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Objective: To report outcomes of dogs with common calcanean tendon (CCT) ruptures treated with a platelet-rich plasma (PRP) enhanced nonabsorbable loop-suture technique., Study Design: Retrospective case series., Animals: Client-owned dogs (n = 12)., Methods: Medical records (2015-2017) of dogs with CCT ruptures repaired with a loop-suture tenorrhaphy and autogenous leukoreduced PRP were reviewed for signalment, history, type of injury, treatment, and clinical follow-up. Outcomes were assessed by functional anatomic measurements and Canine Orthopedic Index (COI) scores transformed to percentages, with 100% representing no problems., Results: Twelve tendons were treated. Two dogs had major complications that were successfully revised. Follow-up was available in 11 of 12 dogs, with a median time of 12 months (range, 4-36), including COI for 11 dogs and anatomic measurements for 6 dogs. Anatomic measurements did not differ between treated and normal contralateral limbs (midthigh muscle mass P > .99, cranial tibial muscle mass P = .37, CCT diameter P = .08, tibiotarsal joint angle P > .99). Owners scored function (COI) as 96.4% (range, 93.3%-97.8%) and quality of life as 94.6% (range, 92%-98.2%)., Conclusion: Loop-suture tenorrhaphy with application of autogenous leukoreduced PRP at the repair site resulted in restoration of functional anatomic measurements, high COI, and client satisfaction., Clinical Significance: Loop-suture tenorrhaphy with local application of autogenous leukoreduced PRP appears to offer an acceptable option to treat CCT injuries in dogs., (© 2019 The American College of Veterinary Surgeons.)

Objective: To determine the effect of sliding humeral osteotomy (SHO) on frontal plane thoracic limb alignment in standing and recumbent limb positions., Study Design: Canine cadaveric study., Sample Population: Canine thoracic limbs (n=15 limb pairs)., Methods: Limbs acquired from healthy Labrador Retrievers euthanatized for reasons unrelated to this study were mounted in a limb press and aligned in a standing position followed by axial loading at 30% body weight. Frontal plane radiography was performed in standing and recumbent positions pre- and post-SHO. In the standing position, lateralization of the foot was measured pre- and post-SHO using a textured grid secured to the limb press base plate. Twelve thoracic limb alignment values (mean ± SD and 95% CI) were determined using the center of rotation of angulation (CORA) method were compared using linear mixed models to determine if significant differences existed between limb alignment values pre- or post-SHO, controlling for dog, limb, and limb position., Results: Six of 12 standing or recumbent alignment values were significantly different pre- and post-SHO. SHO resulted in decreased mechanical lateral distal humeral angle and movement of the mechanical humeral radio-ulnar angle, radio-ulnar metacarpal angle, thoracic humeral angle, and elbow mechanical axis deviation toward coaxial limb alignment. In the standing position, the foot underwent significant lateralization post-SHO., Conclusion: SHO resulted in significant alteration in frontal plane thoracic limb alignment. Additional studies are necessary to determine if the changes reported using our ex vivo model occur following SHO in vivo., (© Copyright 2016 by The American College of Veterinary Surgeons.)

Medial compartment disease (MCompD) of the canine elbow can be defined as clinical signs attributable to articular cartilage loss of the medial coronoid process (MCP) of the ulna and medial aspect of the humeral condyle without significant lateral compartment pathology. Whereas outcomes associated with treatment of defined cohorts of dogs with MCompD have not been published, the impressions of many surgeons are that non-surgical management or surgical treatment of the MCP alone does not result in long term highly functional outcomes. Thus, alternative surgical options for treatment of MCompD have been developed including various osteotomies and total elbow replacement (TER) with "successful" outcomes reported in case series. Results and data on safety have been reported for relatively few of these procedures and when reported, major complication rates have been >10% and catastrophic complications have been reported. Accordingly, we sought to develop a surgical technique with the objective of obtaining higher levels of safety and efficacy in the treatment of dogs with MCompD. This report describes the rationale for, and development of, a unicompartmental resurfacing system for treatment of MCompD in the canine elbow., (© Copyright 2014 by The American College of Veterinary Surgeons.)

