Long-term follow-up in eight Bernese Mountain Dogs

Therapeutic success in fragmented coronoid process disease and other canine medial elbow compartment pathology: a systematic review with meta-analyses

Introduction

The correct treatment of elbow dysplasia is controversial in modern small animal orthopedics. The aim of this study was to compile all relevant literature of the therapy of fragmented coronoid process and other hereditary disorders of the medial elbow compartment and to statistically evaluate the therapeutic results in three meta-analyses.

Methods

The basis for the systematic literature review was a comprehensive database search of Web of Science, PubMed and Medline. Studies on living patients with above mentioned degenerative joint disease were included in the initial literature search. The data from the final studies, selected according to the PRISMA guidelines, was subsequently extracted. Finally, the success of the different therapies was compared and analyzed by three meta-analyses: success rate, mean difference and standardized mean difference.

Results

Fourteen of 494 publications covered by the systematic literature search remained. Their overall truth was: In studies where surgery outcomes was determined by clinical examination and owner questionnaires, it was found that surgical intervention had a significant positive outcome in the presence of fragmented coronoid process and medial compartment disease. Surgical outcomes were also good in three cross-over studies that investigated treatment success using computerized gait analysis. In contrast, comparative studies between surgical and conservative management yielded controversial results. The meta-analysis found no significant difference between medical and surgical therapy.

Discussion

The positive results of studies investigating owner satisfaction and veterinary clinical examination of surgical therapy for medial compartment disease were confirmed by two meta-analyses. However, their study designs were susceptible to observer biases. A third meta-analysis of standardized mean difference differentiating computerized gait analysis results of surgical and conservative management found no evidence of significant superiority of each treatment modality. It however had a limited number of subjects. More comparative studies of high evidence are needed to better understand medial compartment disease and provide the clinician with more accurate diagnostics to separate pathology that should be treated surgically from pathology that can benefit from conservative therapy similarly. Given the invasiveness a more cautious approach might be warranted regarding generally recommending surgery for pathology of the medial elbow compartment.

Owner assessed outcomes following elbow arthroscopy with or without platelet rich plasma for fragmented medial coronoid process

Objective

Document the outcomes of bilateral arthroscopic subtotal coronoidectomy for the fragmented medial coronoid process, quantify persistent lameness that required additional treatment (PRP), and document the outcomes of dogs that followed up with PRP injections.

Study design

Retrospective study.

Sample population

Overall, 115 dogs underwent arthroscopy alone and 31 received PRP at least 6 weeks after arthroscopy. The owner's response rate was ~50% (73 dogs).

Methods

Collected data included signalment, unilateral or bilateral clinical signs, intra-articular chondroprotective injection during the procedure, if PRP intra-articular injection was received postoperatively, and if it was received, the time from the initial surgery to administration was recorded. Outcomes were assessed via standardized owner questionnaires using the Liverpool Osteoarthritis in Dogs (LOAD) score, the Canine Brief Pain Inventory (CBPI) score, and the overall quality of life (QOL) assessment.

Results

Approximately 20% of the patients received PRP post-operatively due to persistent lameness following surgery. Similar pain scores were found between the two groups with an average of 11–13 LOAD score, 13–15 CBPI score, and good quality of life. Older animals at the time of surgery and those that received pain-relieving medications after the procedure were more painful and affected their functional outcome. PRP as an adjunctive therapy achieved a perceived good to excellent quality of life in ~90% of pets in this population.

Conclusion

Arthroscopy and subtotal coronoidectomy followed by PRP, if needed, seemed to decrease pain, and improve lameness in the long term.

Clinical significance

PRP should be considered as adjunctive therapy in dogs with the limited response to arthroscopy alone.

Long-Term Prognosis of Quality of Life in Dogs Diagnosed With Mild to Moderate Elbow Dysplasia in Sweden

Objective: The objective of this study was to increase knowledge regarding long-term prognosis of mild to moderate elbow dysplasia (ED) using a canine orthopedic index.

Study Design: Cross-sectional observational study.

Sample Population: Sixty dogs randomly selected from each of five different breeds and three ED groups: ED0 (control), ED1, and ED2, based on the Kennel Club's screening results. The total number of selected dogs was 900 (60^*5^*3).

