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Objective:  The objective of this prospective study was to evaluate the use of ultrasonography in the diagnosis of medial coronoid process disease in unclear cases., Study Design:  Fifteen elbows (on thirteen dogs) for which radiography and computed tomography did not lead to a clear diagnosis of medial coronoid process disease were included. On each elbow, ultrasonography was performed with a high frequency linear transducer (12-18Hz). Then, arthroscopic examination of the joint was performed by a surgeon who was unaware of ultrasonographic findings to confirm medial coronoid process disease., Results:  At least one ultrasonographic lesion was detected in 13 out of 15 elbows. The main reported ultrasonographic lesions were joint effusion (10/15 elbows) and an abnormal shape of the medial coronoid process (irregular, ill-defined or fragmented) (9/15)., Conclusion:  Ultrasonography can be a helpful additional diagnostic tool to confirm medial coronoid process disease of the elbow joint before performing arthroscopy in unclear cases. Further studies will be needed to evaluate the use of higher frequency transducers and determine if it could improve the diagnostic value of ultrasonography., Competing Interests: None declared., (Thieme. All rights reserved.)

Medial glenohumeral ligament injury is commonly reported during medial shoulder joint instability in dogs. Arthroscopy is considered the gold standard procedure, but it is invasive and requires distension of the joint. Ultrasonographic examination of the medial glenohumeral ligament has been studied as a possible, less invasive alternative to arthroscopy however it has not been considered a useful method of assessment due to the interference of the probe with the pectoral muscles. The aims of this prospective analytical randomized pilot study were to develop a standardized ultrasound protocol for visualizing the canine medial glenohumeral ligament and to compare goniometry and ultrasound findings in cadaver dogs with versus without transection of the medial glenohumeral ligament. Nine adult Beagle cadavers (18 shoulders) were used. The first six shoulders were used in a preliminary study to describe an ultrasound technique to identify the medial glenohumeral ligament. Arthroscopy was performed on the remaining 12 shoulders, with six randomly selected medial glenohumeral ligaments from these shoulders, transected during the procedure. Ultrasound examination was performed after each arthroscopic procedure by an ultrasonographer blinded to the patient group. Four medial glenohumeral ligaments (67%) were correctly identified during the preliminary study. Ultrasonographic examination failed to diagnose the transection of all six medial glenohumeral ligaments in the second part of the study. No difference was observed in the ligament thickness between the dogs with and without a transected medial glenohumeral ligament. Dogs with a transected medial glenohumeral ligament had a wider articular space compared to dogs without a transected ligament (P < 0.001), and an articular space wider than 8.2 mm was discriminatory of a transected medial glenohumeral ligament in all the shoulders. In conclusion, the medial glenohumeral ligament could be identified with a medial ultrasonographic approach of the shoulder and a wider articular space can be a sign of a medial shoulder joint instability. Further studies are needed to confirm these preliminary findings in living dogs, with and without shoulder instability., (© 2022 American College of Veterinary Radiology.)

Objective:  The aim of this study was to assess the feasibility and efficiency of an arthroscopically guided ligamentoplasty of the medial glenohumeral ligament to treat medial shoulder joint instability., Study Design:  Six Beagle cadavers were used (12 limbs). Both arms of the medial glenohumeral ligament were severed using arthroscopic guidance. Arthroscopically guided reconstruction of the ligament was performed. Threaded sutures were fixed with a bone anchor on the medial aspect of the glenoidal cavity of the scapula, passed through a humeral tunnel and finally tensioned with a suture button on lateral aspect of the humerus. Shoulder abduction angles were measured before and after the section of the medial glenohumeral ligament, and following the surgery. Two orthogonal radiographic projections and dissections were performed after each procedure to grade the placement of the implants., Results:  Surgical repairs were achieved in 10 out of 12 limbs. The abduction angles after repair with ligamentoplasty were not significantly different from the abduction angles measured before the section of the medial glenohumeral ligament., Conclusion:  Arthroscopically guided ligamentoplasty with a scapular bone anchor and a humeral drilling tunnel is feasible in cadavers, and efficient to restore acutely shoulder abduction angle in a minimally invasive manner. Further clinical studies are required to assess in vivo results., Competing Interests: T.C. is a paid consultant for Arthrex., (Thieme. All rights reserved.)

Proximal tibial deformities or patellar luxation may occur concurrently with cranial cruciate ligament rupture. The objective of this study was to describe the management of those conditions with a modified triple tibial osteotomy (TTO) in nine dogs. Medical records of dogs who underwent a modified TTO were reviewed. The mean pre- and postoperative patellar tendon angles were 104.2° and 92.9°, respectively. The mean pre- and postoperative mechanical medial proximal tibial angles were 99.5° and 91.5°, respectively. Medial patellar luxation was present in five dogs (55.6%) and treated in all five dogs with a tibial crest transposition. Tibial torsion was grossly resolved in two dogs (22.2%). Perioperative distal tibial crest fracture was treated by pins and a figure-of-eight tension-band wire in five dogs (55.6%). One major (surgical site infection) and three minor postoperative complications were observed. At the last follow-up, seven dogs (77.8%) had no lameness, one dog (11.1%) had mild lameness, and one dog (11.1%) had moderate lameness. Radiographic evaluation showed good (2/9; 22.2%) to excellent (7/9; 77.8%) bone healing. The visual analog scale evaluation revealed good-to-excellent owner satisfaction. Cranial cruciate ligament rupture, tibial deformities, and medial patellar luxation are difficult to treat together. A modified TTO may be used to treat these conditions.

Objectives:  This study aimed to compare outcomes between the tibial plateau levelling osteotomy (TPLO) procedure and a modified tibial tuberosity advancement (TTA Rapid) in dogs with cranial cruciate ligament rupture., Materials and Methods:  Twenty-six dogs were prospectively randomized into two groups: a TPLO group ( n  = 13) and a TTA Rapid group ( n  = 13). A lameness score evaluation, gait analysis and radiographical examination were performed before surgery, the 3 days after surgery, and then at 1, 3 and 6 months postoperatively. Finally, owners were asked to subjectively rate their level of satisfaction., Results:  The duration of surgery was significantly shorter for the TTA Rapid procedure ( p  < 0.0001). There was no significant difference in the occurrence of complications between groups. Lameness scores were significantly higher during the first 3 days after surgery for the TPLO group ( p  = 0.01 at day 1, p  = 0.01 at day 2 and p  = 0.003 at day 3). One month after surgery, the symmetry index between healthy and affected limbs for the relative stance time during the gait cycle (symmetry index/%) was significantly higher for the TTA Rapid group ( p  < 0.01). No gait parameters were significantly different between the two groups 6 months after surgery. All of the owners of dogs in the TPLO group were completely satisfied, whereas only 11/13 owners of dogs in the TTA rapid group were completely satisfied., Clinical Significance:  Tibial plateau levelling osteotomy and TTA Rapid were associated with high long-term success rates in dogs. The immediate postoperative recovery seemed faster with TTA Rapid, but thereafter there was no difference., Competing Interests: The authors have no conflict of interests with regard to this manuscript., (Georg Thieme Verlag KG Stuttgart · New York.)