Stifle Joint Disease Research Articles

Chronic rhinosinusitis with osteomyelitis in a geriatric snow leopard (Panthera uncia)

AbstractA geriatric, 16‐year‐9‐month‐old, male snow leopard (Panthera uncia) under human care was necropsied after euthanasia over concerns for worsening chronic kidney disease and bilateral blindness. Gross and histological examinations revealed necrotising frontal sinusitis and osteomyelitis with mixed‐cellular rhinotracheitis, affecting the right frontal sinus, right nasal cavity and trachea, respectively, with intralesional and cilia‐associated Gram‐negative bacilli detected. Microbiological cultures were inconclusive, although Bordetella bronchiseptica and feline herpesvirus 1 were positive on PCR analysis. Immunohistochemistry, however, refuted active feline herpesvirus 1 involvement. Marked, chronic, bilateral, renal degeneration and fibrosis (chronic kidney disease), mild hepatic cirrhosis, bilateral chronic degenerative stifle joint disease and testicular intratubular seminoma were also detected on postmortem examination. No gross ocular or optic nerve lesions were identified; however, histology indicated bilateral diffuse outer retinal atrophy and retinal detachment, supportive of clinical blindness at time of death. This case represents the first report of chronic rhinosinusitis and osteomyelitis in a snow leopard.

Etiopathogenesis of Canine Cruciate Ligament Disease: A Scoping Review.

The spontaneous rupture of the cranial cruciate ligament in dogs remains a pathoetiologic puzzle. Despite much progress in research over the past years, the systemic and local mechanisms leading to ligament degeneration and structural failure remain largely obscure. This scoping review focuses on pathogenesis and aims at summarizing and interpreting today's knowledge on causes of canine cruciate ligament rupture, i.e., the multifactorial mechanisms leading to degenerative stifle joint disease with collagen matrix degeneration and structural failures. Thus, the initial view of traumatic ligament rupture, fostered by "wear and tear", has clearly been replaced by a new concept of systemic processes linked to progressive degenerative joint disease and ligament failure; thus, the term "cranial cruciate ligament disease" has been coined and is generally accepted. In addition, cruciate ligament rupture in people shares some similarities with the lesion in dogs; therefore, the review also includes comparative studies. The methods used were based on the PRISMA-ScR model (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews).

The epidemiology of stifle joint disease in an insured Swedish dog population.

Stifle joint diseases (SJD) are common in dogs and include a variety of diagnoses. The objective of the study was to provide an overview of the epidemiology of SJD in insured dogs. An historical single cohort study of dogs insured in Agria Pet Insurance (2011-2016) in Sweden was performed. Incidence and relative risk (RR) of SJD was calculated for the whole dog population and for subgroups divided by breed, breed group and sex. The study population included almost 600,000 insured dogs (>1.7 million dog-years). Ninety-three different stifle joint diagnoses were reported in 9624 dogs, and the most common were cruciate ligament rupture and patellar luxation. The incidence of SJD was 55.4 cases per 10,000 dog-years at risk. Bulldog and boerboel had the highest RR of SJD. The breeds that accounted for the highest proportion of all SJD claimed dogs were mixed breed and Labrador retriever. Female dogs had a slightly increased RR compared with male dogs (RR 1.06, p = 0.006). The incidence increased yearly during the observation period. The study demonstrates breed-specific differences in incidence of SJD in dogs, which may be of importance for breeders, dog owners and veterinarians.

Ultrasonographic Characteristics of the Stifle Joint in Clinically Normal Donkeys (Equus asinus)

Stifle ultrasonography is a widely accepted diagnostic tool that has been used for diagnosing articular and peri-articular stifle injuries in horses. Limited information is available regarding the ultrasonographic appearance of the stifle joint in donkeys. The aim of the present study was to describe the normal ultrasonographic characteristics of the stifle joint in clinically normal donkeys. A descriptive study was done on 15 clinically normal donkeys (30 joints). Ultrasonographic examination was done in a systematic manner including both supra- and infra-patellar regions. The patella, patellar ligaments and tibial tuberosity were taken as palpable anatomical landmarks for localization of different stifle structures. A detailed description of the ultrasonographic appearance of the quadriceps muscle, supra-patellar pouch and femoropatellar joint was done through the supra-patellar approach. In infra-patellar approach, thepatellar ligaments, medial and lateral femorotibial joints, collateral ligaments, menisci, origin of peroneous tertius and popliteal tendon were described. Standardized, repeatable and reliable images were achieved from both approaches. Ultrasonography provided a clinically useful tool for diagnosing donkeys with stifle joint disease.

