Arthritis of the canine stifle joint.

A survey of cadaver material was undertaken in order to determine the prevalence of arthritis of the canine stifle joint. One hundred and fifty unselected cadavers were obtained from veterinary practices for this purpose, and their stifle joints were radiographed and dissected to discover abnormalities. Thirty-one dogs (20 per cent) had stifle arthritis and in all except one the lesions were characteristic of osteoarthritis. In the exceptional case infection was the cause. A mechanical derangement was present in 20 of the 54 affected joints, in the form of rupture of the anterior cruciate ligament (10), meniscal tears (9) and patellar dislocation (1). The cause of the arthritis in the other 33 joints is unknown.     

Osteochondritis dissecans of the canine stifle joint

In fourteen dogs with osteochondritis dissecans of the stifle joint the lesion was found in the articular cartilage of the medial condyle of the femur in six and the lateral condyle in eight. Both stifle joints were affected in eight dogs and in two of these, both Wolfhounds, the shoulder joints were also affected. Ten dogs were treated surgically and three by conservative means. The results of treatment are discussed.     

Ultrasonographic, computed tomographic and magnetic resonance imaging anatomy of the normal canine stifle joint

Ultrasonographic (US), magnetic resonance (MR) and computed tomographic (CT) images of normal canine stifle joints were obtained and compared with plastinated cross-sectional slices of cadaver specimens from the same dogs. The bony and articular structures were identified and correlated with the three diagnostic imaging modalities. These results provide an atlas of normal cross-sectional US, MR and CT anatomy of the canine stifle, which can be used for the interpretation of stifle images from any of these imaging modalities.     

The canine stifle

Cranial cruciate ligament (CCL) injury is a leading cause of lameness in dogs. Recent advances in diagnostic visualization and surgical treatments for CCL injury have stimulated an increased emphasis on early clinical recognition and an early return to function. Many surgical treatments have been described that aim to restore stifle joint stability and minimize the progression of osteoarthritis. Major advances have occurred not only in the treatment of CCL injury, but also in postoperative recovery, specifically, rehabilitation therapy. The benefits of rehabilitation therapy following CCL surgery are multifaceted including pain relief, decreased inflammation and swelling, increased tissue flexibility, strengthening, improved proprioception, improved limb and joint biomechanics, and improved weight-bearing. In this article, we introduce a variety of rehabilitation therapy options for postoperative CCL patients including modalities, manual therapy, therapeutic exercise, and the benchmarks for a full return to function.     

The canine stifle joint II. Medial luxation of the patella

A method of assessment of cases of medial luxation of the patella for deciding the type of surgical intervention is described. The results of treatment of the cases after such an assessment indicate that, if there is no gross distortion and no deviation of the tibial tuberosity, simple lateral capsular overlap gives a satisfactory return of function, even in cases of irreducible patellar luxation.
Résumé. Les auteurs décrivent une méthode propre à évaluer les luxations médiales de la rotule en vue de déterminer la nature de l'intervention chirurgicale à pratiquer. Les résultats thérapeu-tiques obtenus sur la base de cette évaluation portent à conclure que, sauf grave déformation ou déviation de la tubérosité du tibia, le simple chevauchement capsulaire latéral permet de rétablir un état fonctionnel satisfaisant, měme dans les cas de luxation rotulaire irréductible.
Zusammenfassung. Es wird eine Methode zur klinischen Beurteilung von Fällen einer medialen Luxation der Patella zwecks Entscheidung über die Art des erforderlichen chirurgischen Eingriffs beschrieben. Die Behandlungsergebnisse in den Fällen nach einer solchen Beurteilung zeigen, dass beim Fehlen einer makroskopischen Verformung und einer Abweichung der Tuberositas tibiae die einfache laterale Kapselüberlappung eine zufriedenstellende Rückkehr der Funktion selbst in Fällen nicht reduzierbarer patellarer Luxation ergibt.     

The surgical significance of the blood supply of the canine stifle joint

The blood supply of the stifle joint was investigated in ten fresh dog cadavers using injections of Micropaque into the aorta and subsequent radiographic examination. The relevance of the blood supply to surgical intervention and the repair of injuries is discussed.     

