Magnetic resonance imaging for detection of late meniscal tears in dogs following tibial tuberosity advancement for treatment of cranial cruciate ligament injury

Summary

Objectives

To document the use of and to estimate the accuracy of magnetic resonance (MR) imaging for detection of late meniscal tears in dogs with cranial cruciate ligament injury treated with tibial tuberosity advancement (TTA).

Methods

Medical records of dogs that had TTA followed by stifle MR imaging for suspected meniscal tear and subsequent arthrotomy were reviewed retrospectively. Magnetic resonance images were reviewed independently by an observer blinded to clinical information who classified menisci as torn, abnormal but intact, or normal. Magnetic resonance and surgical findings were compared.

Results

Eight stifles from large breed dogs were included. Six stifles had a medial meniscal tear identified in MR images and later confirmed surgically. In the remaining two stifles, the menisci appeared intact in MR images and no tear was identified at subsequent arthrotomy. Lateral menisci in all stifles appeared intact in MR images and were considered normal at surgery. Susceptibility artefacts associated with TTA implants were present in all images but did not adversely affect interpretation of intra-articular structures.

Clinical significance

Magnetic resonance imaging appears to be accurate for diagnosis of late meniscal tears. Artefacts associated with TTA implants did not prevent evaluation of critical intra-articular structures. Further investigation with MR imaging should be considered when late meniscal tear is suspected following TTA.

