Chapter 68-74 Flashcards

Question

Miller JAVMA 23 Joint injections

Answer 1

* Minor complications were noted in 70 of 283 visits and included transient soreness (18.4%, lasting a median of 2 days; range, 1 to 20 days) and gastroenteritis (6.8%). * One case of septic arthritis (1/505 joints), which possessed risks of a hematogenous source, was the only potential major complication. * Therapeutic joint injections in dogs are safe, with an extremely low risk of major adverse effects. Transient soreness is a commonly expected minor adverse event.

Answer 2

* Injuries that can be sustained by dogs in an elevator include crush injuries from doors closing on limbs or tails and injury due to leash entrapment in an elevator door. * Many elevator-related injuries required surgical intervention, and recovery was often protracted. * All dogs survived to hospital discharge in the present study, and none of the injuries in these dogs had serious long-term consequence

Answer 3

* Thirteen animals sustaining ballistic trauma. Twelve of 13 animals survived to discharge. Two animals had ophthalmic abnormalities, 9 animals had neurologic lesions, and 2 animals had no significant ophthalmic or neurologic deficits. o Seven dogs underwent surgical intervention: 5 neurosurgical, 1 enucleation, and 1 laparotomy. Median hospitalization time was 6 days with a range from 1 to 31 days. * Overall prognosis and outcome are variable and dependent on specific injury location and degree of injury.

Answer 4

* 99% survived to discharge compared to 73.5% of the nonsurgical group * The most common surgery services involved were orthopedics (41%) and dentistry (38%) Most common surgeries performed were mandibular fracture stabilization and internal fixation for long bone fractures * Surgical intervention in feline trauma patients appears to be associated with higher survival rates, but no difference in mortality was found across surgery services. OR surgical intervention, in particular, orthopedic surgery, was associated with increased length of hospitalization, increased cost, and increased use of blood products.

Answer 5

● constructs prepared with hybrid and figure-8 patterns sustained 2x higher forces before gap formation compared to those prepared with simple interrupted pattern ● no difference between tendons whose plate was secured with hybrid or figure 8 suture patterns

Answer 6

● tested 3 loop pulley, exposed double-cross-lock, embedded double-cross-lock, triple-circle-lock, and modified Tang patterns ● exposed double-cross-lock, embedded double-cross-lock, and modified Tang had ~2x higher yield, peak, and failure loads than 3 loop pulley ● these patterns also had higher load to 1 and 3 mm gapping ● these patterns failed by suture breakage, vs 3 loop pulley failed by suture pull through

Answer 7

● 5 labs between 6-8 months of age, avulsion injuries diagnosed on rads or CT ● All treated asymptomatically with rest, NSAIDS, all improved (most had concurrent other ortho issues, MCP, OCD)

Answer 8

higher rate of increase in the muscle length was observed when femotibial joint was >135* and tibiotarsal joint was <125*

Answer 9

Quadriceps muscle length/femur length ratio increased with the hip extended and with stifle flexed

Answer 10

● all tendons healed and no complications noted ● utilized Fixin L or T plate to the medial tibia and calcaneus, 2 locking screws in each bone

Answer 11

● no change in tibiotarsal angle in any technique tested ○ single circular ring, calcaneotibial screw, calcaneotibial screw + cranial cast, cranial cast alone, type IA linear ESF, type II linear ESF

Answer 12

● 2 dogs had major comps, successfully revised ● PRP either injected directly into tendon ends or delivered via collagen sponge ● At long-term follow up - anatomic measurements did not differ btwn treated and normal contralateral tendons ● Owners scored fxn as 96% and QOL as 95%

Answer 13

● mode of failure different between groups: o w/ epitendinous horizontal mattress suture: failed by suture breakage o w/o epitendinous suture, failed by suture pull through ● Addition of an epitendinous suture pattern significantly reduced gap formation between tendon ends and significantly increased loads at yield (2x) and failure (2.0x) ● Use of an epitendinous suture should be considered to significantly increase biomechanical strength of repairs

Answer 14

● Resistance to 1 and 3mm gap formations was greater for epitendinous groups than LL alone ● No differences in yield, peak, failure forces or gapping was noted btwn Epitendinous groups

