Meniscal Mineralization in Domestic Cats

Objective: To (1) determine prevalence of radiographically detectable meniscal mineralization in domestic cats and (2) to evaluate the association between meniscal mineralization and degenerative joint disease (DJD). Study Design: Prospective study. Animals: Client‐owned cats (n=100) and 30 feline cadavers. Methods: Randomly selected client‐owned cats were used to determine the prevalence of meniscal mineralization. Stifles from feline cadavers were used to evaluate the relationship between meniscal mineralization (using high‐resolution X‐ray), radiographic DJD, and cartilage damage. Menisci were evaluated histologically. Results: Forty‐six percent of the client‐owned cats had meniscal mineralization detected in 1 or both stifles. Pain scores were not significantly different between stifles with meniscal mineralization and those with no radiographic pathology (P=.38). Thirty‐four of 57 cadaver stifles had meniscal mineralization, which was always located in the cranial horn of the medial meniscus. Percentage mineralization of the menisci was significantly correlated with the cartilage damage score of the medial femoral (r²=0.6; P<.0001) and tibial (r²=0.5; P<.0001) condyles as well as with the total joint cartilage damage (r²=0.36; P<.0001) score and DJD score (r²=0.8; P<.0001). Conclusion: Meniscal mineralization is a common condition in domestic cats and seems to indicate medial compartment DJD. Clinical Relevance: Clinical significance of meniscal mineralization is uncertain. Further work is needed to determine if the meniscal mineralization is a cause, or a consequence of joint degeneration.     

Primary degenerative joint disease of the shoulder in a colony of beagles

Shoulder joints of 149 Beagles over 8 years old at the time of death (mean age, 13.8 years +/- 3.21), were examined radiographically throughout their life-times for the frequency of degenerative joint disease (DJD). Clinical histories revealed no underlying cause for DJD. The shoulder joints of a subgroup of 18 dogs were examined at necropsy, and thin sections of the joints were evaluated radiographically and histologically. Serial clinical radiographic studies indicated that normal shoulder joint development during the first year of life was followed by the appearance of subchondral bone sclerosis and bony remodeling of normal joint contour, and by the formation of periarticular osteophytes and enthesiophytes. All changes were progressive with age and typical for DJD in dogs. Bilateral involvement was common. Evaluation of specimens obtained at necropsy revealed: articular cartilage change with roughening of the surface layer, degeneration and death of superficial chondrocytes, exposure of deeper layers of chondrocytes that had proliferated with fissuring of the damaged cartilage, total cartilage loss with polishing of the exposed subchondral bone, mixed patterns of subchondral bone sclerosis and osteoporosis, change in contour of the articular surfaces, and formation of periarticular osteophytes and enthesiophytes. Joint capsule thickening, synovitis, pannus formation, and synovial chondroma formation were observed. Because of the available clinical information, in addition to the typical changes of DJD, it was thought that the changes were primary. Instability appeared to play a role in the pathogenesis of the joint disease described; however, it was not clear whether the instability caused abnormal forces on healthy cartilage or whether the primary cartilage wear caused the instability.     

Cross‐Sectional Study of the Prevalence of Radiographic Degenerative Joint Disease in Domesticated Cats

Objective: To determine the prevalence of radiographic signs of degenerative joint disease (DJD) in a randomly selected sample of domestic cats. Study Design: Prospective observational study. Animals: Client‐owned cats. Methods: Cats (n=100) from a single practice and equally distributed across 4 age groups (0–5; 5–10; 10–15, and 15–20 years old) were randomly selected (regardless of heath status) and sedated for orthogonal radiographic projections of all joints and the spine. Quasi‐Poisson regression analysis was used to investigate the relationship between patient demographics, blood biochemistry, hematologic and urine analysis variables, and DJD severity. Results: Most (92%) cats had radiographic evidence of DJD; 91% had at least 1 site of appendicular DJD and 55% had ≥1 site of axial column DJD. Affected joints in descending order of frequency were hip, stifle, tarsus, and elbow. The thoracic segment of the spine was more frequently affected than the lumbosacral segment. Although many variables were significantly associated with DJD, when variables were combined, only the association between age and DJD was significant (P<.0001). For each 1‐year increase in cat age, the expected total DJD score increases by an estimated 13.6% (95% confidence interval: 10.6%, 16.8%). Conclusion: Radiographically visible DJD is very common in domesticated cats, even in young animals and is strongly associated with age. Clinical Relevance: DJD is a common disease of domesticated cats that requires further investigation of its associated clinical signs.     

