Vet Comp Orthop Traumatol 2009; 22(06): 437-441.
DOI: 10.3415/VCOT-08-12-0125
Original Research
Schattauer GmbH

Sensitivity and specificity of arthroscopic estimation of positive and negative radio-ulnar incongruence in dogs

An in vitro study
H. Werner
1   University of Leipzig, Department of Small Animal Medicine, Leipzig, Germany
,
P. Winkels
1   University of Leipzig, Department of Small Animal Medicine, Leipzig, Germany
,
V. Grevel
1   University of Leipzig, Department of Small Animal Medicine, Leipzig, Germany
,
G. Oechtering
1   University of Leipzig, Department of Small Animal Medicine, Leipzig, Germany
,
P. Böttcher
1   University of Leipzig, Department of Small Animal Medicine, Leipzig, Germany
› Author Affiliations
Further Information

Publication History

Received: 17 December 2008

Accepted: 29 May 2009

Publication Date:
17 December 2017 (online)

Summary

Objectives: To determine the sensitivity and specificity of arthroscopic estimation of positive and negative radio-ulnar incongruence (RUI) in the canine elbow joint.

Methods: Experimental radial shortening and lengthening by 1 and 2 mm increments were performed in nine right elbow joints, extending an established surgical in vitro model of RUI. Arthroscopic estimation of each artificially produced radio-ulnar joint conformation (RUJC) was done using a graduated hook probe. A total of 72 RUJC were blindly evaluated in a random manner by an independent investigator and estimated in 1 mm increments (-2, -1, 0, +1, +2).

Results: The sensitivity for identification of an incongruent joint was 0.98 (95% CI: 0.90 to 0.99). The specificity for identification of a congruent joint was 0.89 (95% CI: 0.65 to 0.98). Analysing the data only in respect to a congruent joint versus one with a shortened radius (positive RUI) resulted in a sensitivity of 0.96 (95% CI: 0.80 to 0.99) and a specificity of 1.00 (95% CI: 0.92 to 1.00).

Clinical significance: Accurate estimation of RUI in dogs affected by elbow dysplasia might improve functional outcome and prevent osteoarthritis when corrective or modifying osteotomies are being considered as part of the treatment plan. Arthroscopy has been shown to be highly accurate and precise in detecting both positive and negative RUI in vitro. However, its diagnostic strength under clinical conditions still has to be proven.