Answer 15

● Gap formation best prevented with 3LP vs LL when used alone ● Tendonorrhaphies combined with epitnedinous suture achieved higher yield, peak, and failure forces without gapping btwn tendon ends ● Addition of epitendinous suture eliminated gapping btwn tendon ends until failure and increased resistance to loads tolerated at repair site

Answer 16

● force to create 1 mm and 3 mm gaps was greater in complete vs partial circumferential ES placement ● complete circumferential ET sutures failed by suture pull through; partial circumferential ET sutures failed by suture breakage ● addition of complete circumferential ET suture with single or double knotting technique increased biomechanical strength of normal tendon repairs ● no difference between the two 360* ET suture groups for yield or failure point

Answer 17

● compared locking loop + smooth suture/V-loc/Quill/Stratafix epitendinous sutures ● yield and failure loads greater for smooth suture and Stratafix epitendinous sutures ● groups with epitendinous suture required higher loads to generate 1 and 3 mm gaps

Answer 18

● failure mode differed: ○ suture pull through in non-ET suture augmentation ○ tissue failure distant to repair when using ET suture ● no difference between 3LP + ET vs NBSP + ET ● NBSP may be advantageous as it is as strong and doesn’t require knot tying

Answer 19

● yield and failure loads were 2X greater when accessory tendon graft was used for repair ● greater forces was required to cause 1 mm and 3 mm gaps in the accessory tendon graft group

Answer 20

six-strand repair was strongest ● mode of failure in all groups was suture pull-through

Answer 21

● strength doubled with autologous lateral digital flexor graft ● stabilized lateral digital flexor to calcanean tendon via Krackow pattern ○ 85% of these failed via tissue rupture at myotendinous junction distant to repair site

Answer 22

* All cats walked more comfortably post-tenectomy surgery. * Onychectomy can lead to pain, inappropriate elimination and aggressive behavior. The presented salvage tenectomy procedure can alleviate or eliminate inappropriate behaviors by reducing the pain from the original onychectomy.

Answer 23

* A significant reduction in the most central portion of the supraspinatus tendon was found for every increased year in age

Answer 24

the distal radioulnar ligament could be seen as a triangular-shaped structure extending between the dorsal surface of the distal radius and ulna * In the cat, there appears to be a less extensive interosseous component of the distal radioulnar ligament compared with the dog and cheetah. Instead, the ligament follows the articular surfaces of the distal radius and ulna. * These anatomical differences may account for increased rotation of the feline antebrachium

Answer 25

* Most cases involved closed injuries of the CCT (69.7%). o Twenty- one of 46 cats had closed atraumatic injuries (45.7%). o Open injuries (30.3%) were most commonly lacerations (65%). o Twenty-one injuries were classified as atraumatic (31.8%), whereas 25 were traumatic (37.9%). With every year of age, the odds of having an atraumatic injury increased by a factor of 1.021. o Most acute lesions were Meutstege type I injuries (55.6%). o Subacute and chronic lesions were more commonly Meutstege type IIc injuries (58.8% and 60%, respectively). o Considering all CCT injuries, a Meutstege type IIc injury was most common (53%). * Older cats more commonly presented with atraumatic CCT injuries.

Answer 26

* 83.3% were treated surgically. All limbs were immobilised for a mean time of 48.2 days o 63 cats that had the temporary tarsal joint immobilisation technique recorded, a transarticular external skeletal fixator (ESF; 57.1%) or a calcaneotibial screw (33.3%) were used most commonly. Method didn't affect outcome * The total short-term complication rate was 41.3%, with pin tract infections being the most commonly o Three cats (6%) had a total of four major complications over the long term. * Most cats (86%) were free of lameness at the long-term evaluation, with an overall successful clinical long-term outcome of 84.9%, according to the owner questionnaire. * Outcome was generally good in cats with CCT injury, irrespective of the type of treatment. Surgically treated cats had a slightly better long-term outcomes.

