Feline talocrural luxation: a cadaveric study of repair using ligament prostheses

Currently recommended surgical techniques to treat severe biaxial feline talocrural soft-tissue injuries commonly lead to unsatisfactory outcome. Data relating to canine talocrural stabilisation may not be useful in cats due to major differences in tarsal anatomy between the species. This experimental biomechanical cadaveric study used specimens (n = 10) prepared from the distal pelvic limbs of five adult cats. The aim was to design a technique for treating talocrural luxation using suture prostheses and bone tunnels, and to investigate its suitability for use in clinical cases. Four prosthetic ligaments were placed through a series of five 1.5 mm bone tunnels. Two prostheses, the caudoproximal pair, were taut in talocrural flexion and two prostheses, the craniodistal pair, were taut in extension. The intact specimens had their range-of-motion (ROM) and stability tested, after which they were transected at the talocrural joint (simulated luxation) and repaired using the technique described. The ROM and stability of the repaired specimens were tested and compared to the intact specimens. The repaired specimens had comparable stability to the intact specimens, although the ROM was different (p <0.05) in six of 16 positions (p <0.003125). These corresponded to the positions where the lateral prostheses were taut. The repair technique described may be useful in the treatment of talocrural luxation, as it is low-profile in an area of limited soft-tissue cover, allows anatomic reduction, restores normal talocrural joint stability and near-normal tarsal ROM.     

Repair of shoulder luxation in a horse

Shoulder luxation in a 3-year-old Thoroughbred filly was treated by closed reduction, using a calf jack to provide traction on the limb. Arthroscopic examination of the shoulder allowed removal of soft tissue and bony debris. After surgery, the filly was confined to a box stall for 6 months. Eight months after surgery, the filly was doing light work and was not lame. Muscular atrophy present before surgery had resolved. Use of a calf jack may allow reduction of shoulder luxation under field conditions.     

Arthrodesis for congenital luxation of the shoulder in a dog

Congenital luxation of the shoulder in a 7-month-old Chihuahua was corrected by use of arthrodesis. A single lag-screw fixation technique was used. Arthrodesis of the shoulder provides a favorable alternative to other salvage techniques such as glenohumeral resection or amputation.     

Surgical repair of coxofemoral luxation in a horse.

A 4-year-old castrated male Miniature Horse was evaluated because of severe right hind limb lameness of 5 days' duration. The diagnosis of craniodorsal luxation of the right coxofemoral joint was made by physical examination and radiographic imaging. Closed reduction was attempted but was unsuccessful. Surgical reduction was successfully performed, using toggle pin, synthetic capsular reconstruction, and trochanteric transposition techniques. No postoperative complications were observed. Follow-up 26 months after surgery revealed no recurrence of the luxation and no evidence of lameness. These surgical techniques are used successfully for repair of coxofemoral luxations in small animals. To our knowledge, there has been no report of these techniques attempted in horses. These surgical techniques may have merit for the treatment of coxofemoral luxations in small equine patients.     

Surgical repair of a coxofemoral luxation in an alpaca

A female breeding alpaca with acute lameness of the left hindleg was diagnosed with a craniodorsal coxofemoral luxation. Repair was achieved using extracapsular stabilisation. Two nylon sutures were passed through a hole drilled in the femoral neck and anchored to the dorsal acetabulum using two screws and two spiked washers. A metal crimp was used to tighten and maintain the sutures. Postoperatively the alpaca was confined to a stall for 4 weeks before being returned to a paddock. At 6 months after surgery the alpaca was free of lameness and was successfully mated.     

Management of concurrent patellar luxation and cranial cruciate ligament rupture using modified tibial plateau levelling

Objectives : To evaluate a novel surgery aimed at managing concurrent medial patellar luxation (MPL) and cranial cruciate ligament (CCL) ruptures in dogs weighing more than 30 kg. Methods : Tibial plateau levelling osteotomy (TPLO) and femoral trochleopasty were performed. The principal tibial fragment was laterally translated by 3 to 6 mm and was externally and abaxially rotated to create a wedge measuring 1·5 to 2·5 mm at the medial and cranial aspect and 1 to 3 mm at the medial and distal aspect of the tibial plateau fragment. The fragments were stabilised with a narrow TPLO plate. Results : Thirteen surgeries were performed in 12 dogs with a mean weight of 39·8 kg. The mean postoperative tibial plateau slope was 8·1°. Additional surgery was required in two cases, one due to failure of fixation and another due to screw breakage. The mean lameness score was 3·5 (out of 5) before surgery, 0·7 after 8 to 12 weeks, and 0·3 at final follow-up. Median follow-up was 1115 days (range, 270 to 2040 days). No patella luxated after surgery. Clinical Significance : MPL and CCL ruptures may be successfully managed by performing a TPLO and simultaneously altering the relationship of the principal and tibial plateau fragments during surgery.     

