Quantitative evaluation of canine cranial cruciate ligament disease by stress radiography

Abstract BACKGROUND To establish a quantitative parameter reflecting displacement of the tibia relative to the femoral condyle in dogs with damage to the cranial cruciate ligament (CrCL).ANIMALS One hundred and forty-eight client-owned dogs with intact (n=34), partial rupture (n=43), or complete rupture (n=93) of the CrCL confirmed by arthroscopy of the stifle joint.PROCEDURES The Cranial Tibial Displacement Index (CTDI) was measured on mediolateral radiographs obtained in lateral recumbency with the tarsal and stifle joints at 90° of flexion. The sensitivity and specificity of the CTDI for assessment of CrCL damage was compared with that of the cranial drawer test, tibial compression test, fat pad sign, and radiographic OA score.RESULTS The mean CTDI (mean ±SD) scores were 0.5±0.1, 0.8±0.2, and 1.2±0.3 in the groups with an intact, partially ruptured, and completely ruptured CrCL, respectively; the differences between the three study groups were statistically significant (p<0.001). The sensitivity, specificity, and positive and negative predictive values of the CTDI for distinguishing damaged and intact CrCLs were 89.0%, 85.3%, 96.0%, and 65.9%, respectively.CONCLUSIONS AND CLINICAL RELEVANCE The CTDI, which quantifies cranial displacement of the tibia, could be an objective indicator reflecting the grade of CrCL damage. CrCL injury could be evaluated indirectly from the CTDI score, which may allow a minimally invasive early diagnosis of a ruptured CrCL.

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Short-Term Complications following Single-Session versus Staged Bilateral Tibial Plateau Levelling Osteotomies Stabilized with Locking Plates for Treatment of Bilateral Cranial Cruciate Ligament Disease: A Retrospective Study

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0039-1693153 ◽

2019 ◽

Vol 32 (06) ◽

pp. 460-466 ◽

Cited By ~ 1

Author(s):

Kelsey K. Cappelle ◽

Matthew D. Barnhart

Keyword(s):

Tibial Plateau ◽

Cruciate Ligament ◽

Significant Risk ◽

Study Groups ◽

Complication Rates ◽

Locking Plates ◽

Single Session ◽

Cranial Cruciate Ligament ◽

Major Complications ◽

Cranial Cruciate Ligament Disease

Objective The aim of this study was to compare complications between dogs with bilateral cranial cruciate ligament disease treated with single-session bilateral tibial plateau levelling osteotomies (BSSTPLO) versus staged bilateral TPLO (STPLO) procedures stabilized with locking plates. Study Design Medical records of client-owned dogs treated with BSSTPLO or STPLO stabilized with locking plates between March 2017 and July 2018 at two associated institutions were reviewed. Patient data and complications from 37 dogs with BSSTPLO and 18 with STPLO were compared between groups. Major complications were defined as any complication that required further surgical or medical treatment whereas minor complications did not. Results Incidence for major complications for BSSTPLO and STPLO was 7/37 and 6/18 respectively. Incidence for minor complications for BSSTPLO and STPLO was 3/37 and 2/18 respectively. No significant differences in minor or major complication rates existed between study groups (p = 0.2). Mean body weight was significantly higher in the STPLO group (p = 0.001); however, no correlation between weight or BCS and complication rate existed within either group. Increasing age was the only significant risk factor for major complications (p = 0.01) in either group. Conclusion Our findings support the claim that BSSTPLO and STPLO performed with locking implants have similar complication rates. The decision to perform BSSTPLO or STPLO in dogs with bilateral cranial cruciate ligament disease should be based on other considerations rather than just complication rates.

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Distal femoral lateral closing wedge osteotomy as a component of comprehensive treatment of medial patellar luxation and distal femoral varus in dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-16-07-0103 ◽

2017 ◽

Vol 30 (01) ◽

pp. 20-27 ◽

Cited By ~ 12

Author(s):

Barry Brower ◽

Ann Peruski ◽

Antonio Pozzi ◽

Jonathan Dyce ◽

Kenneth Johnson ◽

...