Radiographic evidence of degenerative joint disease in geriatric cats: 100 cases (1994-1997)

OBJECTIVE: To determine prevalence of radiographic evidence of degenerative joint disease (DJD) in geriatric cats. DESIGN: Retrospective study. POPULATION: 100 cats > 12 years of age. PROCEDURE: One investigator reviewed radiographs and for each articulation (or group of articulations) that was visible assigned a grade of severity (0, 1, 2, 3) for DJD. Another investigator reviewed medical records and recorded signalment, environment, previous disease, diseases evident at time of radiography, FeLV vaccination and infection status, feline immunodeficiency virus serologic status, serum creatinine concentration, serum globulin concentration, and any other important findings. Associations between DJD of grade 2 or 3 and variables recorded from the medical record were determined. RESULTS: Radiographic evidence of DJD was evident in 90% of cats. Neurologic disease was associated with lesions in the lumbosacral portion of the vertebral column. Severe lesions were found in 17% of the elbow joints, but an underlying cause was not determined. CONCLUSIONS AND CLINICAL RELEVANCE: Degenerative joint disease was detected radiographically in most geriatric cats and may be an overlooked cause of clinical disease. Clinicians should be alert to the possibility that DJD is associated with neurologic signs.     

PREVALENCE OF CANINE HIP DYSPLASIA IN A VETERINARY TEACHING HOSPITAL POPULATION

The purpose of this study was to determine the prevalence of canine HD in a population in which there was minimal or no prior screening of radiographs for the disorder. Patient information was obtained from the radiographic database at the University of Missouri-Columbia Veterinary Teaching Hospital during the five-year period of 1991-1995. The coxofemoral joints on ventrodorsal radiographs of the pelvis were independently evaluated by three veterinary radiologists. A consensus evaluation of normal, borderline, or dysplastic was compiled. There were 2885 dogs identified representing 116 breeds and the mixbreds. There were 2236 purebred dogs (1071 males and 1165 females) and the prevalence of HD was 19.7%. There were 649 mixbred dogs (340 males and 309 females) and the prevalence of HD was 17.7%. There was no significant difference in the prevalence of HD between sexes or between purebred and mixbred dogs (P = 0.16; P = 0.29). Degenerative joint disease (DJD) was the most common radiographic manifestation of HD and there appeared to be a threshold at 12 months of age after which the presence of DJD was the primary diagnostic criteria.     

Feline Degenerative Joint Disease

Objective: To critically review and collate published information on feline degenerative joint disease (DJD) and identify areas in which information is lacking.
Study Design: Critical literature review.
Methods: Literature search through Pub Med, Commonwealth Agricultural Bureau Abstracts published in the English Language, or translated into English (January 1940–August 2008).
Results: Although there are no prospective studies, the prevalence of radiographic DJD appears to be high and can be associated with clinical signs of decreased mobility. There appears to be a mismatch between radiographic and clinical examination findings (pain response). There is little information on the cause of DJD in different joints. There are no fully validated subjective or objective assessment systems for the measurement of chronic DJD-associated pain in the cat. Development of a feline model of chronic DJD-associated pain may speed the development and evaluation of candidate pain-alleviating compounds and treatments.
Conclusions: The high prevalence of feline DJD and lack of information about it, suggests further investigation is needed.
Clinical Relevance: Feline DJD occurs with high frequency, and yet there is little to guide the clinician on prevention or treatment.     

