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Vet Comp Orthop Traumatol 2021; 34(02): 085-090
DOI: 10.1055/s-0040-1716843
Original Research

Mid- to Long-Term Outcome after Arthroscopy and Proximal Abducting Ulnar Osteotomy Versus Arthroscopy Alone in Dogs with Medial Compartment Disease: Thirty Cases

Fiona J. Coghill
1   Animal Referral Hospital Canberra, Fyshwick, Australia
,
Louisa K. Ho-Eckart
1   Animal Referral Hospital Canberra, Fyshwick, Australia
,
Wendy I. Baltzer
2   School of Veterinary Science, Massey University, Palmerston North, New Zealand
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Abstract

Objective The aim of this study was to determine owner-assessed mid- to long-term outcome for dogs with medial compartment disease treated arthroscopically with fragment removal with or without proximal abducting ulnar osteotomy (PAUL).

Study Design This was a retrospective clinical study.

Materials and Methods Records from 30 dogs with medial compartment disease treated with arthroscopy with or without PAUL were retrospectively reviewed over a 5-year period. Proximal abducting ulnar osteotomy cases were matched to arthroscopy-alone controls based on bodyweight and modified Outerbridge score. Outcome was assessed via owner questionnaire using the Canine Brief Pain Inventory (CBPI), frequency of non-steroidal anti-inflammatory drug (NSAID) administration and owner-assessed overall improvement.

Results Canine Brief Pain Inventory score for dogs in the PAUL group was not significantly different from the control group (p = 0.54). Non-steroidal anti-inflammatory drug administration was similar between groups (p = 0.61) and there was no significant difference between modified Outerbridge score and outcome (p = 0.57) over a median of 43 months post-surgically (range: 7–66 months). Canine Brief Pain Inventory and NSAID use were affected by the age of the dog with dogs greater than 3 years of age at the time of surgery having a higher CBPI score and increased NSAID use regardless of the surgery that was performed. Overall, owner-assessed improvement was not different between groups (p = 0.72).

Clinical Significance Proximal abducting ulnar osteotomy showed no owner-assessed benefit over arthroscopic medial coronoid fragment removal for dogs with medial compartment disease and modified Outerbridge score of 3 or greater. A prospective, blinded, controlled clinical trial is warranted to determine the appropriate clinical application of the PAUL procedure.

Keywords

medial compartment disease - elbow dysplasia - proximal abducting ulnar osteotomy - arthroscopy - dogs

Authors' Contributions

F.J.C. contributed to conception of study, acquisition of data and data analysis and interpretation. L.K.H. contributed to study design. W.I.B. contributed to data analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.