Answer 27

4LP pattern was biomechanically superior to a 3LP pattern. 4LP suture pattern better resists gap formation and requires greater load prior to construct failure compared with a 3LP

Answer 28

* Computed tomography and mag- netic resonance imaging revealed an irregular, contrast-enhancing mass extending along the proximolateral right tibia, involving the long digital extensor tendon (LDET) ± cranial tibialis muscle

Answer 29

Each injured tendon was reconstructed with a fascia lata graft. The radius and metacarpal bones were immobilized by a type I external skeletal fixation for 6 weeks. * No difference was detected between the operated and contralateral limbs on postoperative examination, including range of motion, and angles of the carpus during standing or extension stress. No recurrence of carpal hyperextension was observed over 36 months after surgery. * Carpal hyperextension was successfully treated by primary repair of the damaged area and reinforcement with fascia lata and maintained long- term joint mobility in two dogs.

Answer 30

● unguarded cannulas resulted in more total iatrogenic injury, larger injury area, and larger injury length ● Silicone guarded arthroscopy cannulas decreased iatrogenic cartilage injury number and size during canine cadaveric stifle arthroscopy without increasing duration of procedure or surgical difficulty ● ET tube cut an used as “guard” Canula sheath

Answer 31

Experience of the observer increased the strength of agreement btwn scores

Answer 32

● cartilage pathology and synovitis seen in all joints ● overall cartilage scores were low (Modified Outerbridge 1) ● median outerbridge score of proximal trochlear groove (2) was significantly higher than all other locations ● higher synovitis scores were significantly associated with higher cartilage severity scores ● medial meniscus tear had no association with cartilage severity scores or synovitis

Answer 33

● sensitivity of meniscal flounce sign for indicating intact or torn meniscus was 97% ● a positive meniscal flounce sign was associated with a normal meniscus; absence of a flounce sign was associated with a meniscal tear

Answer 34

● The stifle joint fluid temperature was significantly higher when there was no contact between the tissue and RF probe compared with when tissue was contacted ● The temperature was higher during the 30-second application of RF energy than the 15-second group ● Bipolar RF energy without firm tissue contact rapidly and significantly increased joint fluid temperature beyond the level reported to damage chondrocytes (above 45°C) : mean 58°C ■ Compared to 29°C when contacting tissues ○ An 18-gauge egress needle had minimal effect on reducing joint fluid temperature ○ Caution is required in the use of bipolar RF energy in the canine stifle joint ● FYI: Previous in vitro studies reported that temperatures greater than 45°C for 3 seconds decreased the viability of chondrocytes in tissue culture, and caused 50% chondrocyte death at 55°C and death of all chondrocytes at 65°C

Answer 35

● arthroscopy resulted in greater iatrogenic injury than mini arthrotomy ● arthroscopy had higher number of injury sites per stifle, larger area ● visualization of articular structures not fully appreciated during mini arthrotomy

Answer 36

● pin sites: midway between apex of patella and lateral fabella; at level of tibial tuberosity in caudal tibia ● sufficient distraction was achieved for all stifle joints ● no damage to surrounding structures observed ● complete caudal horn meniscectomies possible with less articular damage than when attempted with manual distraction

Answer 37

● humeral anchors were safer to place than glenoid anchors ● arthroscopic imbrication of medial glenohumeral ligament and subscapularis tendon was feasible

Answer 38

● utilized a further caudal scope portal to better evaluate caudal humeral condyle ● all elbows with humeral intracondylar fissure showed a focal cartilage lesion on the caudal aspect of the humeral condyle ● Humero-anconeal incongruity was identified in all elbows with fissures

Answer 39

* Caudal cruciate ligament tearing was identified in 94% of stifles. o Longitudinal tearing (76%) was the most common type of damage (45% partial, 31% full thickness). o Synovitis was present in all joints and changes to the synovium overlying the CdCL were less frequently identified (67%).  Synovitis was associated with the degree to CdCL tearing. Synovitis overlying the CdCL was associated with lower body weight and lower CdCL damage. * Caudal cruciate ligament damage is common in dogs with cranial cruciate ligament disease and longitudinal tearing was the most common injury identified. Severity of joint pouch synovitis was positively correlated with the degree of CdCL damage and the portion of the CdCL not exposed to the synovium was unaffected. These findings suggest synovitis is likely a contributor to CdCL injury.