Evaluation of Fibular Head Transposition for Repair of Experimental Cranial Cruciate Ligament Injury in Dogs

Unilateral cranial cruciate ligament excision and fibular head transposition (FHT) were performed on 30 adult dogs. Vertical ground reaction forces were determined using force plate data before and after surgery. Cranial drawer motion, tibial rotation, and varus-valgus motion were measured at monthly intervals. Radiographic, gross, and histological examinations of the stifle joints that had been operated on were performed 3 weeks, 4 months, and 10 months after surgery. A scoring system was used to evaluate lameness, osteophyte formation, and meniscal damage. Rank correlation coefficients were calculated between variables tested in pairs. Cranial drawer motion and abnormal tibial rotation were present in all of the joints that had been operated on. Peak vertical force and associated impulse were not restored during the study time period. Meniscal damage was noted in 25% of the dogs at month 4 and in 50% of the dogs at month 10. Progressive gross and histological deterioration of the articular cartilage was observed in all joints. Positive correlations were noted between the degree of stifle joint instability and meniscal injury or radiographic changes. FHT did not control cranial drawer motion and rotational instability, was not successful in restoring limb function, and did not prevent joint degeneration, especially meniscal damage.     

Evaluation of Experimental Transection and Partial Excision of the Caudal Cruciate Ligament in Dogs

The caudal cruciate ligament (CaCL) of one stifle joint in seven dogs was transected and a 2 to 4 mm section was removed. Six months after surgery, none of the dogs were lame. Thigh muscle circumference, stifle range of motion, and internal tibial rotation in the operated limb were not significantly different from the preoperative measurements or the contralateral, unoperated limb. A caudal drawer motion was consistently present in the stifle joints with a transected CaCL. A radiographic evaluation of the operated stifle joints did not reveal osteoarthritic changes; four of seven stifle joints had an irregular fat pad 6 months after surgery. Results of a joint fluid analysis revealed a slight increase in synovial cells within treated stifle joints; inflammatory cells were not observed. The only gross morphologic change in stifle joints with a severed ligament was enlarged knobby remnants of the CaCL. Articular cartilage defects or osteophytes were not observed. Results of a histologic examination of the CaCL remnants revealed synovial cellular capping and intraligamentous fibroplasia. Based on a limited number of dogs, it was concluded that isolated transection of the CaCL produced minimal clinical and pathologic changes in the stifle joint during a 6 month period.     

Clinical and Radiographic Evaluation of Intertrochanteric Osteotomy in Dogs: A Retrospective Study of 18 Dogs

Objective- To determine whether intertrochanteric osteotomy (ITO) can prevent the progression of degenerative joint disease (DJD) in dysplastic hip joints.
Study Design- The results of ITO were assessed retrospectively by using owner questionnaires, physical examination, and radiographic evaluation.
Animals- Eighteen client-owned dogs (29 coxofemoral joints were evaluated).
Methods- Lameness was scored according to a grading system. A scoring system was also developed to assess radiographically evident osteoarthritis on a ventrodorsal projection of the coxofemoral joints in extension.
Results- Twenty-nine ITO were performed in 18 dogs with varying degrees of hip dysplasia. The dogs were lame on 19 of 29 rear limbs on physical examination before surgery. In 22 of the 29 hip joints, palpation caused signs of pain. The median age at the first and second surgical procedure was 14.5 months and 18 months, respectively. Follow-up evaluation was performed on average at 9.77 (FU I), 22.52 (FU II), and 47.50 months (FU in) after surgery. Based on the owners' evaluation, there was a tendency toward improvement after surgery. The results of the physical examination at the preoperative examination and at the three follow-up examinations did not differ significantly. The follow-up radiographic scores showed significantly worse DJD than the preoperative scores.
Conclusions- ITO does not prevent progression of DJD in the dysplastic hip.
Clinical Relevance- Knowledge of the long-term effects of ITO is essential for surgeons trying to achieve improvement in dogs with hip dysplasia.     

Progression of radiographic evidence of osteoarthritis following tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 295 cases (2001-2005)

OBJECTIVE: To determine whether radiographic signs of osteoarthritis became progressively worse and tibial slope angle (TSA) changed substantially following tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs. DESIGN: Retrospective case series. ANIMALS: 295 dogs (373 stifle joints). PROCEDURES: Medical records were reviewed. Radiographs obtained before and 8 weeks after surgery were used to determine the degenerative joint disease (DJD) score, calculated as the sum of individual scores (0 through 3) assigned to 30 radiographic factors. Radiographs obtained immediately and 8 weeks after surgery were used to measureTSA. For dogs that underwent bilateral surgery, data for the first joint treated were used in analyses. Data for the second joint treated in dogs that underwent bilateral surgery were analyzed separately. RESULTS: A small, but significant, increase was found in mean DJD score 8 weeks after surgery, compared with mean preoperative score. An inverse relationship was found between preoperative DJD score and the difference between postoperative and preoperative DJD scores. Mean TSA 8 weeks after surgery was significantly higher than mean TSA immediately after surgery. Analysis of data for the second stifle joints in the 78 dogs that underwent bilateral surgery yielded similar results. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that there was a small, but measurable, increase in the severity of radiographic changes attributed to osteoarthritis in the stifle joints of dogs that underwent tibial plateau leveling osteotomy because of cranial cruciate ligament rupture.     

