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

Cranial cruciate ligament (CCL) disease is one of the most common causes of lameness in dogs. Surgical treatment is recommended to stabilize the stifle joint, alleviate pain, and delay the progression of osteoarthritis (OA). A variety of surgical techniques has been introduced and can be broken down into the more traditional intracapsular ligament replacement and extracapsular suture techniques and the newer neutralizing dynamic osteotomy techniques. Although an enormous amount of literature is available concerning this disease, surprisingly few studies have assessed surgical outcome with objective evaluation methods and comparison between groups. Previous studies have demonstrated significant improvement of limb function after CCL surgery. However, OA has been shown to progress in most patients, and this may cause deterioration in the function of the surgically treated limb over time. Long-term follow-up studies that include objective evaluation methods designed for assessing orthopedic outcome are needed. This thesis aimed to evaluate the long-term surgical outcome and signs of chronic pain after CCL surgery. Also, outcomes between the intracapsular, extracapsular and osteotomy techniques were compared. A multimodal approach, including an owner questionnaire and assessment of chronic pain using the validated Helsinki Chronic Pain Index (HCPI), orthopedic and radiographic examinations, force plate analysis, and as a new evaluation method, a physiotherapeutic examination was included. To provide reference values, clinically healthy Rottweilers and Labrador Retrievers were examined. A long-term retrospective follow-up with a mean time interval of at least 2.7 years between the surgery and evaluation was conducted. Of the 206 surgically treated dogs that were evaluated by their owners, 31.1% had a HCPI value ≥ 12, indicating pain. Of the 47 dogs evaluated by a veterinarian 31.9% showed a pain response to flexion/extension of the surgically treated joint. In addition to the unilaterally treated CCL rupture, contralateral stifle joint pathology and other orthopedic problems were frequently diagnosed during the evaluation. When symmetry of weight bearing was evaluated in dogs with no other orthopedic findings (n=21),approximately 30% of dogs had decreased dynamic and static weight bearing in the surgically treated limbs. Also, goniometric angles of the surgically treated limbs remained inferior to those of healthy limbs, and impairment of active range of motion was frequently observed. The owner assessments revealed no significant differences between the surgical techniques in long-term outcome. However, differences were seen in clinical evaluation of dynamic and static weight bearing between intracapsular and osteotomy technique groups. Although the retrospective study design and low sample size have to be acknowledged and may cause bias to the results, osteotomy techniques may offer long-term limb function that is superior to that achieved with the intracapsular technique. The low number of dogs treated with the extracapsular technique did not allow comparison of dynamic or static weight bearing to other technique groups.Eturistisiderepeämä on koirien yleisin takajalan ontuman aiheuttaja ja tavallisin polviniveleen nivelrikkoa aiheuttava sairaus. Leikkaushoitoa suositellaan ristisidevammaan liittyvän polvinivelen löysyyden poistamiseksi, kivun lievittämiseksi ja nivelrikon etenemisen hidastamiseksi. Suuri määrä erilaisia leikkausmenetelmiä on kehitetty, ja ne voidaan jakaa ns. perinteisiin nivelensisäisiin eli intrakapsulaarisiin ja nivelenulkoisiin eli ekstrakapsulaarisiin sekä uudempiin luuleikkaus- eli osteotomiamenetelmiin. Koirien eturistisidevammoista ja niiden hoidosta on julkaistu valtava määrä kirjallisuutta. Suurin osa leikkauksella hoidetuista koirista hyötyy hoidosta eli jalan toiminnan on todettu paranevan selvästi leikkausta edeltävään tilanteeseen nähden. Polvinivelen nivelrikkomuutokset kuitenkin usein etenevät leikkaushoidosta huolimatta, ja tämä saattaa aiheuttaa jalan toiminnan heikkenemistä ajan myötä. Pitkän aikavälin tutkimuksia, joissa käytetään objektiivisia ortopedisen hoitotuloksen mittaamiseen tarkoitettuja menetelmiä, on kuitenkin julkaistu vain vähän. Leikkausmenetelmiä vertailtaessa osteotomiamenetelmien etuna näyttää olevan leikatun jalan nopea käyttöönotto leikkauksen jälkeen. Lopullisen hoitotuloksen osalta ei ole kuitenkaan pystytty tieteellisesti osoittamaan, että mikään yksittäinen leikkausmenetelmä olisi selvästi toisia parempi. Tämän tutkimuksen tavoitteena oli kartoittaa pitkän aikavälin hoitotulosta ja kroonisen kivun esiintyvyyttä ristisideleikkauksen jälkeen. Toisena tavoitteena oli vertailla intrakapsulaarisen, ekstrakapsulaarisen ja osteotomiamenetelmien hoitotuloksia. Käytetyt tutkimusmenetelmät olivat omistajakysely, sisältäen kroonisen kivun määrittämiseen validoidun kipuindeksin (Helsinki Chronic Pain Index, HCPI), ortopedinen ja radiologinen tutkimus, askelvoimamittaus sekä uutena tutkimusmenetelmänä fysioterapeuttinen tutkimus. Kontrolliryhmänä käytettiin terveitä rottweilereita ja labradorinnoutajia. Omistajakysely lähetettiin 507:lle vuosina 2004 2006 eturistisideleikatun koiran omistajalle ja 53.6 % omistajista vastasi kyselyyn. Tutkimuskäynnille Yliopistollisessa eläinsairaalassa osallistui 47 leikattua koiraa. Keskimääräinen retrospektiivinen seuranta-aika ristisideleikkauksen ja tutkimusten välillä oli 2.7 vuotta. Kyselytutkimuksen perusteella 31.1 %:lla (64/206) leikatuista koirista havaittiin HCPI-arvolla mitattuna kroonista kipua. Tutkimuskäynnillä tehdyssä ortopedisessa tutkimuksessa 31.9 % (15/47) koirista osoitti kipua leikattua polviniveltä koukistettaessa ja/tai ojennettaessa. Toispuoleisesti leikatun ristisidevamman lisäksi tutkituilla koirilla diagnosoitiin usein myös nivelrikkomuutoksia vastakkaisessa polvinivelessä sekä muita samanaikaisia ortopedisia ongelmia kuten lonkka- ja kyynärnivelten nivelrikkomuutoksia. Askelvoimamittauksella määritetyn dynaamisen ja fysioterapeuttiseen tutkimukseen sisältyvän staattisen painonvarauksen mittausten perusteella leikatun jalan painonvaraus oli ravissa ja paikallaan seistessä normaalia alhaisempi noin 30 %:lla niistä koirista, joilla ei havaittu muita merkittäviä ortopedisia ongelmia (n=21). Myös goniometrilla mitatut leikatun polven koukistus- ja ojennuskulmat jäivät normaaliarvoja alhaisemmiksi ja aktiivisessa liikelaajuudessa havaittiin usein poikkeamia normaalista. Omistajakyselyn perusteella pitkän aikavälin hoitotuloksessa ei havaittu tilastollisesti merkitseviä eroja intrakapsulaarisen, ekstrakapsulaarisen ja osteotomiamenetelmien välillä. Sen sijaan tutkimuskäynnillä mitatussa dynaamisessa ja staattisessa painonvarauksessa havaittiin eroja, joiden perusteella osteotomiamenetelmillä leikattujen koirien jalankäyttö saattaa pitkällä aikavälillä yltää intrakapsulaarisella menetelmällä saavutettua paremmaksi. Retrospektiivinen aineisto ja pieni otoskoko täytyy kuitenkin huomioida tuloksia tulkittaessa. Ekstrakapsulaarisella menetelmällä leikattujen koirien pieni määrä esti dynaamisen ja staattisen painonvarauksen vertaamisen muihin leikkausmenetelmäryhmiin