Objective: To describe the technique for, and long-term clinical outcome of, a modified hip toggle stabilization using the TightRope® system for coxofemoral luxation repair., Study Design: Retrospective case series., Methods: Medical records (July 2008-July 2010) including radiographs (17 limbs) of dogs that had coxofemoral luxation repaired with the TightRope system were reviewed. Follow-up (≥12 months) was obtained by telephone interview of owners. Six dogs were available for re-evaluation, radiographs, and objective gait analysis., Results: Follow-up (mean, 24 months; range, 12-43 months) by telephone interview was available for 17 dogs. Of these, 6 dogs were re-evaluated (mean, 7.5 months; median 12.5 months: range, 4-24 months) and had gait analysis. Mean duration of luxation before surgical intervention was 7.5 days (median, 7 days; range, 2-44 days). There was a single case of relaxation 27 months postoperatively. One dog died from non-surgical related circumstances. Objective gait analysis showed equal pelvic limb use in all 6 dogs available for re-evaluation. All owners of living dogs reported limb function as being good to excellent, and perceived that their dogs were pain free. Radiographs (mean, 7.5 months; median, 12.5 months; range, 4-24 months post surgery) of 6 dogs showed no progression of osteoarthritis in comparison to immediate postoperative radiographs., Conclusions: Hip toggle with the TightRope system as a prosthetic ligament of the head of the femur produces a favorable clinical outcome with high owner acceptance., (© Copyright 2014 by The American College of Veterinary Surgeons.)

Objectives: To compare (1) pullout properties between 3.5 mm cortical and locking screws, and (2) mechanical properties and gap displacements between the 3.5 mm broad limited-contact dynamic compression plate (LC-DCP), broad dynamic compression plate (DCP), and narrow locking compression plate (LCP), during axial loading of plate-stabilized diaphyseal fragments with an interfragmentary gap., Study Design: In vitro mechanical testing of implanted polyurethane foam (PUF) hollow cylinders that simulated compact or osteopenic diaphyseal bone., Sample Population: (1) Five cortical and locking screws and (2) 4 PUF-plate constructs for each plate type; using high- and low-density (0.8 and 0.32 g/cm(3)) cylinders., Methods: (1) Screws were completely extracted at 5 mm/min. (2) Plated constructs were axially compressed at 300 N/s for 10 cycles from 5 to 355 N to determine gap displacement during physiologic loading, followed by single cycle increasing load to failure., Results: Pullout properties were not different between screw types. All plate constructs had yield loads over 3 times trotting loads. Gap closure occurred with LC-DCP and DCP constructs, but not LCP constructs. LCP construct properties were most similar to LC-DCP and DCP construct properties in the low-density model., Conclusion: All plate systems sustained physiologic limb loads. Only LCP constructs maintained some gap integrity, although LC-DCP and DCP screws were placed in neutral position., Clinical Relevance: The LCP system is more likely than LC-DCP and DCP systems, with neutrally positioned screws, to maintain a planned interfragmentary gap, although gap strains range from 0% to 15% across the 2 mm gap during a trot load.

Objective: To determine the effect of humeral wedge and humeral slide osteotomies on force distribution between the articular surfaces of the humerus and the radius and ulna in normal canine thoracic limbs., Study Design: In vitro mechanical testing., Sample Population: Cadaveric canine right thoracic limbs (n=12)., Methods: Transarticular elbow force maps were measured using a tactile array pressure sensor in elbow joints of axially aligned limbs under 200 N axial load before and after humeral wedge and humeral slide osteotomies., Results: Loading induced 2 distinct areas of high forces that corresponded with the proximal articular surfaces of the radius and ulna. Mean force on the proximal articular surface of the ulna was reduced by 25% and 28% after 4 and 8 mm sliding osteotomies, respectively. Statistically significant differences were not observed for the wedge osteotomies., Conclusion: Humeral slide osteotomy significantly decreases force on the proximal articular surface of the ulna., Clinical Relevance: The proximal articular surface of the ulna contributes significantly to load transfer through the canine elbow joint. Abnormalities that significantly increase this force might contribute to canine elbow dysplasia, specifically fragmentation of the medial coronoid process and osteochondritis dissecans of the medial aspect of the humeral condyle. Under the conditions studied, the overall reduction in mean joint surface force across the proximal articular surface of the ulna after humeral slide osteotomy indicates that this technique merits further investigation for potential use in medial compartmental osteoarthritis of the canine elbow joint.