Validity of goniometric joint measurements in cats

OBJECTIVE: To compare and validate goniometric joint measurements obtained from nonsedated and sedated cats with measurements from radiographic evaluation. ANIMALS: 20 adult cats with no evidence of joint disease. PROCEDURES: Measurements of flexion and extension of the carpus, elbow, shoulder, tarsus, stifle, and hip joints and of carpal and tarsal joints during varus and valgus angulation were made by a single investigator before and after sedation of cats. Measurements were made by use of a goniometer with a masked dial. Joint angle measurements were compared between nonsedated and sedated cats and also with measurements from radiographs made while cats were sedated. Each series of measurements was repeated 4 times. To evaluate repeatability, Cronbach alpha values were calculated for repeated measure results of goniometric joint measurements of nonsedated and sedated cats. An intraclass correlation was calculated to determine reliability among the 3 measurement types (ie, measurements from nonsedated and sedated cats and on radiographic evaluation). RESULTS: Joint measurements did not differ significantly by measurement type, when comparing radiographic measurements with goniometric measurements in sedated and nonsedated cats. Cronbach alpha values were > 0.99 for goniometric joint measurements within individual nonsedated and sedated cats and also for comparison of mean measurements obtained from sedated cats versus nonsedated cats versus radiographs. An intraclass correlation of 0.999 revealed high reliability among measurement types. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that goniometric joint measurements in nonsedated and sedated cats are repeatable and valid.     

Absolute and relative cell counts for synovial fluid from clinically normal shoulder and stifle joints in cats

OBJECTIVE: To determine absolute and relative cell counts for synovial fluid from grossly, radiographically, and histologically normal shoulder and stifle joints in healthy cats. DESIGN: Clinical study. ANIMALS: 52 cats scheduled to be euthanatized for unrelated reasons. PROCEDURE: Arthrocentesis of the shoulder and stifle joints was performed bilaterally, and synovial fluid was analyzed for absolute WBC count, WBC morphology, and percentages of neutrophils and mononuclear cells. Joints were examined grossly and radiographically, and synovial membrane specimens were submitted for histologic examination. Synovial fluid samples that were contaminated with blood and samples from joints with any gross, radiographic, or histologic abnormalities were excluded. RESULTS: 82 of the 208 synovial fluid samples were excluded because abnormalities were identified during physical examination; the volume of fluid obtained was insufficient for analysis; there was evidence of blood contamination; or the joint had gross, radiographic, or histologic abnormalities. Median WBC count for the remaining 126 synovial fluid samples was 91 cells/microL (96.4% mononuclear cells and 3.6% neutrophils); WBC count was not significantly different between left and right joint samples or between shoulder and stifle joint samples. Body weight was associated with synovial fluid WBC count, with WBC count increasing as body weight increased. Sixteen of the 52 (30%) cats had radiographic evidence of osteoarthritis involving at least 1 joint. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that synovial fluid can be obtained reliably from shoulder and stifle joints in cats.     

RADIOGRAPHIC AND MAGNETIC RESONANCE IMAGING OF THE STIFLE JOINT IN EXPERIMENTAL OSTEOARTHRITIS OF DOGS

Radiography and magnetic resonance imaging were used to evaluate osteoarthritis at 2, 6, and 12 weeks following transection of the cranial cruciate ligament of the stifle (femorotibial) joint of 6 dogs. A quantitative radiographic scoring system was used to assess the progression of hard and soft tissue changes of osteoarthritis. Mediolateral (flexed joint) and oblique (extended joint) radiographic projections enabled identification of small osteophytes on the femoral trochlear ridges, which were detected at an earlier stage of development than was previously reported. Magnetic resonance imaging was useful in detecting changes in cartilage thickness, osteophytosis and intraarticular loose bodies. Radiography and magnetic resonance imaging were complementary in the assessment of pathologic changes of osteoarthritis.     