Lymfooman kliininen kuva, hoito ja ennuste koiralla -kirjallisuuskatsaus

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Intraluminal tracheal lipoma as a rare cause of dyspnoea in a dog

Background: Tracheal tumors are rarely diagnosed in veterinary medicine and the majority of tracheal neoplasia reported in adult dogs are malignant. Intratracheal lipoma has not been previously reported in the veterinary literature. Case presentation: A 7-year-old Briard dog was evaluated for inspiratory dyspnoea and an inspiratory wheeze. Cervical radiographs and tracheoscopic examination revealed an intratracheal mass that was surgically removed. The dog has been asymptomatic after the surgery. Conclusions: Based on histopathology, the mass was diagnosed as lipoma. To the authors' knowledge, this is the first published report of an intratracheal lipoma in the veterinary literature.Peer reviewe

CT imaging of dogs with perineal hernia reveals large prostates with morphological and spatial abnormalities

The etiology of canine perinea) hernia (PH) remains unclear, although as a disease of older male dogs, it is likely to be hormonal. The role of the prostate in the formation of PH has been questioned; however, prospective and systematic evaluation of prostates in these dogs is absent in the literature. In this prospective case-control study, CT imaging was used to assess prostatic changes in dogs with PH (n = 46) and compare these findings with those of intact age-matched male dogs (n = 23). Using the OsiriX (R) DICOM viewer, we measured prostatic volume and correlated it with the size of the dog by using the length of the sixth lumbar vertebra. In addition, we recorded spatial and morphological changes of the prostate, such as heterogenicity, intra- and paraprostatic cysts, and mineralizations, as well as prostatic location and rotation. We found that dogs with PH had larger prostates (P < .001) that more often contained cysts (P < .001) and had larger cyst diameters (P = .013) than age-matched controls. Prostates of PH dogs also contained paraprostatic cysts (17.4%) and focal mineralizations (32.6%), which were absent in the control group. Abnormal rotation and location of the prostate were common in dogs with PH. In conclusion, these findings support the use of CT as an adjunct diagnostic imaging modality for the evaluation of the prostate in dogs with PH. Further studies are needed to evaluate nonprostatic CT findings in the pelvic cavity of PH dogs.Peer reviewe

Breed-typical front limb angular deformity is associated with clinical findings in three chondrodysplastic dog breeds

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Primary hyperparathyroidism caused by bilateral parathyroid cystic carcinoma in a cat