Pressuring of Acupoints as a Complement to the Diagnosis of Stifle Diseases in Horses

Diseases of the stifle joint remain a challenge for veterinarians. The objective of this study was to achieve a valuable acupuncture suggestive diagnosis to be considered for stifle joint diseases in horses. Thirty-nine nonlame horses involved in different activities were assessed. Acupuncture was independently performed by two evaluators. Reactions of the animal when pressurizing the point suggestive of stifle disease (PSSD), Bladder-20 and/or Bladder-21, were considered as the inclusion criteria for inclusion in the stifle group (SG, n = 31), and the animals with no reactions were assigned to the control group (n = 8). Radiographic and ultrasonographic examinations were performed and evaluated by two independent professionals blinded to the group allocation. Thermographic examination of the PSSD and stifles was also performed, after acclimatization. The ultrasound scores and radiographic findings were higher in the SG than in the control group. Thermography evidenced increased temperature in the PSSD and stifles in the SG. The minimum acupuncture diagnostic criteria for stifle joint disease had a sensitivity of 87.5% and a specificity of 57.0%, and the addition of the acupoints Gallbladder–dorsal tuber coxae, Gallbladder-27, and Spleen-13 to the minimum diagnostic criteria improved sensitivity and specificity. In conclusion, assessing the reaction at the demonstrated acupoints can facilitate a diagnosis of a potential stifle lesion.

Radiographic Assessment of the Popliteal Lymph Node to Aid the Differentiation of Canine Stifle Osteosarcoma From Moderate to Severe Stifle Degenerative Joint Disease

Degenerative joint disease of the stifle is a common canine osseous pathology. Early degenerative changes may show mild mineral proliferation of periarticular margins with soft tissue, resulting in joint distension. If the joint is chronically unstable, osseous changes become more complex. Moderate to severe stifle degenerative disease then transitions to a combination of bony proliferation and resorption as subchondral cystic changes develop. The radiographic descriptions of moderate to severe degenerative disease overlap with those of subtle aggressive disease. If this occurs in a location prone to primary bone tumors, like the distal femur, radiographic interpretation becomes difficult. The aim of this study was to evaluate the utility of objectively assessing the popliteal lymph node size and shape on radiographs to differentiate moderate to severe stifle degenerative joint disease from distal femoral or tibial osteosarcoma. Stifle radiographs were acquired for evaluation of pelvic lameness localized to the stifle joint. Dogs with moderate to severe degenerative stifle joint disease were radiographed at 3 time points: prior to surgery for a tibial plateau leveling osteotomy (103), immediately postoperation (103), and at a recheck 6-8 weeks postsurgery (62). Dogs with osteosarcoma were radiographed only at time of diagnosis (42). Length and width gross popliteal lymph node measurements and a ratio of long axis to short axis were compared between groups using nonparametric analysis. No significant difference was determined using a long axis to short axis ratio for the popliteal lymph node to differentiate moderate to severe stifle degenerative joint disease and osteosarcoma (P = .290). The gross measurements of the long axis and short axis of the popliteal lymph node for dogs with osteosarcoma were significantly greater than the degenerative joint disease groups (P = .017, P = .000). Thus, evaluation of a long axis to short axis ratio for popliteal lymph nodes does not provide a clinically useful objective measure in differentiating peristifle osteosarcoma from moderate to severe degenerative disease of the stifle joint. The length and width of the popliteal lymph node differed significantly; however, the clinical difference is minimal.

Arthroscopic Approach and Intraarticular Anatomy of the Stifle inSouthAmerican Camelids

To describe a cranial arthroscopic approach to the stifle of South American camelids and to report our clinical experience with camelid stifle arthroscopy. Experimental study and retrospective case series. (1) Cadaveric alpaca hindlimbs (n = 18; 9 alpacas); (2) 1 alpaca and 1 llama Polymethylmethacrylate joint casts (n = 2) were made to define stifle joint dimensions. Cadaveric stifle joints (n = 16) were evaluated arthroscopically to determine arthroscopic portal locations, describe the intraarticular anatomy, and report potential complications. An alpaca and a llama with stifle joint disease had diagnostic arthroscopy. Successful entry into the stifle joint was achieved in 16 cadaver limbs. Observed structures were: the suprapatellar pouch, articular surface of the patella, femoral trochlear ridges and groove, cranial aspect of the femoral condyles (n = 16); distal aspect of the cranial and proximal aspect of the caudal cruciate ligaments (14); and cranial aspects of the medial and lateral menisci (11), and cranial meniscotibial and intermeniscal ligaments (8). Stifle arthroscopy allowed for joint evaluation and removal of osteochondral fragments in 1 alpaca and 1 llama with naturally occurring stifle disease. Complications of cadaver or live procedures included minor cartilage scoring (3 stifles) and subcutaneous periarticular fluid accumulation (8 stifles). Arthroscopy provides a safe approach for diagnosis and treatment of stifle lesions in South American camelids.