Keywords

Cranial cruciate ligament - dog - magnetic resonance imaging - meniscus - stifle

• References

• 1 Johnson JA, Austin C, Breuer GJ. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp Orthop Traumatol 1994; 7: 59-69.
• 2 Ralph SC, Whitney WO. Arthroscopic evaluation of menisci in dogs with cranial cruciate ligament injuries: 100 cases (1999-2000). J Am Vet Med Assoc 2002; 221: 1601-1604.
• 3 Bennett D, May C. Meniscal damage associated with cruciate disease in the dog. J Small Anim Pract 1991; 32: 111-117.
• 4 Flo G. Meniscal injuries. Vet Clin North Am Small Anim Pract 1993; 3: 831-843.
• 5 Metelman LA, Schwarz PD, Salman M. et al. An evaluation of 3 different cranial cruciate ligament surgical stabilization procedures as they relate to postoperative meniscal injuries - a retrospective study of 665 stifles. Vet Comp Orthop Traumatol 1995; 8: 118-123.
• 6 Stauffer KD, Tuttle TA, Elkins AD. et al. Complications associated with 696 tibial plateau levelling osteotomies (2001-2003). J Am Hosp Assoc 2006; 42: 44-50.
• 7 Lafaver S, Miller NA, Stubbs WP. et al. Tibial tuberosity advancement for stabilization of the canine cruciate ligament-deficient stifle joint: surgical technique, early results and complications in 101 dogs. Vet Surg 2007; 36: 573-586.
• 8 Case JB, Hulse D, Kerwin SC. et al. Meniscal injury following initial cranial cruciate ligament stabilization surgery in 26 dogs (29 stifles). Vet Comp Orthop Traumatol 2008; 21: 365-367.
• 9 Steinberg EJ, Prata RG, Palazzini K. et al. Tibial tuberosity advancement for the treatment of CrCL injury: complications and owner satisfaction. J Am Anim Hosp Assoc 2011; 47: 250-257.
• 10 Muller S, Kramer M. Dei Eignung der Sonographie für die Diagnostik von Meniskusläsionen beim Hund [The use of ultrasonography in the diagnostic of meniscus lesions in the dog]. Tierärztl Praxis 2003; 31 (K) 10-15.
• 11 Arnault F, Cauvin E, Viguier E. et al. Diagnostic value of ultrasonography to assess stifle lesions in dogs after cranial cruciate ligament rupture: 13 cases. Vet Comp Orthop Traumatol 2009; 22: 479-485.
• 12 Tivers MS, Mahoney PN, Baines EA. et al. Diagnostic accuracy of positive contrast computed tomography for the detection of injuries to the medial meniscus in dogs with naturally occurring cranial cruciate ligament insufficiency. J Small Anim Pract 2009; 50: 324-332.
• 13 Samii VF, Dyce J, Pozzi A. et al. Computed tomographic arthrography of the stifle for detection of cranial and caudal cruciate ligament and meniscal tears in dogs. Vet Rec 2009; 50: 144-150.
• 14 Banfield CM, Morrison WB. Magnetic resonance arthrography of the canine stifle joint: technique and applications in eleven military dogs. Vet Radiol Ultrasound 2000; 41: 200-213.
• 15 Barrett E, Barr F, Owen M. et al. A retrospective study of the MRI findings in 18 dogs with stifle injuries. J Small Anim Pract 2009; 50: 448-455.
• 16 Blond L, Thrall DE, Roe SC. et al. Diagnostic accuracy of magnetic resonance imaging for meniscal tears in dogs affected with naturally occurring cranial cruciate ligament rupture. Vet Radiol Ultrasound 2008; 49: 425-431.
• 17 Boettcher P, Bruhschwein A, Winkels P. et al. Value of low-field magnetic resonance imaging in diagnosing meniscal tears in the canine stifle: a prospective study evaluating sensitivity and specificity in naturally occurring cranial cruciate ligament deficiency with arthroscopy as the gold standard. Vet Surg 2010; 39: 296-305.
• 18 Martig S, Konar M, Schmoekel HG. et al. Low-field MRI and arthroscopy of meniscal lesions in ten dogs with experimentally induced cranial cruciate ligament insufficiency. Vet Radiol Ultrasound 2006; 47: 515-522.
• 19 Galindo-Zamora V, Dziallas P, Ludwig DC. et al. Diagnostic accuracy of a short-duration 3 Tesla magnetic resonance protocol for diagnosing stifle joint lesions in dogs with non-traumatic cranial cruciate ligament rupture. BMC Vet Res. 2013 9. 40.
• 20 Oei EH, Ginai AZ, Hunink MG. MRI for traumatic knee injury: a review. Semin Ultrasound CT MR 2007; 28: 141-157.
• 21 Meyers AN, Haims AH, Menn K. et al. Imaging of anterior cruciate ligament repair and its complications. Am J Roentgenol 2010; 194: 476-484.
• 22 Mesgarzadeh M, Moyer R, Leder D. et al. MR imaging of the knee: expanded classification and pitfalls to interpretation of meniscal tears. Radiographics 1993; 13: 489-500.
• 23 Hargreaves BA, Worters PW, Butts K. et al. Metal-induced artifacts in MRI. Am J Roentgenol 2011; 197: 547-555.
• 24 David FH, Grierson J, Lamb CR. Effects of surgical implants on high-field magnetic resonance images of the normal canine stifle. Vet Radiol Ultrasound 2012; 53: 280-288.
• 25 David FH, Grierson J, Lamb CR. Reducing susceptibility artifacts in magnetic resonance images of the canine stifle following surgery for cranial cruciate ligament deficiency. Vet Comp Orthop Traumatol 2012; 25: 488-497.
• 26 Bryan S, Weatherburn G, Bungay H. et al. The cost-effectiveness of magnetic resonance imaging for investigation of the knee joint. Health Technol Assess 2001; 5: 1-95.
• 27 DAMASK (Direct Access to Magnetic Resonance Imaging: Assessment for Suspect Knees) Trial Team. Cost-effectiveness of magnetic resonance imaging of the knee for patients presenting in primary care. Br J Gen Pract 2008; 58: e10-16.
• 28 Harper TA, Jones JC, Sauders GK. et al. Sensitivity of low-field T2 images for detecting the presence and severity of histopathologic meniscal lesions in dogs. Vet Radiol Ultrasound 2011; 52: 428-435.
• 29 Kumar R, Lerski R, Gandy S. et al. Safety of orthopedic implants in magnetic resonance imaging: An experimental verification. J Orthop Res 2006; 24: 1799-1802.
• 30 Saito M, Ono S, Kayanuma H. et al. Evaluation of the susceptibility artefacts and tissue injury caused by implanted microchips in dogs on 1.5 T magnetic resonance imaging. J Vet Med Sci 2010; 72: 575-581.
• 31 Molea G, Schonauer F, Bifulco G. et al. Comparative study on biocompatibility and absorption times of three absorbable monofilament suture materials (Polydioxanone, Poliglecaprone 25, Glycomer 631). Br J Plas Surg 2000; 53: 137-141.