Abstract Case summary A 16-year-old neutered female Korat cat presented with chronic vomiting, mild azotaemia and mild hypercalcaemia. Physical examination revealed bilateral palpable masses on each side of the trachea. Laboratory results were consistent with primary hyperparathyroidism, diagnostic imaging findings with cystic thyroid or parathyroid masses, and fine-needle aspiration cytology with thyroid hyperplasia or adenoma. In order to confirm whether one or two of the masses were the cause of the hyperparathyroidism, cystic fluid was aspirated from both for parathyroid hormone concentration measurement. The concentration was shown to exceed that of the serum manyfold in both samples, confirming both masses to be functional and of parathyroid origin. A total parathyroidectomy and thyroidectomy were performed on the right side, and a subtotal thyroidectomy and a subtotal to total parathyroidectomy on the left, without any major postoperative complications. Histopathology was consistent with bilateral parathyroid carcinoma. Relevance and novel information To our knowledge, this report is the first to describe a rare case of bilateral parathyroid cystic carcinoma in a cat. It highlights the usefulness of determining parathyroid hormone concentration in the cystic fluid of a suspected neoplastic parathyroid mass preoperatively. It also demonstrates that it may be possible to remove most of the cervical parathyroid and thyroid tissue of a cat without causing any clinically relevant hypocalcaemia or iatrogenic hypothyroidism. However, serum concentrations of ionised calcium, thyroxine and creatinine should be closely monitored in the postoperative period in order to detect and control possible complications.Peer reviewe

Exploring the association between canine perineal hernia and neurological, orthopedic, and gastrointestinal diseases

Publisher Copyright: © 2022, The Author(s).Background: Perineal hernia (PH) is a relatively common condition in intact male dogs, but the etiology remains unclear. The objective of this study was to assess the contribution of gastrointestinal (GI), neurological, and orthopedic conditions to the development of PH in male dogs. Patient history with a focus on chronic GI disease was assessed using an owner questionnaire. Neurological conditions were explored, applying neurological, electromyographic (EMG), and motor nerve conduction velocity (MNCV) examinations and combining these with computed tomography (CT) imaging. To exclude possible orthopedic diseases, an orthopedic examination was conducted together with CT analysis. The chi-squared test was used to assess the associations between categorical variables. Results: Altogether, 66 male dogs with diagnosed PH were recruited for this study. The frequency of neurological, orthopedic, and GI diseases was low in dogs with PH. No signs of generalized neuro- or myopathies were detected. Still, perineal and bulbourethral reflexes were decreased or missing in 44.6% (29/65) and 40.0% (26/65) of dogs, respectively. Mild or moderate occlusion of the intervertebral foramen at the lumbosacral (LS) junction occurred in 18.5% (12/65) of dogs and was caused by spondylosis deformans in 83.3% (10/12). Moderate disc protrusion was evident in 9.2% (6/65) of dogs. Conclusion: No evidence was found that PH is caused by gastrointestinal, orthopedic, or neurological conditions. Abnormalities in perineal and bulbourethral reflexes are most likely secondary to PH.Peer reviewe

Ranking of physiotherapeutic evaluation methods as outcome measures of stifle functionality in dogs

BACKGROUND: Various physiotherapeutic evaluation methods are used to assess the functionality of dogs with stifle problems. Neither validity nor sensitivity of these methods has been investigated. This study aimed to determine the most valid and sensitive physiotherapeutic evaluation methods for assessing functional capacity in hind limbs of dogs with stifle problems and to serve as a basis for developing an indexed test for these dogs. A group of 43 dogs with unilateral surgically treated cranial cruciate ligament deficiency and osteoarthritic findings was used to test different physiotherapeutic evaluation methods. Twenty-one healthy dogs served as the control group and were used to determine normal variation in static weight bearing and range of motion. The protocol consisted of 14 different evaluation methods: visual evaluation of lameness, visual evaluation of diagonal movement, visual evaluation of functional active range of motion and difference in thrust of hind limbs via functional tests (sit-to-move and lie-to-move), movement in stairs, evaluation of hind limb muscle atrophy, manual evaluation of hind limb static weight bearing, quantitative measurement of static weight bearing of hind limbs with bathroom scales, and passive range of motion of hind limb stifle (flexion and extension) and tarsal (flexion and extension) joints using a universal goniometer. The results were compared with those from an orthopaedic examination, force plate analysis, radiographic evaluation, and a conclusive assessment. Congruity of the methods was assessed with a combination of three statistical approaches (Fisher’s exact test and two differently calculated proportions of agreeing observations), and the components were ranked from best to worst. Sensitivities of all of the physiotherapeutic evaluation methods against each standard were calculated. RESULTS: Evaluation of asymmetry in a sitting and lying position, assessment of muscle atrophy, manual and measured static weight bearing, and measurement of stifle passive range of motion were the most valid and sensitive physiotherapeutic evaluation methods. CONCLUSIONS: Ranking of the various physiotherapeutic evaluation methods was accomplished. Several of these methods can be considered valid and sensitive when examining the functionality of dogs with stifle problems