Objective: To measure and compare activities of interleukin-1beta (IL-1beta), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and matrix metalloproteinase-3 (MMP-3); as well as sulfated glycosaminoglycan (S-GAG) content in synovial fluid from dogs with cranial cruciate ligament rupture (CCLR) and dogs with clinically normal stifles. To determine whether correlations exist between demographic and disease-related variables and these synovial markers., Study Design: Prospective clinical study., Animals: Dogs with CCLR (n=23) and Beagles with normal stifle joints (n=21)., Methods: Synovial fluid activities of proinflammatory cytokines (IL-1beta, IL-6, and TNF-alpha) were determined by bioassay. MMP-3 activity was measured using fluorogenic substrate. S-GAG contents were determined by dimethylmethylene blue dye-binding assay. Mann-Whitney U-test was used to compare results from CCLR joints with normal controls. Spearman's rank correlation test was used to evaluate associations between demographic and disease-related markers and synovial markers., Results: Mean values for synovial markers were significantly higher in CCLR joints compared with controls. IL-1beta and MMP-3 were positively correlated with lameness duration., Conclusions: Activities of proinflammatory cytokines, MMP-3 activity and S-GAG contents were significantly elevated in synovial fluid from canine stifle joints with naturally acquired CCLR. These results indicate that there is joint inflammation and increased release of GAGs into synovial fluid, suggesting that these inflammatory changes are associated with depletion of proteoglycan from articular cartilage., Clinical Relevance: Medical and surgical treatments designed to decrease joint inflammation and breakdown of proteoglycans may be of value in the management of CCLR in the dog.

Objective: To compare radioulnar incongruence (RUI) of normal canine elbows and elbows with arthroscopically confirmed medial compartment disease in vivo using systematic computed tomography (CT) measurements., Study Design: Prospective comparison of RUI measurements in normal and dysplastic canine elbows., Sample Population: Right elbows of 25 medium-large breed, adult dogs with medial compartment disease and 9 medium-large breed, adult dogs with no elbow disease., Methods: Transverse CT images of proximal radioulnar articulation were reformatted to dorsal and sagittal planes. RUI in 3 locations of the forelimb's medial coronoid was measured. Arthroscopy confirmed diagnosis of medial compartment disease in the diseased group. RUI measurements of the diseased and normal elbows were compared., Results: Cumulative statistical analysis of RUI in all planes revealed no significant difference between the normal and abnormal elbows (P = .61). The abnormal elbows had negative mean RUI at the mid (P = .56) and cranial (P = .24) coronoid regions that were not significantly different from normal elbows and mean positive RUI at the base coronoid that was significantly greater than in normal elbows (P = .00082)., Conclusion: Canine elbows with established medial compartment disease do not have significant RUI at the medial coronoid region at the time of diagnosis when compared with normal elbows., Clinical Relevance: If RUI is a significant factor in the pathophysiology of medial compartment elbow disease in the dog, it does not appear to be present at the time of diagnosis of disease. Ulnar or radial osteotomies do not appear to be indicated for restoration of normal radioulnar articular surface alignment.

Objective: To evaluate the accuracy of linear measurements obtained from computer tomography (CT) images of staged radio-ulnar incongruence in a canine cadaver forelimb model., Study Design: CT evaluation of induced progressive radio-ulnar incongruence in canine cadaveric forelimbs., Sample Population: Eight cadaveric canine left forelimbs., Procedure: A type 2 external skeletal fixator (ESF) with linear motors was attached to the radius in 8 cadaveric left canine forelimbs. Contiguous incremental and helical CT images of the proximal radio-ulnar articulation were acquired in the transverse, sagittal and dorsal planes. The radius was shortened by 1, 2, and 4 mm increments and scanning protocols were repeated at each increment. Digital caliper and CT image analysis measured the progressive change in distance between 2 marking spheres and the epiphyseal bone surfaces of the radio-ulnar articulation. Statistical analysis of measurements from incremental and helical CT acquisitions, and direct and reformatted images were compared with inter-sphere distance using Pearson product moment correlation coefficients., Results: The reformatted incremental acquisition series at the mid-coronoid in the oblique plane had the highest correlation coefficient (r-value) at 0.908. The mid-coronoid in the dorsal plane had the second highest r-value (0.856). The coronoid incisure in the sagittal plane had an r-value of 0.826. The reformatted incremental acquisition series at the coronoid incisure in the oblique plane had the lowest r-value, 0.592., Conclusion: Measurement of radioulnar incongruence may be best performed using reformatted incremental acquisition CT in the mid-coronoid region in an oblique plane., Clinical Relevance: Use of the technique reported in this study may enable determination of the association, if any, between radioulnar incongruence and developmental diseases of the canine elbow.

