in the CrCL-deficient pelvic limb computer simulation model. Ligament loads, relative tibial translation, and relative tibial rotation in the orthosis-stabilized stifle joint (baseline scenario; high-durometer hinge]) were determined and compared with values for CrCL-intact and CrCL-deficient stifle joints. Sensitivity analysis was conducted to evaluate the influence of orthosis hinge stiffness on model outcome measures. RESULTS The orthosis decreased loads placed on the caudal cruciate and lateral collateral ligaments and increased load placed on the medial collateral ligament, compared with loads for the CrCL-intact stifle joint. Ligament loads were decreased in the orthosis-managed CrCL-deficient stifle joint, compared with loads for the CrCL-deficient stifle joint. Relative tibial translation and rotation decreased but were not eliminated after orthosis management. Increased orthosis hinge stiffness reduced tibial translation and rotation, whereas decreased hinge stiffness increased internal tibial rotation, compared with values for the baseline scenario. CONCLUSIONS AND CLINICAL RELEVANCE Stifle joint biomechanics were improved following orthosis implementation, compared with biomechanics of the CrCL-deficient stifle joint. Orthosis hinge stiffness influenced stifle joint biomechanics. An orthosis may be a viable option to stabilize a CrCL-deficient canine stifle joint.

Partial Cranial Cruciate Ligament Tears Treated with Stem Cell and Platelet-Rich Plasma Combination Therapy in 36 Dogs: A Retrospective Study

Objective

To evaluate outcomes in 36 dogs with a partial cranial cruciate ligament (CCL) tear treated with autologous bone marrow aspirate concentrate (BMAC) or adipose-derived progenitor cells (ADPC) with platelet-rich plasma (PRP) combination.

Materials and methods

Medical records of client-owned dogs diagnosed with an early partial (≤50%) tear of the craniomedial band of the CCL that was treated with BMAC–PRP or ADPC–PRP were reviewed from 2010 to 2015. Signalment, medical history, physical and orthopedic examination, objective temporospatial gait analyses, radiographs, day 0 and day 90 diagnostic arthroscopy findings, treatment, and outcome were among the data collected. A functional owner questionnaire, including the validated Helsinki chronic pain index (HCPI), was sent to owners whose dog was known to not have had a tibial plateau leveling osteotomy (TPLO). Statistical analysis was performed on data, where significance was established at p < 0.05.

Results

Stifle arthroscopy findings at 90 days posttreatment were available on 13 of the 36 dogs. In nine dogs, a fully intact CCL with marked neovascularization and a normal fiber pattern was found with all previous regions of disruption healed. One dog revealed significant improvement and received an additional injection. The remaining three dogs had a >50% CCL tear, and a TPLO was performed. Four additional dogs were known to have had a TPLO performed elsewhere. Baseline and day 90 posttreatment objective gait analyses were available on 11 of the 36 dogs. A significant difference was found between the treated limb total pressure index percent (TPI%) at day 0 and day 90 (p = 0.0124), and between the treated limb and contralateral limb TPI% at day 0 (p = 0.0003). No significant difference was found between the treated limb and contralateral limb TPI% at day 90 (p = 0.7466). Twelve questionnaires were returned, of which eight were performance/sporting dogs. Seven of the eight had returned to sport; the remaining dog had just begun a return to sport conditioning program 6 months posttreatment. All 12 respondents believed that their dog had an excellent or very good quality of life and rated their dog’s procedural outcome as excellent or good.

Conclusion

The use of BMAC–PRP and ADPC–PRP shows promise for the treatment of early partial CCL tears in dogs. Further studies are needed and should be randomized, blinded, and controlled.

Effect of intraarticular inoculation of mesenchymal stem cells in dogs with hip osteoarthritis by means of objective force platform gait analysis: concordance with numeric subjective scoring scales

Background

Subjective pain assessment scales have been widely used for assessing lameness in response to pain, but the accuracy of these scales has been questioned. To assess scale accuracy, 10 lame, presa Canario dogs with osteoarthritis (OA) associated with bilateral hip dysplasia were first treated with mesenchymal stem cells. Then, potential lameness improvement was analyzed using two pain scales (Bioarth and visual analog scale). These data were compared with similar data collected using a force platform with the same animals during a period of 6 months after treatment.

Results

The F test for intraclass correlation showed that concordance in pain/lameness scores between the 2 measuring methodologies was not significant (P value ≥ 0.9213; 95 % confidence interval, –0.56, 0.11). Although subjective pain assessment showed improvement after 6 months, force platform data demonstrated those same animals had returned to the initial lameness state.

Conclusion

Use of pain assessment scales to measure lameness associated with OA did not have great accuracy and concordance when compared with quantitative force platform gait analysis.

Electronic supplementary material

The online version of this article (doi:10.1186/s12917-016-0852-z) contains supplementary material, which is available to authorized users.

Systematic review of surgical treatments for cranial cruciate ligament disease in dogs

Surgery for cranial cruciate ligament disease is often recommended; however, it is unclear if one procedure is superior. The aim of this systematic review was to answer the a priori question, "Is there a surgical procedure that will allow a consistent return to normal clinical function in dogs with cranial cruciate ligament disease and is that procedure superior to others?" A systematic literature search was performed through September 2013. Peer reviewed publication in the English language and 6 mo of postoperative follow-up were required. In total, 444 manuscripts were identified and reviewed, and 34 met the inclusion criteria. Two studies provided level 1, 6 provided level 2, 6 provided level 3, and 20 provided level 4 evidence relative to the study question. The most common surgical procedures included tibial plateau leveling osteotomy (TPLO, n = 14), lateral extracapsular suture (n = 13), tibial tuberosity advancement (n = 6). The strength of the evaluated evidence most strongly supports the ability of the TPLO in the ability to return dogs to normal function. It also provided strong support that functional recovery in the intermediate postoperative time period was superior following TPLO compared with lateral extracapsular suture. There was insufficient data to adequately evaluate other surgical procedures.