Methods: Questionnaires were administered to owners by telephone interview. Bayesian network modeling was used to assess the relation between ED grade, treatment options, dog demographics, and quality-of-life indicators.

Results: Seven hundred sixty-five questionnaires were collected (85% response rate), of which 61 concerned dogs euthanized due to osteoarthritis. There was no direct association between ED grade and owner's perceived quality of life, but ED1 and ED2 dogs were more likely to receive veterinary care and subsequent NSAID treatment compared to ED0 dogs. A significant association was found between the occurrence of euthanasia due to orthopedic disease and ED scores 1 and 2 in the sample (p < 0.001).

Conclusion: The degree of osteoarthritis was not directly associated with the canine orthopedic index, except for ED2 and lameness score. It can be speculated that owners who paid closer attention to orthopedic symptoms and perceived them as impairing their dogs' lives were also more likely to seek veterinary care and get treatment, irrespective of the ED grading.

Impact: ED1-graded dogs had a lower risk than might be expected to develop visible clinical symptoms and showed a similar quality of life as dogs with ED0. ED2-graded dogs were more likely than ED0-graded dogs to have their lives impaired by lameness, according to the owners' perception.

Erosion of the medial compartment of the canine elbow: occurrence, diagnosis and currently available treatment options

Erosion of the medial compartment of the elbow joint refers to full thickness cartilage loss with exposure of the subchondral bone (modified Outerbridge grades 4–5) of the medial part of the humeral condyle (MHC) and the corresponding ulnar contact area. This finding may appear in the absence of an osteochondral fragment or a cartilage flap, or in combination with fragmentation of the medial coronoid process (MCP) or osteochondritis dissecans (OCD) of the MHC. With regard to the prognosis, it is important to diagnose these severe erosions. Imaging of cartilage lesions by means of radiography, ultrasonography, computed tomography or magnetic resonance imaging is challenging in dogs. In contrast, direct arthroscopic inspection provides detailed information about the cartilage.

The treatment of these severe erosions is difficult because of the limited regenerative capacity of cartilage and presumed mechanical or physical triggering factors. Several conservative and surgical treatment methods have been proposed to treat elbows with severe cartilage defects. However, due to irreversible loss of cartilage, the prognosis in these cases remains guarded.

Analysis of risk factors for elbow dysplasia in giant breed dogs

Objective: Identify radiographic risk factors for development of elbow dysplasia in giant breed dogs less than one year of age.

Methods: Twenty-five giant breed puppies (Bernese Mountain dogs, English Mastiff, and Newfoundland) were studied. Both elbows of each dog were radiographed monthly from two to six months of age, then every other month until radial and ulnar physeal closure, followed two months later by bilateral elbow computed tomography. Radiographic parameters measured included the presence or absence of a separate centre of ossification of the anconeal process (SCOAP), medial coronoid disease (MCD), ununited anconeal process, humeral osteochondrosis, elbow incongruity, as well as the length of the radius and ulna, radius-to-ulna ratio, and date of closure of the radial and ulnar physes.

Results: Fifteen dogs completed the study. Two Bernese Mountain dogs were diagnosed with MCD. Risk factors significantly associated with medial coronoid disease included dyssynchronous physeal closure and a decreased radius-to-ulna ratio, both detected between eight to 11 months of age. A separate centre of ossification of the anconeal process was present in 60% of the dogs, and was not a risk factor for development of elbow dysplasia.

Clinical significance: Transient, dyssynchronous growth of the radius and ulna may be a risk factor for development of MCD in Bernese Mountain dogs. Dyssynchronous physeal closure or decreased radius-to-ulna ratio prior to radiographic closure of the distal ulnar and radial physes warrants further study in Bernese Mountain dogs and other breeds subject to MCD development.