Applications of evidence-based medicine: cranial cruciate ligament injury repair in the dog

OBJECTIVE: To evaluate the literature reporting surgical interventions pertaining to canine cranial cruciate ligament (CCL) injury using an evidence-based medicine paradigm. STUDY DESIGN: Systematic literature review. METHODS: An on-line bibliographic search through Medline, PubMed, Veterinary Information Network, and Commonwealth Agricultural Bureau Abstracts was performed during August 2004. Two hundred and forty resources of information were identified. Studies were compared and evaluated with regard to study design (retrospective, prospective, randomization), surgical technique, short- and long-term follow-up, and evidence classification. RESULTS: Twenty-eight resources qualified to assist with evidence classification. No class I or class II studies were present, 5 studies were categorized as a class III and 23 studies were categorized as a class IV. Seventeen studies were retrospectively designed and 11 studies were prospectively designed. Proposed results ranged from a wide variety of subjective findings including clinical impression, radiographic analysis, synovial fluid analysis, gross pathology, and histopathology. Objective results, although infrequent, included force plate analysis and cadaveric biomechanical testing. CONCLUSIONS: At this time, the application of evidence-based medicine in analyzing the current available evidence suggests that there is not a single surgical procedure that has enough data to recommend that it can consistently return dogs to normal function after CCL injury. The requirement for assessing and categorizing the available evidence becomes increasingly important as more data becomes available and the quality of research improves. CLINICAL RELEVANCE: An evidence-based medicine paradigm did not provide sufficient evidence favoring 1 surgical technique for management of canine CCL injury.     

Feline polycystic kidney disease in Persian and other cats: a prospective study using ultrasonography

OBJECTIVE: To determine the prevalence of feline polycstic kidney disease in Persian cats presented to the University of Melbourne Veterinary Clinic and Hospital between February and August 1999. DESIGN: A prospective clinical study using client owned animals was performed. PROCEDURE: Two hundred and fifty Persian cats, ranging in age from 13 weeks to 10 years, were presented to the University of Melbourne Veterinary Clinic and Hospital for ultrasound examination of both kidneys. The cats were placed in dorsal and lateral recumbency and alcohol and ultrasonic coupling gel were applied to the skin. The kidneys were examined ultrasonographically in longitudinal, sagittal and transverse planes. Results were recorded for each cat at the time of examination as either negative or positive for PKD. In addition 14 Exotics (short-haired Persians), 4 Ragdolls and 3 British Short-Hair cats were examined. RESULTS: Forty five percent of Persian cats examined were found to be positive for feline polycystic kidney disease on the basis of presence of anechoic cysts within the renal parenchyma. These cats ranged in age from 13 weeks to 10 years. Fifty per cent of the Exotic cats were positive for polycystic kidney disease whereas all Ragdolls and British Short Hairs were negative for the disease. Only one positive cat was reported to be showing clinical signs of renal disease. CONCLUSION: The prevalence of feline polycstic disease in Persian cats presented to the University of Melbourne between February and August 1999 was 45%. Exotic cats were found to have the slightly higher incidence of 50%.     

Feline gastrointestinal adenocarcinoma: a review and retrospective study

Feline gastrointestinal adenocarcinomas are the most common nonhematopoietic gastrointestinal tumors in cats. They are highly malignant tumors causing intestinal obstruction due to the annular, stenosing nature to their growth. Current literature is largely based on surveys of pathology records. Therefore, a retrospective study was conducted to evaluate clinical course and prognosis with surgical excision of the tumor. In published reports feline gastrointestinal adenocarcinoma represented 20-35% of gastrointestinal neoplasia in the cat; the average age was greater than ten years; and there was a greater incidence in Siamese. The small intestine accounted for 70% of cases. In this retrospective study, cats usually had a long history of non-specific gastrointestinal disease; weight loss and vomiting were the most common signs. Abdominal radiographs demonstrate intestinal obstruction, and an abdominal mass is often palpable. With intestinal resection and anastomosis, median survival time was 2.5 months (range: 0-24 months). Tubular adenocarcinomas may have a better prognosis than other histological types, especially if metastasis is not present at the time of surgery. A significant disease-free interval is possible in some cases.     