Long-term functional outcome after surgical repair of cranial cruciate ligament disease in dogs

Background

Cranial cruciate ligament (CCL) rupture is a very common cause of pelvic limb lameness in dogs. Few studies, using objective and validated outcome evaluation methods, have been published to evaluate long-term (>1 year) outcome after CCL repair. A group of 47 dogs with CCL rupture treated with intracapsular, extracapsular, and osteotomy techniques, and 21 healthy control dogs were enrolled in this study. To evaluate long-term surgical outcome, at a minimum of 1.5 years after unilateral CCL surgery, force plate, orthopedic, radiographic, and physiotherapeutic examinations, including evaluation of active range of motion (AROM), symmetry of thrust from the ground, symmetry of muscle mass, and static weight bearing (SWB) of pelvic limbs, and goniometry of the stifle and tarsal joints, were done.

Results

At a mean of 2.8 ± 0.9 years after surgery, no significant differences were found in average ground reaction forces or SWB between the surgically treated and control dog limbs, when dogs with no other orthopedic findings were included (n = 21). However, in surgically treated limbs, approximately 30% of the dogs had decreased static or dynamic weight bearing when symmetry of weight bearing was evaluated, 40-50% of dogs showed limitations of AROM in sitting position, and two-thirds of dogs had weakness in thrust from the ground. The stifle joint extension angles were lower (P <0.001) and flexion angles higher (P <0.001) in surgically treated than in contralateral joints, when dogs with no contralateral stifle problems were included (n = 33). In dogs treated using the intracapsular technique, the distribution percentage per limb of peak vertical force (DPVF) in surgically treated limbs was significantly lower than in dogs treated with osteotomy techniques (P =0.044).

Conclusions

The average long-term dynamic and static weight bearing of the surgically treated limbs returned to the level of healthy limbs. However, extension and flexion angles of the surgically treated stifles remained inferior to healthy joints, and impairment of AROM and weakness in thrust from the ground in the surgically treated limbs were frequently present. Ground reaction forces may be inadequate as a sole method for assessing functional outcome after cranial cruciate ligament repair.

Veterinarians' attitudes to chronic pain in dogs

Veterinary surgeons in the UK were invited to complete an internet survey concerning their attitudes to chronic pain in dogs. UK veterinary surgeons numbering 215 completed surveys in full along with 48 worldwide specialists in anaesthesia and 37 worldwide specialists in oncology. Osteoarthritis, dental and aural disease, vertebral and spinal cord conditions, neoplasia and skin conditions were considered important causes of chronic pain in dogs. UK practitioners used significantly fewer classes of analgesic drugs regularly than either category of specialist. The major barriers to adequate treatment of chronic pain were reported as difficulties with pain assessment, expense of drugs, and difficulties with owner compliance. Illustrations of six common neoplastic conditions were used and scored for pain according to prior experience by practitioners. All six conditions were consistently described as involving some degree of pain with primary bone tumour and oral tumour, causing severe pain and moderate to severe pain, respectively. Years since graduation and specialist status affected the pain scores attributed to the conditions. There was a significant correlation between the pain score attributed to the illustrated condition, and the tendency to administer analgesia.

A retrospective review of antebrachial angular and rotational limb deformity correction in dogs using intraoperative alignment and type 1b external fixation

AIM

The aim of this study was to report the outcome of acute antebrachial angular and rotational limb deformity (AARLD) correction using a standard radial ostectomy, an unarticulated type 1b external skeletal fixator (ESF) and intra-operative alignment with no pre-operative planning.

METHODS

A retrospective evaluation was performed of dogs with carpal valgus, radial procurvatum and rotational deformity of the forelimb. All 39 cases presented and were treated surgically at a referral hospital in Melbourne, Australia, between September 2008 and March 2012. Surgical correction involved a standard closing cuneiform radial ostectomy, distal ulnar ostectomy and application of an unarticulated type 1b ESF. The method used intra-operative limb alignment and did not use pre-operative planning. Outcome was assessed via client phone interviews in all cases. Five cases were evaluated post-operatively using centre of rotation and angulation (CORA) methodology.

RESULTS

As reported by owners of the 39 cases following surgery, limb function was excellent in 26 (67%), good in 12 (31%) cases and acceptable in one (2.5%) case. Frame tolerance was reported as good in 24 (62%), acceptable in 14 (36%) cases and poor in one (2.5%) case. Limb appearance was reported as straight in 25 (64%) cases and mildly rotated in 14 (36%) cases. In five cases that were evaluated, post-operative frontal and sagittal plane alignment ranged from 0-3.1° and 9.1-12.2°, respectively, and distal CORA was corrected to <6.1°. These were within the normal reported reference ranges. Pin tract infections were reported in seven (18%) cases CONCLUSIONS AND CLINICAL RELVANCE: This study suggests that the described technique may be an effective practice for the correction of AARLD that provides good clinical results, based on client assessment. The effectiveness of this technique was further supported by the five cases that underwent objective radiographic assessment. The technique is simpler than techniques that use extensive pre-operative planning, uses a smaller inventory and is easily applicable in companion animal practice.