Objective: To determine the effects of femoral prosthesis stem length on positioning of the femoral component within the canine femur., Study Design: An in vitro experimental study., Sample Population: Eleven adult, mixed breed, canine cadaver femurs., Methods: Polymethylmethacrylate centralized Biomedtrix size 5, 6, and 7 standard and 1cm shortened implants were placed in specimens, manipulated to achieve maximal displacements of the implant tip in each plane, and radiographed. Measurements of the implant angle, tip offset, and minimal tip to endosteal surface distance were obtained with image processing software. The effects of implant length and size on implant positioning were evaluated with the use of Student's t, chi(2) exact, and 2-way ANOVA testing., Results: Statistically significant increases were noted in tip to caudal cortex distance in the sagittal plane, and available angle variability and tip offset variability in the transverse plane for shortened size 6 and 7 stems relative to the standard stems. No significant differences were noted in size 5 stems. Statistically significant increases in tip to caudal cortex distance and transverse plane available angle variability for standard 6 compared to standard 7 stems were noted., Conclusions: Shortened stems result in statistical improvement of several variables of femoral component positioning. However, the improvement appears to be clinically negligible., Clinical Relevance: Alteration of current stem lengths is not recommended. The use of undersized standard implants may improve femoral component positioning in total hip arthroplasty.

Objective: To describe self-retaining braces for canine shoulder, elbow, hip, and stifle arthroscopy., Study Design: Clinical design and application., Sample Population: Clinical patients admitted for elective arthroscopy., Methods: Self-retaining braces were designed and constructed from commercially available products, steel tubing, and upholstery. The design efficacy was determined by clinical use., Results: A shoulder/hip retraction device was constructed from a heavy-duty Mayo stand and a steel T frame. An elbow brace and a stifle brace were constructed from a commercially available positioning arm and steel tubing. These devices were used successfully in clinical canine arthroscopy and provided consistent stability for arthroscopic surgery without the need of a surgical assistant., Conclusions: Arthroscopic self-retaining braces can be constructed from commercially available products and other simple materials to provide reliable patient positioning without the need for a surgical assistant., Clinical Relevance: Self-retaining braces may provide improved patient stabilization and eliminate the need for a surgical assistant in most cases of canine arthroscopy.

Objective: To determine the practicality and clinical outcome of miniature total hip replacement (THR) in dogs., Study Design: Retrospective study. Sample Population- Seventeen client-owned dogs that had miniature THR., Methods: Patient data surveyed included signalment, body weight, diagnosis, implant size, surgical technique, and intraoperative and postoperative complications. Radiographic evaluation included angle of lateral opening of the acetabular component, implant positioning, cement mantle quality, and femoral displacement measurement and ratio. Client questionnaire and orthopedic examination were used to obtain long-term follow-up information., Results: Miniature THR was performed to address hip dysplasia and secondary osteoarthritis. In 1 dog, a staged bilateral procedure was performed. Mean body weight was 19 kg (range, 12 to 25 kg). Penetration or fissure of the femoral cortex was the most common intraoperative complication and occurred in 3 dogs. In 3 dogs, there was excessive coxofemoral laxity after reduction of the prosthesis. This instability was addressed specifically in 2 dogs by capsulorrhaphy or capsular prosthesis. Postoperative convalescent complications (craniodorsal luxation, 2 dogs; acetabular cup displacement, 1 dog) were related to surgical errors. Aseptic loosening of the femoral implant was diagnosed in 1 dog at 18 months. Mean follow-up time was 17 months (range, 4 to 42 months). Fifteen of 18 (83%) miniature THRs had good or excellent outcomes., Conclusions: Miniature THR should be considered a satisfactory alternative to femoral head and neck ostectomy in medium-size dogs affected by hip dysplasia and secondary osteoarthritis. The population of medium-size dogs that might derive more benefit from THR than FHO has yet to be defined., Clinical Relevance: Miniature THR is a viable treatment option in medium-size dogs with hip dysplasia., (Copyright 2003 by The American College of Veterinary Surgeons)