Radiographic assessment of humeroulnar congruity in a medium and a large breed of dog

Elbow joint incongruity is recognized as an important factor in the development, treatment, and prognosis of canine elbow dysplasia. Elbow incongruity has been measured based on radiographic joint space widths, however these values can be affected by the degree of elbow joint flexion. Recent studies have reported radiographic curvature radii as more precise measures of humeroulnar congruity in dogs. The aim of this prospective observational study was to describe radiographic curvature radii measured from flexed and extended elbow radiographs for a sample of dogs representing a medium breed (Portuguese Pointing Dog) and a large breed (Estrela Mountain Dog). The curvature radii from the ulnar trochlear notch and humeral trochlea were measured in 114 mediolateral elbow extended radiographic views (30 Portuguese Pointing Dog and 27 Estrela Mountain Dog), and 84 mediolateral flexed views (22 Portuguese Pointing Dog and 20 Estrela Mountain Dog). The sampled animals' ages ranged from 12 to 84 months (34.6 ± 17.8 months). Good agreement was observed between curvature radii measurements for flexed vs. extended views in both breed groups. Ulnar trochlear notch curvature radii measurements were greater than humeral trochlea curvature radii measurements in both breed groups. Both curvature radii were greater in the large-breed dog group vs. the medium-breed dog group. Both breed groups had ulnar and humeral curves with similar typology. However, the large breed group had greater intermediate differences between the humeroulnar surface curvature radii. Results from this study supported the use of curvature radii as measures of humeroulnar congruity in mediolateral flexed elbow radiographs of medium and large breed dogs.

Computed tomography and radiographic assessment of congruity between the ulnar trochlear notch and humeral trochlea in large breed dogs

OBJECTIVE

Assess the fit between the ulnar trochlear notch (UTN) and humeral trochlea (HT) in elbow radiographs and computed tomography (CT) images by measuring the curvature radii in normal joints.

METHODS

Mediolateral extended view (MLE) and CT were performed on 16 elbows from cadaveric dogs weighing over 20 kg. Curves were traced at the subchondral level from the UTN central ridge and the HT sagittal groove related to the UTN on ~132° joint extension. Curvature radii were achieved using appropriate computer software.

RESULTS

Intraclass correlation coefficient between MLE/CT measurements were statistically significant, with lower limits of a 95% confidence interval (CI) >0.75. The mean differences between MLE/CT measurements were -0.71 mm (95% CI: -0.97 to -0.45) for UTN and -1.04 mm (95% CI: -1.21 to -0.87) for HT. The UTN and HT curvature radii typology were similar, with maximum radius values at the starting point and two intermediate peaks. The UTN curvature radii were bigger than the HT radii, with the largest differences in the most proximal aspect of the joint and in the second intermediate peak.

CLINICAL SIGNIFICANCE

To the authors' knowledge, this is the first report on humeroulnar congruity through curvature radii evaluation. The software and methodology proposed enabled an adequate UTN and HT radii curvature assessment in MLE and CT images. Comparative studies in normal and dysplastic dogs of various breeds could better clarify the role of UTN and HT curvature radii in elbow incongruity and dysplasia.

In vitro biomechanical comparison of load to failure testing of a canine unconstrained medial compartment elbow arthroplasty system and normal canine thoracic limbs

Elbow dysplasia, primarily affecting the medial compartment, is the most common cause of lameness in the thoracic limb. Elbow arthroplasty is an option for end stage or severely affected patients. The purpose of this study was to compare ex vivo axial load to failure of an implanted novel elbow arthroplasty system to control limbs. The partial arthroplasty is a medial compartmental, unconstrained system, intended to allow conversion to total arthroplasty. We hypothesized that there would not be any significant difference between implanted and controlled limbs when loaded to failure. Six pairs of medium mixed breed canine cadaveric thoracic limbs were prepared for comparison of failure loading of control and implanted limbs. Axial compression was performed using a mechanical testing system. Failure loads were normalized to bodyweight. The mean normalized failure load (N/kg) for the implanted limbs and control limbs were 2.47 (range: 1.62-3.38) and 2.68 (range: 2.25-3.25), respectively. An implanted to control ratio of 0.93 ± 0.19 was calculated. The difference between paired control and implanted limbs in normalized failure loading was not significant (p = 0.38). There were not any differences noted in the yield load (p = 0.30), stiffness (p = 0.62), or energy (0.58). Failure modes were recorded. We concluded that the differences between implanted and control limbs in supra-physiologic axial load to failure were not significant.