Answer 40

Synthetic Osteochondral Resurfacing (SOR) ● 14 stifles in 9 dogs ● used both 1st and 2nd generation of a synthetic osteochondral resurfacing implant (SynACart, Arthrex) ● all dogs had femoral condyle OCD ● polycarbonate urethane weight- bearing surface, with or without a titanium bone in-growth surface ● Gen 1 (monolayer) ● Gen 2 (bilayer with metal disc) ● At 12 weeks 93% (13/14) of stifles displayed implant stability ● 8/9 dogs achieved a good-excellent clinical outcome o 1 got infective arthritis and required explant

Answer 41

* Outcomes of dogs treated with generation 1 (G1 – 13 dogs, 15 shoulders) and G2 (11 dogs, 13 shoulders) SOR implants ● Lameness resolved in all dogs treated with G1 and 10/11 dogs treated with G2 by 12 wk ● Implant associated infection in one G2 implant required explant ● No recurrence of lameness in 9/15 G1 shoulders and 10/13 G2 shoulders at ~1 year post op

Answer 42

● utilized the COR system (Depuy Synthes) for only femoral OCD ● 20 stifles in 18 dogs ● single graft transfer in 6 stifles, 14 mosaicplasty; no major complications ● at 3 months, 15/20 stifles had no lameness ● at 6 months, 12/13 dogs had no lameness

Answer 43

● modified approach allowed visibility and adequate exposure in all cases ● technique provided a reliable approach for treatment of canine shoulder OCD

Answer 44

● A frame at 3 different angles of incline (40 degrees (standard), 35 and 30) ● Compared with 30° incline, ascent up the A-frame at a 40° incline requires a higher propulsive force and extended time in propulsion to maintain forward movement and convert potential energy into forward kinetic energy

Answer 45

● no effect of A-frame angle on the highest carpal joint extension angle ● mean carpal angle for all angles of A-frame was ~60* ● physiologic limits of carpal extension were reached at all A-frame angles

Answer 46

● There was no clinically significant reduction in carpal extension measurements with and without the brace

Answer 47

● No difference was detected between Numerical rating score (NRS) and visual analog score (VAS) at walk or at trot before and after orthopedic examination

Answer 48

● Dysplastic dogs had lower PVF (4% of BW difference), increased symmetry index (13% difference) and reduced maximum hip joint extension angle and ROM in all tests ● Mean hip ROM difference was 11, 20, 25, 25 for walking, climbing stairs, walking down a slope, sitting down/standing up

Answer 49

Symmetry Index values are likely to be different between Force Plate and Pressure Mat systems

Answer 50

The weight distribution platform had the highest combined sens/spec at cut off point 2 below the normal value for the detection of both objective lameness and orthopedic disease

Answer 51

● small breed showed significantly higher weight loading on forelimbs compared to large breeds ● similar compensatory changes with unilateral hind limb lameness between small breed and large breed groups (cranial and lateral shift of center of mass)

Answer 52

● ground reaction forces in FHO legs were lower than those of other legs ● cats with limb shortening (dorsally displaced greater trochanter) did not have different ground reaction forces ● following FHO a long-term residual gait abnormality exists

Answer 53

the proximal row of carpal bones translate and rotate independently from the ulna in the cat during pronation of the antebrachium

Answer 54

● No difference in peak vertical force or vertical impulse between collection methods ● symmetry index was not different between methods ● one plate system took significantly longer

Answer 55

● There was no significant difference in peak vertical force and vertical impulse between dogs with differing TPA (<25 vs >25*)

Answer 56

● 40% demonstrated a standard trot ● 60% utilized a support trot intermittently

Answer 57

* Sagittal, transverse and frontal plane kinematics joint angles were generated by use of a joint coordinate system

Answer 58

Each model produced similar sagittal plane waveforms, though the LIN model had a greater vertical shift along the y-axis for the shoulder and elbow. no differences in angular displacement measurements between models before or after waveform alignment at a walk or trot.