Objective: To report the use of dorsal acetabular augmentation (DAA) in canine total hip arthroplasty (THA) and to evaluate the clinical and radiographic outcome after a minimum of 1 year follow-up., Study Design: Clinical study., Animals: Nine dogs that had THA., Methods: Ten hips requiring acetabular augmentation for optimum acetabular cup implantation for THA were evaluated retrospectively. The excised femoral head and neck was used as the corticocancellous bone graft for index THA surgeries, and the dorsal crest of the ipsilateral ilial wing was used as the bone graft in 1 dog that had a revision surgery. Clinical and radiographic follow-up examinations were performed at approximately 8 weeks and 1 year postoperatively. Long-term radiographic examinations included use of a standing dorsal acetabular rim (DAR) projection for assessment of graft-recipient boundary. Functional clinical outcome was assessed using direct patient evaluation and telephone interview., Results: One dog failed to regain limb function after surgery. Suspected aseptic loosening of the acetabular cup was observed on radiographs approximately 12 weeks postoperatively. Excluding this single explantation, follow-up physical and radiographic examinations indicated good implant and graft positioning and normal function for all dogs., Conclusions: Acetabular augmentation permitted implantation of an appropriately sized acetabular cup while maintaining complete DAR coverage of the prosthesis. Nine out of 10 hips had a successful outcome with minimal radiographic and no functional abnormalities. Further follow-up is necessary to determine the long-term outcome of DAR augmentation in canine THA., Clinical Relevance: Acetabular augmentation with an autogenous corticocancellous bone graft constructed from the femoral head and neck can provide complete DAR coverage to permit use of an appropriately sized acetabular cup in THA., (Copyright 2003 by The American College of Veterinary Surgeons)

Objective: To determine the effects of femoral prosthesis stem length and head size on cement strains in a canine hip replacement system., Study Design: An in vitro experimental model., Sample Population: (1) Three standard and 3 1-cm shortened femoral implants with +3 femoral heads. (2) Two standard implants with +0, +3, and +6 femoral heads., Methods: Femoral stems were embedded in polymethylmethacrylate cement. A uniaxial proximodistal-oriented strain gauge was applied to the cement on the medial and lateral aspects of the construct 1.5 cm, 6.0 cm and 7.0 cm distal to the collar. Each construct with a +3 femoral head was mounted in a materials testing system. An axial compressive load (0-200 N) was applied to the femoral head and cement strains were recorded. Additionally, 2 standard length constructs were also tested with +0 and +6 femoral heads. The effects of stem length and neck length on cement strains were assessed with analysis of variance., Results: Strains increased at all locations with increasing loads for all constructs. Shorter implants had higher strains by 152% and 171%, lateral (P =.003) and medial (P =.0025) to the stem tip. No significant strain differences were noted, at any strain gauge location, between different neck lengths (P values ranged from.20 to.67)., Conclusions: Although a shorter implant stem has a potential to improve implant fit, it led to significantly higher cement strains that may increase the risk for aseptic loosening. Changes in femoral neck length did not significantly affect cement strains under the conditions tested., Clinical Relevance: Shortening of the femoral stem currently cannot be recommended in canine total hip replacement. The existing use of variable neck lengths likely does not increase the risk of failure of the femoral stem., (Copyright 2003 by The American College of Veterinary Surgeons)

Objective: To determine the sensitivity and specificity of radiographic evaluation of radio-ulnar incongruence in canine elbow joints in vitro., Study Design: Radiographic evaluation of induced radio-ulnar incongruence in canine cadaveric forelimbs by radiologists blinded to study design., Sample Population: Six cadaveric canine left forelimbs., Methods: Extended lateral, 90 degrees flexed lateral, and cranio-caudal projections were taken of the elbow joint of six cadaveric canine forelimbs. A four-pin, type I external skeletal fixator (ESF) with a linear motor side bar was attached to the medial aspect of the radius, and a 2-cm segment of bone was removed from the mid-diaphysis. A 3.5-mm cortical bone screw placed from the medial to lateral styloid processes prevented relative movement between the distal radius and ulna during radial shortening. The ESF was used to progressively shorten the radius in increments of 0.5 mm to a total of 4 mm. The three radiographic projections were repeated after each incremental change of length. After the study, each elbow joint was disarticulated to confirm the presence of a step defect. The original radiographs and three copies were randomized and then evaluated by four radiologists blinded to the study design. Radiologists were asked to evaluate whether the joint was normal or abnormal and if there was evidence of radio-ulnar incongruence. The ability of each radiologist to correctly identify congruent elbows (specificity) and incongruent elbows (sensitivity) was calculated., Results: The median specificity was 86% using the lateral projection and 82% using the cranio-caudal projection. The median sensitivities using the lateral and cranio-caudal radiographic projections were 78% and 79%, respectively. The degree of radial shortening required for individual radiologists to achieve a sensitivity of 90% ranged from 1.5 mm to greater than 4 mm., Clinical Relevance: Standard radiographic evaluation for radio-ulnar incongruence in the dog may be associated with relatively poor sensitivity and specificity. Invasive surgical procedures and screening programs that rely on radiographic diagnosis of radio-ulnar incongruence should be discouraged until a more reliable method of diagnosis of this type of elbow joint incongruence is available., (Copyright 2002 by The American College of Veterinary Surgeons)