Minimally displaced tibial tuberosity avulsion fracture in nine skeletally immature large breed dogs

The objective of this study was to describe the clinical and radiographic features, as well as the treatment and outcome of minimally displaced tibial-tuberosity-avulsion-fractures (MDTTAF). Signalment, history, diagnostics, therapy, and outcome were recorded. Follow-up was documented as re-examination, radiographic assessment or telephone conversation. Nine large breed dogs that were presented with lameness originating from the proximal tibia were included. All showed signs of pain when pressure was applied to the tibial tuberosity. There was no stifle instability or intra-articular disease. The main feature on mediolateral radiographs was a widened tibial-tuberosity-physis with reactive new bone and loss of edge definition of the epiphyseal and metaphyseal margins. Non-surgical treatment was chosen in eight dogs, and surgery in one dog. Radiographic follow-up showed progressive closure of the tibial-tuberosity-physis and healing. Clinical signs resolved at a median of 28 days (range: 14-120). Minimally displaced tibial-tuberosity-avulsion-fractures should be a differential diagnosis in skeletally immature large breed dogs older than nine months of age with signs of subtle pelvic-limb lameness, and signs of proximal tibial pain, but no evidence of stifle joint disease. Thorough clinical examination and critical review of bilateral radiographs are important to diagnose MDTTAF. The outcome in these cases suggests that the prognosis for MDTTAF is excellent. Age and size of the affected dogs in this study differ from an earlier publication that illustrated more severely displaced tibial tuberosity avulsion fractures, occurring mainly in terriers around five months of age.

Contribuição do contraste negativo na artrografia tomográfica do joelho normal de cães

A ruptura do ligamento cruzado cranial é uma das causas mais comuns de claudicação do membro pélvico de cães. A radiografia e a ultrassonografia são métodos de diagnóstico frequentemente utilizados na rotina clínica de pequenos animais, porém a tomografia computadorizada é uma modalidade de imagem ainda pouco estudada para avaliar a articulação do joelho de cães. O presente trabalho teve por objetivo avaliar a contribuição do contraste negativo na artrografia tomográfica do joelho normal de cães, para visibilizar as estruturas intra-articulares e padronizar o uso desse contraste na articulação. Foram utilizados 24 membros pélvicos de cães de raças variadas, selecionados pela ausência de histórico de doença articular prévia do joelho e por apresentarem exames radiográficos, ultrassonográficos e macroscópicos normais. O experimento foi delineado em dois grupos, sendo o grupo I constituído de animais com peso até 20 kg e grupo II acima de 20 kg. Foram feitos cortes tomográficos com o membro flexionado e estendido. A quantidade média de ar empregada para a distensão da cápsula articular foi de 49 ml para o Grupo I e de 81 ml para o Grupo II. Utilizou-se um tubo de látex na porção distal à articulação do joelho para reduzir o escape de ar pelo tendão extensor digital profundo, que possui comunicação intra-articular. Foi possível visibilizar pela imagem tomográfica, em todas as articulações, as seguintes estruturas: ligamento cruzado cranial e caudal, meniscos medial e lateral, ligamento patelar, ligamentos colaterais e cápsula articular. Desta forma, o contraste negativo se mostrou uma alternativa eficaz para auxiliar a identificação das estruturas anatômicas do joelho na artrografia tomográfica.

Effect of conformation of the distal portion of the femur and proximal portion of the tibia on the pathogenesis of cranial cruciate ligament disease in dogs

To evaluate mediolateral radiographic views of stifle joints to identify conformational differences between athletically sound dogs and dogs with cranial cruciate ligament disease (CCLD). Radiographic images of 50 stifle joints of 43 dogs with surgically confirmed CCLD and 50 stifle joints of 38 dogs without clinical signs of stifle joint disease. Mediolateral radiographic views of stifle joints were obtained, and long axes of the femur, tibia, and femoral condyles were measured. Angles between long axes of the femur and femoral condyle and between long axes of the femur and tibia were measured. Circles were drawn representing the joint surface of femoral condyles (circle 1), area of contact on the tibial plateau (circle 2), and femoral trochlea (circle 3). Radii of circles 1, 2 (line F), and 3 were measured. Distances between midpoints of circles 1 and 2 (line K) and between midpoint of circle 2 and most cranial aspect of the tibial tuberosity (line G) were measured. To evaluate differences in conformation that could lead to CCLD, quotients derived from measurements were created for comparison; angles were compared between dog groups. Significant differences were found in the quotients created by the lengths of lines G and F and lines G and K between dogs with and without CCLD. No anatomic differences were detected in the distal portion of the femur between dogs with and without CCLD. Development of the tibial tuberosity and shape (convexity) of tibial condyles may be relevant in the pathogenesis of CCLD.