Histoplasma capsulatum Osteomyelitis in the Cat

Seven cats with osseous lesions as the primary manifestation of disseminated Histoplasma capsulatum infection were evaluated. The major clinical signs in these cats were related to the bony lesions and included lameness, bone pain, and soft tissue swelling of limbs and joints. Other clinical and pathologic findings were similar to previously reported forms of disseminated histoplasmosis in the cat. The radiographic appearance of the lesions was predominantly osteolytic; periosteal and endosteal new bone production was present in some cases. Infection occurred primarily in bones of the appendicular skeleton with a predilection for sites below the elbow and stifle joints.     

Comparison of normograde and retrograde intramedullary pinning of feline tibias

This study evaluated the effects of normograde and retrograde intramedullary pinning of mid-diaphyseal fractures of the feline tibia on the anatomical structures of the stifle joint. Using the paired pelvic limbs from five mature feline cadavers, a transverse, mid-diaphyseal osteotomy was performed, and each tibia was pinned in a normograde or retrograde fashion. The stifle joints were examined to determine the pin exit site and measure the distance from the exit site to pertinent anatomical structures of the stifle joint. Neither normograde nor retrograde intramedullary pinning resulted in damage to the cruciate ligaments, menisci, intermeniscal ligament, femoral condyles, or joint capsule. The patellar tendon was penetrated in all five tibias during retrograde pin insertion.     

Incidence of meniscal injury in cats with cranial cruciate ligament ruptures

This retrospective study evaluated the incidence of meniscal injury in cats with cranial cruciate ligament (CCL) ruptures. Medical records for cats diagnosed with CCL ruptures treated by a lateral fabellotibial suture (LFS) were reviewed for signalment, history, physical examination and surgical findings. Ninety-five cats (98 stifles) met the inclusion criteria. The incidence of meniscal injuries in feline CCL deficient stifles was 67%. Isolated medial meniscal injuries were found in 55 stifles (56%), isolated lateral meniscal injuries were found in 5 stifles (5%), and lateral and medial meniscal injuries were found in 6 stifles (6%). There was no correlation between the presence of a meniscal injury and age, breed, sex, weight, duration of lameness, presence of concurrent medial patellar luxation, degree of degenerative joint disease, or presenting side of lameness. Given the high rate of meniscal pathology in cats with CCL ruptures, exploratory surgery for meniscal assessment and concurrent stifle stabilization should be considered in feline patients.     

RADIOLOGIC ABNORMALITIES OF THE APPENDICULAR SKELETON OF THE LION (PANTHERA LEO): INCIDENTAL FINDINGS AND MYCOBACTERIUM BOVIS-INDUCED CHANGES

Thoracic and pelvic limbs from 15 euthanized free-ranging lions (Panthera leo), ranging in age from 16 to 144 months, underwent standard radiographic evaluation. All lions had tested positive for Mycobacterium bovis by means of a modified intradermal tuberculn test. The radiographs of six lions were normal and nine had incidental findings of which six had more than one lesion. Seven lions had lesions suspected to be associated with tuberculosis, which was confirmed in specific joints in two lions. Incidental pathology was classified as traumatic injuries and degenerative or trauma-associated joint disease. The traumatic lesions were fractures of which the most remarkable was a femur malunion. Four lions had fibula and another three lions had metacarpal/tarsal and phalangeal fractures. Joint lesions included glenoid, humeral head, and accessory carpal bone osteophytes. There was evidence of a cranial cruciate ligament rupture in an 8-year-old male. Trauma induced joint lesions were seen in four stifles (fragmented or displaced sesamoid bones, fragmented meniscal ossicle, or mineralized fragments). Radiological abnormalities believed to be caused by M. bovis were present in one stifle, one radiocarpal three tibiotarsal, and one tarsometatarsal joints. These had evidence of septic arthritis with extensive bone formation and capsular mineralization. In one 20-month-old lion, changes typical of a bone abscess were found in a proximal tibia. Radiologic evidence of elbow hygromas were seen in three elbows, all believed to be caused by M. bovis. Lions appeared to cope fairly well with a variety of traumatic injuries and were also susceptible to some of the aging/incidental radiologic findings seen in dogs and cats. The suspected M. bovis osseous lesions were more likely to involve the joints, particularly the tarsal joint and were mainly proliferative.     