Keyword(s):

Clinical Outcome ◽

Cruciate Ligament ◽

Wedge Osteotomy ◽

Comprehensive Treatment ◽

Angular Deformity ◽

Cranial Cruciate Ligament ◽

Closing Wedge ◽

The Mean ◽

Cranial Cruciate Ligament Disease

SummaryObjective: To describe a cohort of dogs with medial patellar luxation managed with a distal femoral lateral closing wedge ostectomy (DFO) as a component of comprehensive treatment, and to report radiographic and long-term clinical outcome of this technique.Methods: Medical records of dogs that had a lateral closing wedge DFO as part of management of medial patellar luxation at three veterinary teaching hospitals were reviewed. Surgical reports as well as the preoperative, postoperative, and follow-up radiographs were reviewed. The anatomical lateral distal femoral angle (aLDFA) was determined. Long-term clinical outcome was assessed by telephone interview with the owner.Results: A lateral closing wedge DFO was performed on 66 limbs. The mean pre- and postoperative aLDFA was 107.6° ± 5.8° and 94.1° ± 4.2°, respectively. Cranial cruciate ligament disease was identified in 28/66 affected limbs. Tibial angular deformity, torsional deformity, or both was identified in nine of the 66 limbs. Ostectomy healing was confirmed radiographically in 51/66 limbs. The mean time to union was 73 ± 37 days. All patellae were in the normal position and stable. Complications included infection (2/51), fixation failure (1/51), delayed healing (2/51), and persistent lameness (1/51).Clinical significance: In this cohort of cases, DFO was a highly successful and repeatable component of surgical treatment for dogs with medial patellar luxation associated with femoral varus. This study also provides more evidence of the high rate of concurrent cranial cruciate ligament disease in cases of medial patellar luxation complicated by fe-moral varus, and supports an association between stifle instability and medial patellar luxation.

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An in vitro Comparison of Two Replacement Techniques Utilizing Fascia Lata after Cranial Cruciate Ligament Transection in the Dog

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633025 ◽

1993 ◽

Vol 06 (02) ◽

pp. 85-92 ◽

Cited By ~ 3

Author(s):

G. L. Coetzee

Keyword(s):

Femoral Condyle ◽

Cruciate Ligament ◽

Maximum Load ◽

Fascia Lata ◽

Patellar Ligament ◽

Cross Sectional ◽

Cranial Cruciate Ligament ◽

Replacement Technique ◽

Over The Top

SummaryThe immediate postoperative biomechanical properties of an “underand-over” cranial cruciate ligament (CCL) replacement technique consisting of fascia lata and the lateral onethird of the patellar ligament, were compared with that of a modified intra- and extracapsular “under-and-over-the-top” (UOTT) method. The right CCL in twelve adult dogs was dissected out and replaced with an autograft. The contralateral, intact CCL served as the control. In group A, the graft was secured to the lateral femoral condyle with a spiked washer and screw. In group B the intracapsular graft was secured to the lateral femoro-fabellar ligament, and the remainder to the patellar tendon. Both CCL replacement techniques exhibited a 2.0 ± 0.5 mm anterior drawer immediately after the operation. After skeletonization of the stifles, the length and cross-sectional area of the intact CCL and CCL substitutes were determined. Each bone-ligament unit was tested in linear tension to failure at a fixed distraction rate of 15 mm/s with the stifle in 120° flexion. Data was processed to obtain the corresponding material parameters (modulus, stress and strain in the linear loading region, and energy absorption to maximum load).The immediate postoperative structural and material properties of the “under-and-over” cranial cruciate ligament replacement technique with autogenous fascia lata, were compared to that of a modified intra- and extracapsular “under-and-over-the-top” (UOTT) method. The combined UOT T technique was slightly stronger (6%), but allowed 2.8 ± 0.9 mm more cranial tibial displacement at maximum linear force.

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Evaluation of Positive Contrast Arthrography in Canine Cranial Cruciate Ligament Disease

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632495 ◽

1996 ◽

Vol 09 (01) ◽

pp. 10-3 ◽

Cited By ~ 2

Author(s):

D.N. Aron ◽

R. Roberts ◽

J. Stallings ◽

J. Brown ◽

C.W. Hay

Keyword(s):