Supplementary Material



Publication History

Received: 21 March 2020

Accepted: 27 July 2020

Article published online:
01 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Krotscheck U, Kalafut S, Meloni G. et al. Effect of ulnar ostectomy on intra-articular pressure mapping and contact mechanics of the congruent and incongruent canine elbow ex vivo. Vet Surg 2014; 43 (03) 339-346
    CrossrefPubMedGoogle Scholar
  • 2 Fitzpatrick N, Smith TJ, Evans RB, Yeadon R. Radiographic and arthroscopic findings in the elbow joints of 263 dogs with medial coronoid disease. Vet Surg 2009; 38 (02) 213-223
    CrossrefPubMedGoogle Scholar
  • 3 Meyer-Lindenberg A, Langhann A, Fehr M, Nolte I. Arthrotomy versus arthroscopy in the treatment of the fragmented medial coronoid process of the ulna (FCP) in 421 dogs. Vet Comp Orthop Traumatol 2003; 16 (04) 204-210
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Vermote KA, Bergenhuyzen AL, Gielen I, van Bree H, Duchateau L, Van Ryssen B. Elbow lameness in dogs of six years and older: arthroscopic and imaging findings of medial coronoid disease in 51 dogs. Vet Comp Orthop Traumatol 2010; 23 (01) 43-50
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Lau SF, Wolschrijn CF, Hazewinkel HAW, Siebelt M, Voorhout G. The early development of medial coronoid disease in growing Labrador retrievers: radiographic, computed tomographic, necropsy and micro-computed tomographic findings. Vet J 2013; 197 (03) 724-730
    CrossrefPubMedGoogle Scholar
  • 6 Lau SF, Hazewinkel HAW, Voorhout G. Radiographic and computed tomographic assessment of the development of the antebrachia and elbow joints in Labrador Retrievers with and without medial coronoid disease. Vet Comp Orthop Traumatol 2015; 28 (03) 186-192
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Fitzpatrick N, Garcia TC, Daryani A, Bertran J, Watari S, Hayashi K. Micro-CT structural analysis of the canine medial coronoid disease. Vet Surg 2016; 45 (03) 336-346
    CrossrefPubMedGoogle Scholar
  • 8 Schmidt T, Fischer M, Böttcher P. Three dimensional in vivo kinematography of the canine elbow joint in sound dogs and in dogs with elbow dysplasia. Vet Surg 2014; 43 (05) E123
    PubMedGoogle Scholar
  • 9 Eljack H, Böttcher P. Relationship between axial radioulnar incongruence with cartilage damage in dogs with medial coronoid disease. Vet Surg 2015; 44 (02) 174-179
    CrossrefPubMedGoogle Scholar
  • 10 Fitzpatrick N, Smith TJ, Evans RB, O'Riordan J, Yeadon R. Subtotal coronoid ostectomy for treatment of medial coronoid disease in 263 dogs. Vet Surg 2009; 38 (02) 233-245
    CrossrefPubMedGoogle Scholar
  • 11 Fitzpatrick N, Bertran J, Solano MA. Sliding humeral osteotomy: medium-term objective outcome measures and reduction of complications with a modified technique. Vet Surg 2015; 44 (02) 137-149
    CrossrefPubMedGoogle Scholar
  • 12 Fitzpatrick N, Caron A, Solano MA. Bi-oblique dynamic proximal ulnar osteotomy in dogs: reconstructed computed tomographic assessment of radioulnar congruence over 12 weeks. Vet Surg 2013; 42 (06) 727-738
    CrossrefPubMedGoogle Scholar
  • 13 Pfeil I, Böttcher P, Starke A. Proximal abduction ulna osteotomy (PAUL) for medial compartment diseases in dogs with ED. Proceedings of the 16th European Society of Veterinary Orthopaedics and Traumatology Congress; Bologna, Italy; 2012
    PubMed
  • 14 Burton NJ, Owen MR, Kirk LS, Toscano MJ, Colborne GR. Conservative versus arthroscopic management for medial coronoid process disease in dogs: a prospective gait evaluation. Vet Surg 2011; 40 (08) 972-980
    PubMedGoogle Scholar
  • 15 Dempsey LM, Maddox TW, Comerford EJ, Pettitt RA, Tomlinson AW. A comparison of owner-assessed long-term outcome of arthroscopic intervention versus conservative management of dogs with medial coronoid process disease. Vet Comp Orthop Traumatol 2019; 32 (01) 1-9
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Galindo-Zamora V, Dziallas P, Wolf DC. et al. Evaluation of thoracic limb loads, elbow movement, and morphology in dogs before and after arthroscopic management of unilateral medial coronoid process disease. Vet Surg 2014; 43 (07) 819-828
    CrossrefPubMedGoogle Scholar
  • 17 Tichenor M, Millis D. Treatment of medial compartment disease of the canine elbow using proximal abduction ulnar osteotomy procedure and a custom kyon plate. Vet Comp Orthop Traumatol 2014; 4: A31-A2
    PubMedGoogle Scholar
  • 18 Wendelburg KM, Beale BS. Medium and long term evaluation of sliding humeral osteotomy in dogs. Vet Surg 2014; 43 (07) 804-813
    CrossrefPubMedGoogle Scholar
  • 19 Böttcher P, Bräuer S, Werner H. Estimation of joint incongruence in dysplastic canine elbows before and after dynamic proximal ulnar osteotomy. Vet Surg 2013; 42 (04) 371-376
    CrossrefPubMedGoogle Scholar
  • 20 Burton NJ, Parsons KJ, Cunliffe M, Warren-Smith CM, Ness MG, Fenton G. Canine elbow realignment osteotomy (CERO): validation of the accuracy of acute radial lengthening in a cadaveric incongruency model. Vet Surg 2016; 45 (05) 642-650
    CrossrefPubMedGoogle Scholar
  • 21 Pfeil I, Torrington A, Vezzoni A. In proceedings: Proximal abducting ulnar osteotomy. KYON Symposium; 2014; Zurich, Switzerland
    PubMed
  • 22 Vezzoni A. Ulnar osteotomies in elbow dysplasia: From 4 months of age to adulthood. 4th World Veterinary Orthopaedic Congress; 2014; Breckenridge, CO
    PubMed
  • 23 Pfeil I, Böttcher P, Starke A. Elbow incongruency measured with x-ray and correction by plated proximal ulnaosteotomy: clinical experience in 46 dogs.: 3rd World Veterinary Orthopaedic Congress; Bologna, Italy; 2010: 449-51
    PubMed
  • 24 Krotscheck U, Bottcher P. Surgical diseases of the elbow. In: Johnston SA, Tobias KM. eds. Veterinary Surgery: Small Animal. 2nd. St Louis, Missouri: Elsevier; 2018: 853-84
    Google Scholar
  • 25 KYON VSP. PAUL Principles 2015. [Accessed Aug 12, 2020 at: www.kyon.ch/current-products/proximal-abducting-ulnar-osteotomy-paul/paul-principles
    PubMedGoogle Scholar
  • 26 McConkey MJ, Valenzano DM, Wei A. et al. Effect of the proximal abducting ulnar osteotomy on intra-articular pressure distribution and contact mechanics of congruent and incongruent canine elbows ex vivo. Vet Surg 2016; 45 (03) 347-355
    CrossrefPubMedGoogle Scholar
  • 27 Coppieters E, de Bakker E, Broeckx B. et al. Spectrum of arthroscopic findings in 84 canine elbow joints diagnosed with medial compartment erosion. Vlaams Diergeneeskd Tijdschr 2018; 87 (02) 76-85
    CrossrefPubMedGoogle Scholar
  • 28 Brown DC, Boston RC, Coyne JC, Farrar JT. Ability of the canine brief pain inventory to detect response to treatment in dogs with osteoarthritis. J Am Vet Med Assoc 2008; 233 (08) 1278-1283
    CrossrefPubMedGoogle Scholar
  • 29 Brown DC, Boston RC, Farrar JT. Comparison of force plate gait analysis and owner assessment of pain using the Canine Brief Pain Inventory in dogs with osteoarthritis. J Vet Intern Med 2013; 27 (01) 22-30
    CrossrefPubMedGoogle Scholar