COMPARISONS AMONG RADIOGRAPHY,ULTRASONOGRAPHY AND COMPUTED TOMOGRAPHY FOR EX VIVO CHARACTERIZATION OF STIFLE OSTEOARTHRITIS IN THE HORSE

A better understanding of imaging characteristics of equine stifle osteoarthritis (OA) may allow earlier detection and improve prognosis. Objectives of this ex vivo, prospective, methods comparison study were to (1) describe the location and severity of naturally acquired OA lesions in the equine stifle using ultrasound (US), radiography (XR), computed tomography (CT), and macroscopic evaluation (ME); (2) compare the diagnostic performance of each imaging modality with ME; and (3) describe subchondral bone mineral density (BMD) in equine stifle joints with OA using CT. Radiographic, CT, and US evaluations were performed on 23 equine cadaver stifles and compared with ME. Significant associations were found between osteophyte global scores for all imaging modalities (CT, P ? 0.0001; XR, P = 0.005; US, P = 0.04) vs. ME osteophyte global scores. Osteophytes were detected most frequently in the medial femorotibial (MFT) joint. A specific pattern of osteophytes was observed, with a long ridge of new bone at the insertion of the MFT joint capsule cranially on the medial femoral condyle. A novel caudo‐10°proximo‐5°lateral‐cranio‐disto‐medial oblique radiographic projection was helpful for detection of intercondylar osteophytes. Multiplanar CT reformatted images were helpful for characterizing all osteophytes. Osteophyte grades at most sites did not differ among modalities. Low sensitivity/specificity for subchondral bone sclerosis and flattening of femoral condyles suggested that these signs may not be reliable radiographic and CT indicators of equine stifle OA. Equine stifle OA was associated with a decrease in BMD and specific sites of focal subchondral bone resorption/cyst formation were found in some specimens.     

OSTEOCHONDROSIS LESIONS OF THE CANINE SHOULDER: CORRELATION OF POSITIVE CONTRAST ARTHROGRAPHY AND ARTHROSCOPY

In this study the correlation between positive contrast arthrography and arthroscopy was evaluated in a series of 20 shoulder joints (12 dogs) with radiographic and clinical evidence of osteochondrosis. The joints were consecutively examined by arthrography and arthroscopy. In 12 joints arthrography revealed the presence of a cartilage flap, and this finding was confirmed by arthroscopy. In 3 out of 8 joints where arthrography failed to demonstrate rupture of the cartilage, arthroscopy revealed the presence of a distinct fissure line. In 2 joints arthroscopy demonstrated a lesion comparable with chondromalacia and in 3 only a dimple in the articular cartilage was found. In 2 joints arthroscopy revealed the presence of small joint mice not detected by arthrography. Kissing lesions on the surface of the glenoid cavity opposite to cartilage flaps could be demonstrated as well. Evaluation of synovial inflammation, judged by the aspect and pattern of the synovial villi, correlated well with histologic findings. These results indicate that arthroscopy is a complementary examination in painful joints where arthrography fails to demonstrate rupture of the articular cartilage. It could be the procedure of choice if diagnostic and surgical arthroscopy can be combined. However, arthrography remains the technique of choice to demonstrate joint mice within the bicipital tendon sheath.     

High field (4.7 T) magnetic resonance imaging of feline hip joints

Magnetic resonance imaging (MRI) is a non-invasive technique widely used to investigate degenerative joint disease (DJD). In this study, we obtained magnetic resonance images of feline hip joints, using a high magnetic field MRI unit (4.7 tesla) with proton density (PD)-weighted and T2-weighted fast spin-echo (FSE). PD-weighted FSE provided detailed anatomical images of feline hip joints with superb depiction of subchondral bones of the femoral head and acetabulum. Articular cartilage (AC) was also visualized with PD-weighted and T2-weighted FSE; however, mild AC lesions noted on gross examination were not detectable with these sequences.