Treatment of Monolateral Legg-Calvé-Perthes Disease with Autologous Bone Marrow Mononuclear Cells in 32 Dogs

Edda Francioso,Francesco Staffieri,Giacomo Rossi,Alberto Maria Crovace,Luca Lacitignola,Antonio Crovace

doi:10.1055/s-0040-1701470

Abstract

Abstract Objective In the present study, we report our results of the use of autologous bone marrow mononuclear cells (BMMCs) as a minimally invasive treatment for Legg-Calvé-Perthes in dogs. Study Design In accordance with Ljunggren's scale, inclusion criteria were determined by clinical condition and radiographic features of the disease, resulting in 32 dogs enrolled in this retrospective study from 2007 to 2019. Bone marrow was collected from each dog from the iliac crest and the mononuclear fraction was separated with density gradient centrifugation. The mean number of BMMCs was 104.7 ± 46.5 × 106 cells. The mean BMMC colony-forming units were 71.6 ± 51.9 × 102/mL.Cells were suspended in fibrin glue before BMMC administration and implanted via transcutaneous injection under computed tomography or radiographic guidance, using a Jamshidi needle inserted through the femoral head and neck. Results A progressive reduction of pain within 3 weeks after BMMC administration was observed in 28 patients, with gradually increased weight bearing on the affected limb. In four dogs, however, pain and lameness persisted and at 3 months post-BMMC injection, femoral head and neck resection was performed. Histological and immunohistochemical studies were done on samples from those four dogs, which showed evidence of formation of new cartilage and subchondral bone in the area where cells were implanted. Clinical Significance Based on these results, BMMC therapy may be considered as effective and minimally invasive treatment option for LCPD in dogs.

Highlights

Legg-Calvé-Perthes disease (LCPD) was first identified in children by Legg, Calvé and Perthes in 19101–3; in dogs, the disease was first described by Tutt in 1935.4 In canines, the average time of disease onset is at 7 months of age, with no gender differences
In the present study, we report our results of the use of autologous bone marrow mononuclear cells (BMMCs) as a minimally invasive treatment for Legg-CalvéPerthes in dogs
CD34þ cells were only found in stem cell-injected femoral heads and were completely absent in controls (►Fig. 8A). The aim of this retrospective study was to evaluate the use of BMMCs as a minimally invasive treatment for LCPD in dogs

Summary

Introduction

Legg-Calvé-Perthes disease (LCPD) was first identified in children by Legg, Calvé and Perthes in 19101–3; in dogs, the disease was first described by Tutt in 1935.4 In canines, the average time of disease onset is at 7 months of age, with no gender differences. In 10 to 15% of cases, LCPD is bilateral; the incidence is 2.8 cases per 1000.5. Legg-Calvé-Perthes disease has well-defined clinical and radiologic characteristics, the aetiology and pathogenesis have not yet been completely revealed. The pathological features of LCPD are typical for avascular necrosis of bone tissue, followed by attempts to revascularization and bony remodelling of the femoral head. E2 Treatment LCPD in Dogs with Autologous Bone Marrow Mononuclear Cells Crovace et al. Of a defect in endochondral ossification and considers the disease to be a type of osteochondritis.[6]. Several treatment methods have been proposed in LCPD aimed at promoting blood supply, such as core decompression, or conservative approach such as physiotherapy to reduce pain, and femoral head and neck resection as treatment of choice.[7,8]

Methods

Results

Conclusion