The canine stifle joint I. Rupture of the anterior cruciate ligament

A method of assessment of cases of rupture of the anterior cruciate ligament with a view to prescribing either surgical or conservative treatment is described. The results of treatment of the cases after such an assessment indicates that the majority of small dogs will recover to satisfactory function after 2 months enforced rest, but large breed and working dogs require surgical intervention for successful treatment.
Résumé. Les auteurs décrivent une méthode propre à évaluer les ruptures du ligament cruci-forme antérieur en vue de prescrire soit l'intervention chirurgicale, soit le traitement conserva-teur. Les résultats thérapeutiques obtenus sur la base de cette évaluation portent à conclure que chez le chien de petite taille, 2 mois de repos forcé permettent le plus souvent d'obtenir un rétablissement fonctionnel satisfaisant, tandis que chez les chiens de grande taille et chiens d'utilité, l'intervention chirurgicale s'impose.
Zusammenfassung. Es wird eine Methode zur klinischen Beurteilung von Fällen einer Ruptur des vorderen Kreuzbandes im Hinblick auf die Möglichkeit einer chirurgischen oder konservativen Behandlung beschrieben. Die Behandlungsergebnisse bei den Fällen nach einer solchen Beurteilung zeigen, dass die Mehrzahl von kleinen Hunden sich in 2 Monaten Zwangsruhe zu einer zufriedenstellenden Funktion erholt, grosse Rassen und Arbeitshunde aber einen chirurgischen Eingriff zur erfolgreichen Behandlung benötigen.     

Location of the instantaneous center of joint rotation in the normal canine stifle

Locations of 3 instantaneous centers of joint rotation (ICR) were found in the stifles of 6 healthy dogs. A novel algorithm, verified by computer simulation, was used to determine ICR from radiographs. Comparisons of ICR locations were made between flexion and extension, between left and right limbs, and between living and dead dogs, using analysis of variance. All stifles were examined for evidence of lesions, but all were normal. The normal location of the ICR in the stifle is near the joint surface, indicating that there is a predominantly rolling type of motion. As the limb flexes, the ICR moves caudally; as the limb extends, the ICR moves cranially. Significant differences in ICR position were not found between left and right limbs or between living and dead dogs. The average ICR position was significantly more caudal during extension than it was during flexion. Knowing the normal ICR position is a preliminary to diagnosing joint abnormalities, using the ICR.     

Changes in the canine stifle joint following rupture of the anterior cruciate ligament

Sixty–four dogs with rupture of the anterior cruciate ligament in one or both stifle joints were referred to the Royal Veterinary College, London for treatment. Details of the pathological changes in the joints were recorded at the time of open surgery in fifty–seven and these changes are discussed. A post–mortem examination was made on one dog and the joint lesions were studied more closely.     

Arthroscopy of the canine stifle

Arthroscopy is presented as a safe, non-invasive diagnostic technique in dogs with knee-joint lesions. Equipment, procedure, and indications are briefly described. Advantages and disadvantages are summarized.     

Arthroscopy of the canine stifle

Summary

Athroscopy is presented as a safe, non‐invasive diagnostic technique in dogs with knee‐joint lesions. Equipment, procedure, and indications are briefly described. Advantages and disadvantages are summarized.     

Multiple ligamentous injuries of the canine stifle joint: a study of 12 cases

Multiple ligamentous injuries of the canine stifle are uncommon. In this study, they affected mainly adult, male, working or sporting dogs and occurred secondary to severe trauma, or where chronic joint infection had weakened the supporting structures. Rupture of the cranial cruciate, caudal cruciate and lateral collateral ligaments was the most common injury observed and this occurred after catching the limb in a fence or gate. Reconstruction of the collateral and cranial cruciate ligaments, and careful repair of damaged menisci and joint capsule, was an effective method of treatment for medium- and large-size dogs. Reconstruction of the caudal cruciate ligament and postoperative limb support was not found to be essential. All dogs with subluxated stifles had good to excellent limb function with minimal loss of mid-thigh circumference or stifle joint range of motion at follow-up. Less favourable results were achieved where there was stifle joint luxation with extensive disruption to secondary joint restraints.     

Clinical natural history of the postsurgical cruciate deficient canine stifle joint: year 1

The aims of this prospective study were to investigate the associations and correlations between individual clinical features of osteoarthritis of the cruciate deficient stifle joint and to document the temporal changes in these features over a 13-month period following surgical treatment. Fifty-eight dogs with osteoarthritis of the stifle joint, secondary to cranial cruciate ligament deficiency, were examined before surgical treatment for cruciate deficiency and at one and a half, seven and 13 months after surgery. At each visit, clinical features were graded using four-point, discontinuous, ordinal grading (Likert) scales and intra-articular pathology was also scored in a similar fashion at arthrotomy. No attempt was made to construct an aggregate score because the relative importance of different disease features and the relationships between them were not understood at the time of writing. At entry, the relationships between background and disease variables and clinical parameters were investigated as well as the relationships between clinical parameters and intra-articular pathology scores. Longitudinal analysis was performed to test for those features which showed significant change over the 13-month follow-up period. At entry, periarticular thickening and degree of crepitus were significantly correlated with disease duration. Several features showed significant change over the study period. Notably, the degree of quadriceps atrophy showed significant decrease from baseline scores at seven and 13 months while remaining different from normal, suggesting that a measure of quadriceps atrophy may be a useful measure of long-term outcome in this disease.     