 
  • References

  • 1 Morgan JP, Wind A, Davidson AP. Bone dysplasias in the Labrador Retriever: a radiographic study. J Am Anim Hosp Assoc 1999; 35: 332-340.
  • 2 Wind AP. Elbow incongruity and developmental elbow diseases in the dog 1. J Am Anim Hosp Assoc 1986; 22: 711-724.
  • 3 Boulay JP. Fragmented medial coronoid process of the ulna in the dog. Vet Clin North Am Small Anim Pract 1998; 28: 51-74.
  • 4 Wind AP, Packard ME. Elbow incongruity and developmental elbow diseases in the dog 2. J Am Anim Hosp Assoc 1986; 22: 725-730.
  • 5 Kirberger RM, Fourie SL. Elbow dysplasia in the dog: pathophysiology, diagnosis and control. J S Afr Vet Assoc 1998; 69: 43-54.
  • 6 Griffon DJ. Radio-ulnar incongruity and medial compartment disease of the canine elbow. In ACVS Veterinary Symposium. 2008. Oct 23-25 San Diego, CA: 255-256.
  • 7 Ness MG. Treatment of fragmented coronoid process in young dogs by proximal ulnar osteotomy. J Small Anim Pract 1998; 39: 15-18.
  • 8 Collins KE, Cross AR, Lewis DD. et al Comparison of the radius of curvature of the ulnar trochlear notch of Rottweilers and Greyhounds. Am J Vet Res 2001; 62: 968-973.
  • 9 Puccio M, Marino DJ, Stefanacci JD. et al Clinical evaluation and long-term follow-up of dogs having coronoidectomy for elbow incongruity. J Am Anim Hosp Assoc 2003; 39: 473-478.
  • 10 Fitzpatrick N, Yeadon R, Smith TJ. Early clinical experience with osteochondral autograft transfer for treatment of osteochondritis dissecans of the medial humeral condyle in dogs. Vet Surg 2009; 38: 246-260.
  • 11 Samoy Y, Van Ryssen B, Gielen I. et al Review of the literature: elbow incongruity in the dog. Vet Comp Orthop Traumatol 2006; 19: 1-8.
  • 12 Gemmill TJ, Mellor DJ, Clements DN. et al Evaluation of elbow incongruency using reconstructed CT in dogs suffering fragmented coronoid process. J Small Anim Pract 2005; 46: 327-333.
  • 13 Danielson KC, Fitzpatrick N, Muir P. et al Histomorphometry of fragmented medial coronoid process in dogs: a comparison of affected and normal coronoid processes. Vet Surg 2006; 35: 501-509.
  • 14 Olson NC, Carrig CB, Brinker WO. Asynchronous growth of the canine radius and ulna: effects of retardation of longitudinal growth of the radius. Am J Vet Res 1979; 40: 351-355.
  • 15 Preston CA, Schulz KS, Taylor KT. et al In vitro experimental study of the effect of radial shortening and ulnar ostectomy on contact patterns in the elbow joint of dogs. A J Vet Res 2001; 62: 1548-1556.
  • 16 Sjostrom L, Kasstrom H, Kallberg M. Ununited anconeal process in the dog – pathogenesis and treatment by osteotomy of the ulna. Vet Comp Orthop Traumatol 1995; 8: 170-176.
  • 17 Meyer-Lindenberg A, Fehr M, Nolte I. Co-existence of ununited anconeal process and fragmented medial coronoid process of the ulna in the dog. J Small Anim Pract 2006; 47: 61-65.
  • 18 Eckstein F, Lohe F, Schulte E. et al Physiological incongruity of the humero-ulnar joint: a functional principle of optimized stress distribution acting upon articulating surfaces?. Anat Embryol (Berl) 1993; 188: 449-455.
  • 19 Eckstein F, Lohe F, Müller-Gerbl M. et al Stress distribution in the trochlear notch. A model of bicentric load transmission through joints. J Bone Joint Surg Br 1994; 76: 647-653.
  • 20 Maierl J, Böttcher P, Liebich H-G.. Is incongruity pathological?. In 12th ESVOT Congress. 2004. Sep 10-12 Munich; Germany: 85.
  • 21 Lozier SM. How I treat elbows in the older canine patient and new prospectives in elbow dysplasia. In 13th ESVOT Congress. 2006. Sep 7-10 Munich; Germany: 93-96.
  • 22 Lozier SM. Radial lengthening osteotomy: Early rational, indications, methods and results. In ACVS Veterinary Symposium. 2008. Oct 23-25 San Diego, CA: 259-260.
  • 23 Slocum B, Pfeil I. Radius elongation for pressure relief of the coronoid process of the ulna. In 12th ESVOT Congress. 2004. Sep 10-12 Munich; Germany: 259.
  • 24 Mason DR, Schulz KS, Fujita Y. et al Measurement of humeroradial and humeroulnar transarticular joint forces in the canine elbow joint after humeral wedge and humeral slide osteotomies. Vet Surg 2008; 37: 63-70.
  • 25 Fujita Y, Schulz KS, Mason DR. et al Effect of humeral osteotomy on joint surface contact in canine elbow joints. Am J Vet Res 2003; 64: 506-511.
  • 26 Fitzpatrick N, Yeadon R, Smith TJ. et al Techniques of application and initial clinical experience with sliding humeral osteotomy for treatment of medial compartment disease of the canine elbow. Vet Surg 2009; 38: 261-278.
  • 27 Mason DR, Schulz KS, Samii VF. et al Sensitivity of radiographic evaluation of radio-ulnar incongruence in the dog in vitro. Vet Surg 2002; 31: 125-132.
  • 28 Blond L, Dupuis J, Beauregard G. et al Sensitivity and specificity of radiographic detection of canine elbow incongruence in an in vitro model. Vet Radiol Ultrasound 2005; 46: 210-216.
  • 29 Holsworth IG, Wisner ER, Scherrer WE. et al Accuracy of computerized tomographic evaluation of canine radio-ulnar incongruence in vitro. Vet Surg 2005; 34: 108-113.
  • 30 Kramer A, Holsworth IG, Wisner ER. et al Computed tomographic evaluation of canine radioulnar incongruence in vivo. Vet Surg 2006; 35: 24-29.
  • 31 Gemmill TJ, Hammond G, Mellor D. et al Use of reconstructed computed tomography for the assessment of joint spaces in the canine elbow. J Small Anim Pract 2006; 47: 66-74.
  • 32 Wagner K, Griffon DJ, Thomas MW. et al Radio-graphic, computed tomographic, and arthroscopic evaluation of experimental radio-ulnar incongruence in the dog. Vet Surg 2007; 36: 691-698.
  • 33 Böttcher P, Werner H, Ludewig E. et al Visual estimation of radio-ulnar incongruence in dogs using three-dimensional image rendering: an in vitro study based on computed tomographic imaging. Vet Surg 2009; 38: 161-168.
  • 34 Moores AP, Benigni L, Lamb CR. Computed tomography versus arthroscopy for detection of canine elbow dysplasia lesions. Vet Surg 2008; 37: 390-398.
  • 35 House MR, Marino DJ, Lesser ML. Effect of limb position on elbow congruity with CT evaluation. Vet Surg 2009; 38: 154-160.
  • 36 Beale BS, Hulse DA, Schulz K. et al. Small animal arthroscopy. Philadelphia, PA: Saunders; 2003: 51-79.
  • 37 Preston CA, Schulz KS, Kass PH. In vitro determination of contact areas in the normal elbow joint of dogs. Am J Vet Res 2000; 61: 1315-1321.
  • 38 Bardet JF, Bureau S. Fragmentation of the coronoid process in dogs. A case-control study of 83 elbows treated by shortening osteotomy of the proximal ulna. Prat Med Et Chir Anim 1996; 31: 451-463.
  • 39 Van Ryssen B, van Bree H. Arthroscopic findings in 100 dogs with elbow lameness. Vet Rec 1997; 140: 360-372.
  • 40 Mason DR, Schulz KS, Fujita Y. et al In vitro force mapping of normal canine humeroradial and humeroulnar joints. Am J Vet Res 2005; 66: 132-135.
  • 41 Hamrick MW. A chondral modeling theory revisited. J Theor Biol 1999; 201: 201-208.
  • 42 Theyse LF, Voorhout G, Hazewinkel HA. Prognostic factors in treating antebrachial growth deformities with a lengthening procedure using a circular external skeletal fixation system in dogs. Vet Surg 2005; 34: 424-435.
  • 43 Lawlor G, Hennessy R, Carr AJ. et al 3D analysis of elbow joint geometry. In 16th Meeting of the Northern Ireland Biomedical Engineering Society. 2002. Jan 26-27 Sligo; Ireland: 81.
  • 44 Waide DV, Lawlor GJ, McCormack BA. et al The relationship between surface topography and contact in the elbow joint: development of a two-dimensional geometrical model in the coronal plane. Proc Inst Mech Eng [H] 2000; 214: 413-423.