Abstract
Cranial cruciate ligament rupture (CR) is a degenerative condition in dogs that typically has a non-contact mechanism. Subsequent contralateral rupture often develops in dogs with unilateral CR. Synovitis severity is an important factor that promotes ligament degradation. Consequently, we wished to evaluate the utility of arthroscopy for assessment of stifle synovitis in dogs with CR. Herein, we report results of a prospective study of 27 dogs with unilateral CR and bilateral radiographic osteoarthritis. Arthroscopic images and synovial biopsies from the lateral and medial joint pouches were obtained bilaterally and graded for synovial hypertrophy, vascularity, and synovitis. Synovial tartrate-resistant acid phosphatase-positive (TRAP+) macrophages, CD3+ T lymphocytes, Factor VIII+ blood vessels, and synovial intima thickness were quantified histologically and related to arthroscopic observations. Risk of subsequent contralateral CR was examined using survival analysis. We found that arthroscopic scores were increased in the index stifle, compared with the contralateral stifle (p<0.05). Numbers of CD3+ T lymphocytes (SR = 0.50, p<0.05) and TRAP+ cells in joint pouches (SR = 0.59, p<0.01) were correlated between joint pairs. Arthroscopic grading of vascularity and synovitis was correlated with number density of Factor VIII+ vessels (SR>0.34, p<0.05). Arthroscopic grading of villus hypertrophy correlated with numbers of CD3+ T lymphocytes (SR = 0.34, p<0.05). Synovial intima thickness was correlated with arthroscopic hypertrophy, vascularity, and synovitis (SR>0.31, p<0.05). Strong intra-observer and moderate inter-observer agreement for arthroscopic scoring was found. Dog age and arthroscopic vascularity significantly influenced risk of contralateral CR over time. We conclude that arthroscopic grading of synovitis is a precise tool that correlates with histologic synovitis. Arthroscopy is useful for assessment of stifle synovitis in client-owned dogs, and could be used in longitudinal clinical trials to monitor synovial responses to disease-modifying therapy.
Highlights
Non-contact cranial cruciate ligament rupture (CR) causes approximately 20% of canine lameness and results in substantial healthcare costs [1]
Five dogs were given non-steroidal anti-inflammatory drug (NSAID) medication during the 30 days before arthroscopy and five dogs had no history of NSAID treatment
The arthroscopic synovial assessment method we used was adapted from a validated scoring system used in human beings [27]
Summary
Non-contact cranial cruciate ligament rupture (CR) causes approximately 20% of canine lameness and results in substantial healthcare costs [1]. Residual lameness is common in affected dogs, even after surgical stabilization [2]. Validation of arthroscopic assessment of stifle synovitis in dogs has not been previously described. Synovitis is not routinely assessed during clinical treatment [3]. The clinical value of arthroscopic assessment of stifle synovium for evaluation of disease severity in affected dogs is unclear. Recent research suggests that synovitis, assessed using arthroscopy and histologic examination, is a key early event in the explanatory mechanism for CR disease progression [4,5,6]
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