Biomechanics of tibial plateau leveling of the canine cruciate-deficient stifle joint: a theoretical model

OBJECTIVE: To evaluate the effect of tibial plateau leveling on the biomechanics of the canine stifle. STUDY DESIGN: Analysis of a 3-dimensional (3-D) anatomically accurate theoretical model of the canine stifle. METHODS: A 3-D, 3-segment mathematical model of the normal canine stifle was modified to simulate the effect of rotation of the tibial plateau during tibial plateau leveling osteotomy (TPLO). The model examined the normal stifle, the stifle with a tibial plateau angle (TPA) of 0 degrees, and the stifle with a TPA of 5 degrees. Analysis of the models at 10 consecutive equally spaced positions during the stance phase yielded data such as ligament forces and joint reaction forces at each position. RESULTS: Rotation of the tibial plateau to a TPA of 0 degrees almost eliminates forces in the cranial cruciate ligament (CCL) throughout the stance phase. Rotation to a TPA of 5 degrees did not, however, substantially decrease the load in the CCL. Both procedures increased the load in the caudal cruciate ligament (CaCL). CONCLUSIONS: Cranial tibial thrust (CTT) is converted into caudal tibial thrust when the TPA is 0 degrees ; however, rotating the plateau to a TPA of 5 degrees does not eliminate the CTT. CLINICAL RELEVANCE: The TPLO procedure performed as currently recommended (rotating the tibial plateau to a TPA of 5 degrees) may not eliminate the CTT, but only reduce it. Both TPLO procedures evaluated here were found to increase the load in the CaCL.     

Osteophyte formation in the canine stifle joint following treatment for rupture of the cranial cruciate ligament

A clinical and radiological study of osteophyte formation following surgical or conservative treatment for rupture of the cranial cruciate ligament (C.C.L.), was carried out in thirty-eight dogs. Osteophyte formation had occurred in all of the affected stifle joints, in the period between treatment and the re-examination, irrespective of the method of treatment. In general, the degree of formation was less than that which had occurred before treatment. In the larger and more obese dogs, osteophyte formation was more extensive. The degree of lameness did not appear to be related to the degree of osteophyte formation radiographically evident at re-examination. No direct correlation could be established between the degree of joint instability, assessed at the re-examination, the degree of osteophyte formation following treatment, or the function of the limb.     

Surgical treatment of canine stifle disruption using a novel extracapsular articulated stifle stabilizing implant

A 5-year-old Labrador retriever mixed breed dog was presented for an acute non-weight-bearing left hind limb lameness. A stifle disruption was diagnosed. The patient was treated using a novel extracapsular articulated stifle stabilizing implant (Simitri™). Twelve weeks after surgery the patient had full range of motion of the affected stifle and had begun to return to pre-injury activity. This is the first reported case of this condition being surgically managed successfully in this manner.     

Comparison of the effects of caudal pole hemi-meniscectomy and complete medial meniscectomy in the canine stifle joint

OBJECTIVE: To compare the effects of caudal pole hemi-meniscectomy (CPHM) and complete medial meniscectomy (MM), specifically with respect to development of secondary osteoarthritis, in the stifle joints of clinically normal dogs. ANIMALS: 14 large-breed dogs. PROCEDURE: Unilateral CPHM (7 dogs) or MM (7) was performed, and the left stifle joints served as untreated control joints. Gait was assessed in all dogs before surgery and at 4, 8, 12, and 16 weeks postoperatively. After euthanasia, joints were evaluated grossly; Mankin cartilage scores, subchondral bone density assessment, and articular cartilage proteoglycan extraction and western blot analyses of 3B3(-) and 7D4 epitopes were performed. RESULTS: Weight distribution on control limbs exceeded that of treated limbs at 4 and 16 weeks after surgery in the CPHM group and at 4 and 8 weeks after surgery in the MM group; weight distribution was not significantly different between the 2 groups. After 16 weeks, incomplete meniscal regeneration and cartilage fibrillation on the medial aspect of the tibial plateau and medial femoral condyle were detected in treated joints in both groups. Mankin cartilage scores, subchondral bone density, and immunoexpression of 3B3(-) or 7D4 in articular cartilage in CPHM- or MM-treated joints were similar; 7D4 epitope concentration in synovial fluid was significantly greater in the MM-treated joints than in CPHM-treated joints. CONCLUSIONS AND CLINICAL RELEVANCE: Overall severity of secondary osteoarthritis induced by CPHM and MM was similar. Investigation of 7D4 epitope concentration in synovial fluid suggested that CPHM was associated with less disruption of chondrocyte metabolism.