Articular Surface ◽

Cruciate Ligament ◽

Positive Contrast ◽

Joint Effusion ◽

Radiographic Evaluation ◽

Cranial Cruciate Ligament ◽

Joint Pathology ◽

Meniscal Pathology ◽

Cranial Cruciate Ligament Disease ◽

Better Than

SummaryArthrographic and intraoperative evaluations of stifles affected with cranial cruciate disease were compared. Arthrography did not appear to be helpful in predicting cranial cruciate ligament pathology. The caudal cruciate ligament was consistently not visualized in the arthrograms and was normal at surgery. The menisci were visualized consistently in the arthrograms, but conclusions could not be made as to the benefit of arthrography in predicting meniscal pathology. Arthrography was not helpful in predicting joint capsule and femoral articular surface pathology. Survey radiographic evaluation was better than arthrography in evaluating joint pathology. When cruciate injury is suspected, after history and physical examination, survey radiographs are better than positive contrast arthrograms at supporting the diagnosis.Positive contrast arthrography was evaluated as a diagnostic aid in canine cranial cruciate ligament disease. It did not appear to be useful in predicting joint pathology. With arthrography, both menisci could be visualized and evaluated for abnormalities. Joint effusion and presence of osteophytes evaluated on survey radiographs was better than arthrography in evaluating joint pathology.

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Validity of hearTest Smartphone-Based Audiometry for Hearing Screening in Workers Exposed to Noise

Journal of the American Academy of Audiology ◽

10.1055/s-0040-1718931 ◽

2020 ◽

Author(s):

Luma Cordeiro Rodrigues ◽

Silvia Ferrite ◽

Ana Paula Corona

Keyword(s):

Hearing Loss ◽

High Specificity ◽

Hearing Screening ◽

Youden Index ◽

Hearing Level ◽

Predictive Values ◽

Auditory Thresholds ◽

The Mean ◽

Low Sensitivity ◽

Sensitivity Specificity

Abstract Purpose This article investigates the validity of a smartphone-based audiometry for hearing screening to identify hearing loss in workers exposed to noise. Research Design This is a validation study comparing hearing screening with the hearTest to conventional audiometry. The study population included all workers who attended the Brazilian Social Service of Industry to undergo periodic examinations. Sensitivity, specificity, the Youden index, and positive (PPV) and negative predictive values (NPV) for hearing screening obtained by the hearTest were estimated according to three definitions of hearing loss: any threshold greater than 25 dB hearing level (HL), the mean auditory thresholds for 0.5, 1, 2, and 4 kHz greater than 25 dB HL, and the mean thresholds for 3, 4, and 6 kHz greater than 25 dB HL. Note that 95% confidence intervals were calculated for all measurements. Results A total of 232 workers participated in the study. Hearing screening with the hearTest presented good sensitivity (93.8%), specificity (83.9%), and Youden index (77.7%) values, a NPV (97.2%), and a low PPV (69.0%) for the identification of hearing loss defined as any auditory threshold greater than 25 dB HL. For the other definitions of hearing loss, we observed high specificity, PPV and NPV, as well as low sensitivity and Youden index. Conclusion The hearTest is an accurate hearing screening tool to identify hearing loss in workers exposed to noise, including those with noise-induced hearing loss, although it does not replace conventional audiometry.

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Histologic evidence for a humoral immune response in synovitis associated with cranial cruciate ligament disease in dogs

Veterinary Surgery ◽

10.1111/vsu.13600 ◽

2021 ◽

Author(s):

Keiichi Kuroki ◽

Ned Williams ◽

James L. Cook

Keyword(s):

Immune Response ◽

Humoral Immune Response ◽

Cruciate Ligament ◽

Cranial Cruciate Ligament ◽

Humoral Immune ◽

Histologic Evidence ◽

Cranial Cruciate Ligament Disease

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Conformation of the proximal tibia and cranial cruciate ligament disease in small breed dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-16-07-0115 ◽

2017 ◽

Vol 30 (03) ◽

pp. 178-183 ◽

Cited By ~ 2

Author(s):

Michal Kyllar ◽

Duncan Midgley ◽

Martin Owen ◽

Jan Janovec

Keyword(s):