The Possible Role of the Tibial Plateau Angle for the Severity of Osteoarthritis in Dogs with Cranial Cruciate Ligament Rupture

The purpose of this study was to determine factors correlated with the severity of radiographic osteoarthritis (OA) scoring in dogs with cranial cruciate ligament rupture (CrCLR). Three radiographs of stifle joints (craniocaudal, mediolateral, and mediolateral radiograph with 90 degree flexion of the stifle and tarsal joints) were obtained from 36 dogs with CrCLR (Clinical group) and from 22 dogs without stifle joint disease (Control group). Information about these dogs was collected from the owners and from medical records. Radiographic OA scores in each dog in the clinical group were determined from radiographs using a numeric grading system previously reported. The tibial plateau angle (TPA) in each dog in both groups was measured on mediolateral radiographs with 90 degree flexion of the stifle and tarsal joints. The Mann-Whitney's U test was used for comparing variables between the clinical group and the control group, and Spearman's rank correlation test was used for evaluating correlations between radiographic OA scores and variables in the clinical group. No significant differences were detected between the clinical group and the control group for any of the variables. There were two positive correlations; one between the radiographic OA score and TPA (r=0.395, p=0.014); and the other between body weight and OA score (r=0.399, p=0.013) in the clinical group. Our results indicate that body weight and TPA could affect the severity of the radiographic OA score in dogs with CrCLR.

Prevalence of cranial cruciate ligament rupture in a population of dogs with lameness previously attributed to hip dysplasia: 369 cases (1994–2003)

To determine the prevalence of cranial cruciate ligament rupture (CCLR) in dogs with lameness previously attributed to canine hip dysplasia (CHD). Retrospective study. 369 client-owned dogs. Hospital medical records from 1994 to 2003 were reviewed for dogs in which the referring veterinarian had diagnosed hip dysplasia or hip pain. Dogs were designated as having hind limb lameness because of partial or complete CCLR or CHD. 8% of dogs were sexually intact females, 43% were spayed females, 14% were sexually intact males, and 35% were castrated males. Mean age was 3.8 years (range, 3 months to 15 years). The most common breeds were the Labrador Retriever (21%), German Shepherd Dog (13%), and Golden Retriever (11%). The prevalence of CCLR as the cause of hind limb lameness was 32% (95% confidence interval, 27.2% to 36.8%). The distribution of CCLR among hind limbs was left (29%), right (28%), and bilateral (43%). Of 119 dogs with CCLR, 94% had concurrent radiographic signs of CHD, 92% had stifle joint effusion, and 81% had a cranial drawer sign. On the basis of the high prevalence of CCLR in dogs referred for lameness because of CHD, it is important to exclude other sources of stifle joint disease before making recommendations for treatment of CHD.

Pathologic changes in grossly normal menisci in dogs with rupture of the cranial cruciate ligament.

To determine whether histopathologic changes are detectable in grossly normal medial menisci from dogs with rupture of the cranial cruciate ligament (CCL). Case series. 40 medial menisci from dogs with rupture of the CCL and 20 medial menisci from control dogs without stifle joint disease. Data evaluated included age, duration of clinical signs, and whether rupture of the CCL was complete or incomplete. Three groups (n = 20/group) were also compared on the basis of 5 histologic criteria; group-1 menisci appeared grossly normal and were obtained from dogs with naturally occurring rupture of the CCL, group-2 menisci were grossly abnormal and were also obtained from dogs with naturally occurring CCL ruptures, and group-3 menisci were collected at postmortem from dogs without stifle joint disease that were of similar age and weight as dogs in groups 1 and 2. Group-2 menisci were significantly different from group-1 and -3 menisci in all histologic criteria. Group-1 menisci were significantly different from control menisci in only 1 of the 5 histologic criteria (cartilage differentiation). Dogs that were > or =3 years old had significantly more surface cellularity than did dogs that were < 3 years old. A significant difference was not detected between groups 1 and 2 with regard to completeness of rupture. Histologic changes in meniscal cartilage correlate with gross appearance of the cartilage at time of surgery for rupture of the CCL. On the basis of minimal histologic changes, routine removal of grossly normal menisci does not appear to be warranted.