Feline immune-based polyarthritis: a study of thirty-one cases

Non-infective polyarthritis in the cat is classified into erosive (feline rheumatoid arthritis and feline periosteal proliferative polyarthritis) and non-erosive (feline systemic lupus erythematosus, feline idiopathic polyarthritis) forms. Criteria are used to identify each group. Clinically, all forms are similar. Affected cats are stiff, unwilling to move and may resent any form of handling. Joints are usually swollen and painful on manipulation. Some cases are pyrexic and inappetent. Radiography demonstrates destructive changes within joints in the erosive forms and also the periosteal new bone, characteristic of the periosteal proliferative form. Soft tissue thickening is also demonstrated. Tests for the autoantibodies rheumatoid factor and antinuclear antibody are important in the diagnosis of rheumatoid arthritis and systemic lupus erythematosus. Treatment is with anti-inflammatory and immunosuppressive agents (prednisolone, cytotoxic drugs). Cats with the rheumatoid and periosteal proliferative types do not recover but some manage to cope with the lameness. Cats with idiopathic polyarthritis can make a complete recovery although cases associated with myeloproliferative disease have a hopeless prognosis.     

Feline osteoarthritis: a prospective study of 28 cases

OBJECTIVES: To identify a cohort of cats with clinical osteoarthritis and to report on the clinical signs, the frequency of joints affected and the possible aetiopathogenesis within this population. METHODS: Inclusion criteria for this prospective study were presence of historical evidence and/or clinical signs of osteoarthritis, together with radiographic evidence of osteoarthritis. Patients showed clinical improvement within four weeks of analgesic administration and were free from other disease processes, which might explain the clinical signs and/or their response to analgesia. RESULTS: Twenty-eight cases were included in the cohort. The elbow (45 per cent) and the hip (38 per cent) were the most frequently affected joints. Seventy-one per cent of cases had primary/idiopathic aetiology. Alterations in both the ability to jump (71 per cent) and the height (67 per cent) of jump (lifestyle changes) were the most frequent signs of disease. Sixty-one per cent of owners felt that their pet had made a marked improvement following administration of an analgesic/anti-inflammatory drug. There were statistically significant improvements in the ability to jump (P < 0.001), the height of jump (P < 0.001), lameness (P = 0.03), stiff gait (P = 0.04) and the activity level (P = 0.02) when compared with the start and the end of the study period. CLINICAL SIGNIFICANCE: Osteoarthritis is a clinical problem in cats, but overt lameness is not the most common clinical feature.     

Traumatic craniolateral shoulder luxation and fracture of the lesser tubercle of the humerus in a dog

A five-year old, spayed female, Bearded Collie was presented with a 24-hour history of non-weight-bearing lameness of the right thoracic limb after sustaining vehicular trauma. Radiographs revealed a craniolateral scapulohumeral luxation and a distally and medially displaced fracture of the lesser tubercle of the humerus. Open reduction and internal fixation of the fracture was achieved with lag screw fixation and an anti-rotational Kirschner wire. Surgical repair resulted in compression across the fracture line, anatomic reduction of the articular surface, and a stable scapulohumeral joint following reduction of the humeral head in the glenoid. Six weeks postoperatively, the patient exhibited no evidence of pain or lameness on the right thoracic limb and radiographs revealed complete healing of the fracture and normal articulation of the scapulohumeral joint. This is the first report of a lesser tubercle fracture associated with a craniolateral shoulder luxation. Surgical intervention resulted in the return of full shoulder joint function in this dog.     

Feline plasma cell pododermatitis: a study of 8 cases

Eight cases of feline plasma cell pododermatitis, collected over a 3-year period, were studied using histological (haematoxylin and eosin), histochemical (methyl green-pyronin) and immunohistochemical (antibody against lambda light chains of immunoglobulins) techniques. No sex, breed or age predisposition, or paw predilection was observed. The disease began as a swelling of the footpads, followed by ulceration. Histologically, lesions were characterized by the presence of a large number of plasma cells in a predominantly perivascular pattern. Binucleated plasma cells and mitotic figures were observed. Clinical follow-up for over 1 year revealed total remission of the lesions both after glucocorticoid therapy in four cases, and total surgical excision in two animals. Follow-up studies were not possible in one case.