Body Weight ◽

Clinical Significance ◽

Tibial Plateau ◽

Proximal Tibia ◽

Cruciate Ligament ◽

Tibial Tuberosity ◽

Cranial Cruciate Ligament ◽

Relative Body Weight ◽

Cranial Cruciate Ligament Disease ◽

Small Breed

SummaryObjectives: To investigate the conformation of the proximal tibia in small breed dogs with and without cranial cruciate ligament disease (CCLD) and to identify morphologic abnormalities that may predispose to development of CCLD.Methods: Mediolateral radiographs of the entire tibia of dogs <15 kg with surgically confirmed CCLD were retrospectively evaluated. Proximal tibial width (PTW), tibial plateau length (TPL), tibial plateau angle as described by Slocum and Slocum (sTPA), proximal tibial tuberosity angle (PTTA), tibial plateau angle as described by Inauen and colleagues (nTPA), and diaphyseal tibial width (DTW) were measured. The same variables were obtained from mediolateral radiographs of the entire tibia of dogs <15 kg without CCLD. In addition, a quotient nTPA/ PTW, relative tibial tuberosity width (rTTW), and relative body weight (rBW) were calculated for each dog. Independent two-sample t-test (p = 0.05) was used to compare mean ± SD of all measured variables between the two groups.Results: Gender, age, and weight mean ± SD were not significantly different between the two groups of dogs (p <0.05). Dogs with CCLD had significantly greater sTPA (p = 0.015) and rBW (p = 0.016).Clinical significance: In dogs of small breeds, a combination of an excessively steep tibial plateau and an increased relative body weight may predispose to early CCLD development. The slope of the tibial plateau was found to be caused by an abnormal caudal angulation of the proximal tibia, a phenomenon previously associated with CCLD development in small breed dogs in individual cases.

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In dogs weighing under 15 Kg with unilateral cranial cruciate ligament disease, does tibial tuberosity advancement lead to better long-term functional outcomes than lateral fabellar suture?

Veterinary Evidence ◽

10.18849/ve.v5i2.297 ◽

2020 ◽

Vol 5 (2) ◽

Author(s):

Tafara Mapuvire

Keyword(s):

Functional Outcomes ◽

Cruciate Ligament ◽

Research Question ◽

Tibial Tuberosity ◽

Clinical Expertise ◽

Best Interest ◽

Bottom Line ◽

Cranial Cruciate Ligament ◽

Cranial Cruciate Ligament Disease

PICO question In dogs weighing under 15 kg with unilateral cranial cruciate ligament disease, does tibial tuberosity advancement lead to better long-term functional outcomes than lateral fabellar suture? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed There were no papers that answered the PICO question Strength of evidence Zero Outcomes reported Between TTA and LFS none of the techniques was shown to provide better long-term functional outcomes than the other in dogs weighing less than 15 kg Conclusion Given the absence of evidence answering the PICO question, choice and recommendation of procedure between TTA and LFS in dogs weighing under 15 kg should be guided by what the surgeon deems to be in the best interest of the patient How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

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Comparative study of colour Doppler vs. FNNAC findings in WHO grade II thyroid enlargement in adult females

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20192724 ◽

2019 ◽

Vol 5 (4) ◽

pp. 1025

Author(s):

Sudhakar Rao M. S. ◽

Navneeth T. P. ◽

John C. J.

Keyword(s):

Pulsatility Index ◽

Low Cost ◽

Resistive Index ◽

Colour Doppler ◽

Who Grade ◽

Predictive Values ◽

Non Invasive ◽

Adult Females ◽

The Mean ◽

Sensitivity Specificity

Background: Thyroid gland disorders form one of the most common endocrinal and surgical problems encountered in clinical practice. FNNAC is widely accepted as the primary and better method than FNAC for investigation but has its disadvantages. Colour Doppler is a non-invasive, low cost, easily available and repeatable investigation with least patient discomfort and can be valuable in detection of benign and malignant thyroid enlargements.Methods: Forty cases of adult females with WHO grade 2 thyroid enlargement attending the department of otorhinolaryngology selected on simple random basis were included in this study. Following written consent, Colour Doppler scanning and FNNAC test were done on the thyroid swelling and the results were analysed. Results: The mean age of patients was 32.44 years. The mean age of malignancy was 44.66 years and showed statistically significant association. The Resistive and Pulsatility index and combination of both were found to have statistically significant results in detecting malignant and benign lesions The sensitivity, specificity, positive and negative predictive values of RI and PI were 83.33%, 94.12%, 71.43%, 96.97% and 50%, 94.12%, 60% and 91.43% respectively. On combining both the indices, the sensitivity was 91.67% and the positive predictive value was 97.06%.Conclusions: Colour Doppler can differentiate between benign and malignant thyroid enlargements using Resistive index (of>0.75) and Pulsatility Index (of>1.5) and can be a complementary diagnostic tool in the thyroid enlargement lesions, considering its accuracy, cost-effectiveness, easy availability and non-invasive repeatable nature.

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