MSI

Question 1

Livet VCOT 2019

Beagle cadavers - sound vs transected medial GH lig

Answer 1

16 deg difference with goniometry
(Cook found >20deg difference using goniometry and image analysis)

Question 2

Penelas VS 2018

Cadaveric study in dogs

-1.5mm LabralTape (arthrex) + 2.9mm PushLock (arthrex) for cranial arm medial GH lig imbrication
-1.5mm FibreWire (arthrex) + 2.4mm PushLock (arthrex) for caudal arm
-2mm FibreTape (arthrex) + 3.5mm SwiveLock (arthrex) for subscapularis tendon

Answer 2

2/30 anchors incorrectly placed (glenoid harder to place than humerus)

Question 3

Carwadine JSAP 2019

Cadaveric study in cats - medial / lateral / bilateral injury

3.5M prolene repair (based on description in dogs by Ringwood 2001, Fitch 2001)

Answer 3

4/6 medially injured and 5/6 laterally injured joints were clincially stable

All bilaterally injured were unstable

Prosthetic suture repair was effective

Question 4

Jones VCOT 2019

Measuring shoulder abduction angles - intact and transected medial support structures - fluoro

-Cook VS 2005: MSI had sig higher abduction angles
-Cogar VS 2008: hyperabduction of shoulder found in both MSI and LSI
-Devitt VS 2007: hyperabduction present in MSI but not pathognomonic and may be in other shoulder pathologies

Answer 4

Sig variation exists between observers - caution using this as an outcome measure as response to tx - esp if different clinicians!!!

Shoulder in flexion can influence measured abduction angles - ensure full extension

Question 5

Aoki VS 2021

Cadaveric study
Leipzig distrator shoulder arthroscopy

Answer 5

Decreased iatrogenic articular damage and shortened arthrscopic time

Question 6

Hammer JSAP 2021

Retrospective study
Novel inverted V-shaped screws and spiked washers prosthetic lig

Answer 6

Full fx in 4/6, acceptable in 2/6

Question 7

Gemignani VRU 2023

Cadaveric study
U/S exam of intact vs transected GH lig

Answer 7

Medial GH lig seen in 67% - failed to dx transection in some

Question 7

Von Pfeil VS 2021

Prospective study Alaskan endurance dogs

Answer 7

U/S shoulder muscle abnormalities were common but not a/w clinical lameness

Shoulder abduction varied greatly, up to 75deg in normal

Question 8

Llido VCOT 2023

Cadaveric study
Arthroscopically guided FASTak repair of medial GH lig

Answer 8

Arthroscopically guided FASTak repair feasible

Question 9

Rocheleau VS 2023

Cadaveric study
Arthroscopically assisted intra-articular aiming device and shoulder stabilisation (toggle or bone anchor)

Answer 9

Aiming device accuracy 88%
3 cases violated articular surface
3 cases suture anchor not possible

Question 10

Holman VCOT 2024

FOV lateral shoulder arthroscopy

Answer 10

FOV include
-60% cranial border medial GH lig
-20% subscapularis
-50% intraarticular length of biceps -> but if flexed 60%

(<75% of each of the 3 supporting structures are within FOV)

Question 11

Kieves Vet Evidence 2020

10 papers reviewed (1 prospective, 6 retrospective, 3 case reports)

Answer 11

Conclusion: dogs with MSI may be treated with medical or sx mx

-Becker 2015: shockwave tx - 1/5 improved, no objective measure

-Cook 2005: RITC 43 dogs - 93% improved, no ojective measure

-Fitch 2001: reconstruction medial GH lig, Velpeau, 7/8 improved, no objective measure

-Franklin 2013: 101 dogs MSI, 10 LSI, 19 multidirectional; 40% medical, 10% RITC, 50% reconstruction; Recon 3x more likely successful than medical, 1.6x more likely successful than RITC

-O’Donnell 2017: 39 dogs arthroscopic TightRope (llido used suture anchor); 15% complication rate, 77% full fx; no objective measure
Grading system for arthroscopic MSI
-1: laxity, fraying of SST, MGHL or both
-2: fraying of SST, MGHL, or labrum, focal cartilage damage
-3: complete tear SST, MGHL or both, subluxation humeral head
-4: complete luxation humeral head