Arthroskopische Entfernung des fragmentierten Processus coronoideus medialis bei Hunden

Zusammenfassung

Gegenstand und Ziel Ziel dieser Studie war es, den Behandlungserfolg von Hunden mit medialer Coronoiderkrankung (hier: fragmentierte Processus coronoideus [FPC]), nach arthroskopisch durchgeführter subtotaler Coronoidektomie mittels subjektiver und objektiver Ganganalyse sowie der Arthroseprogression zu beurteilen und mit den Befunden der postoperativen Computertomografie in Verbindung zu setzen. Insbesondere sollte hierbei die klinische Relevanz von postoperativ zurückbleibenden Restpartikeln evaluiert werden.

Material und Methoden 30 Ellbogen von 24 Hunden verschiedener Rassen wurden frühestens 6 Monate nach ein- oder beidseitiger subtotaler Coronoidektomie klinisch orthopädisch und mit Hilfe der Ganganalyse sowie röntgenologisch nachuntersucht und die Ergebnisse mit den präoperativen Befunden der entsprechenden Untersuchungen sowie der postoperativen Computertomografie verglichen.

Ergebnisse 79,2% (19/24) der Patienten verbesserten sich in der orthopädischen Untersuchung um mindestens einen Lahmheitsgrad, 66,7% (16/24) waren lahmheitsfrei. 60% (18/30 Gelenke) zeigten eine Zunahme des Arthrosegrades. In der postoperativen Computertomografie wurden bei 56,7% (17/30) der Gelenke kleine verbliebene Knochenpartikel (<1 mm) im Gelenkspalt oder dem Weichgewebe festgestellt. Es war kein signifikanter Zusammenhang zwischen einer persistierenden Lahmheit und postoperativ zurückgebliebenen Restpartikeln nachzuweisen. Auch ein Zusammenhang zwischen anhaltender Lahmheit und Arthroseprogression konnte nicht hergestellt werden.

Schlussfolgerung Rückstände von kleinen Knochenpartikeln nach arthroskopisch durchgeführter subtotaler Coronoidektomie konnten in keinen Zusammenhang mit postoperativ verbleibenden Lahmheiten gebracht werden. Eine Arthroseprogression war trotz operativen Eingriffs nicht aufzuhalten.

Klinische Relevanz Bleiben nach der subtotalen Coronoidektomie kleine Restpartikel (<1 mm) zurück, scheinen diese keinen Einfluss auf das klinische Ergebnis zu haben.

Abstract

Objective The aim of this study was to assess the treatment success of dogs with medial coronoid disease (here: Fragmented Coronoid Process [FCP]) following arthroscopically performed subtotal coronoidectomy by the use of subjective and objective gait analysis and the evaluation of osteoarthritis progression in addition to their correlation with the findings from postoperative computed tomography. In particular, the clinical relevance of residual particles remaining postoperatively was to be evaluated.

Material and methods Thirty elbows from 24 dogs of different breeds were examined clinically, orthopedically, using gait analysis as well as radiographically at least 6 months after unilateral or bilateral subtotal coronoidectomy. The results were compared with the preoperative findings of the corresponding examinations and postoperative computed tomography.

Results 79.2% (19/24) of the patients improved by at least one degree of lameness in the orthopedic examination, 66.7% (16/24) were free of lameness. 60% (18/30 joints) showed an increase in the degree of arthrosis. Postoperative computed tomography revealed small residual bone particles (<1 mm) in the joint space or soft tissue in 56.7% (17/30) of the joints. No significant association was evident between residual lameness and residual particles remaining within the joint postoperatively. An association between persistent lameness and progression of arthrosis was also not be demonstrable.

Conclusion No evidence was apparent supporting a link between residues of small bone particles after arthroscopic subtotal coronoidectomy and postoperative lameness. The progression of osteoarthritis could not be interrupted despite the surgical intervention.

Clinical relevance When small residual particles (<1 mm) remain after subtotal coronoidectomy, these do not appear to have any influence on the clinical outcome.

Schlüsselwörter

Mediale Coronoiderkrankung - FPC - subtotale Coronoidektomie - Arthroskopie - postoperative Computertomografie

Keywords

medial coronoid disease - fcp - subtotal coronoidectomy - arthroscopy - postoperative computed tomography

Publication History

Received: 24 June 2024

Accepted: 12 September 2024

Article published online:
24 October 2024

• Literatur

• 1 Fitzpatrick N, Smith TJ, Evans RB. et al. Radiographic and Arthroscopic Findings in the Elbow Joints of 263 Dogs with Medial Coronoid Disease. Vet Surg 2009; 38: 213-223
• 2 Kirberger RMFS. Elbow dysplasia in the dog: pathophysiology, diagnosis and control. JI S Afr Vet Assoc 1998; 69: 43-54
• 3 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
• 4 LaFond E, Breur GJ, Austin CC. Breed susceptibility for developmental orthopedic diseases in dogs. J Am Anim Hosp Assoc 2002; 38: 467-477
• 5 Meyer-Lindenberg A, Langhann A, Fehr M. et al. Prevalence of fragmented medial coronoid process of the ulna in lame adult dogs. Vet Rec 2002; 151: 230-234
• 6 Read RA, Armstrong SJ, Black AP. et al. Relationship between physical signs of elbow dysplasia and radiographic score in growing Rottweilers. J Am Vet Med Assoc 1996; 209: 1427-1430
• 7 Fossum T. Small Animal Surgery. St. Louis, Missouri: Elsevier Mosby; 2013
• 8 Morgan JP, Wind A, Davidson AP. Bone dysplasias in the labrador retriever: a radiographic study. J Am Anim Hosp Assoc 1999; 35: 332-340
• 9 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
• 10 Berry CR. Radiology corner evaluation of the canine elbow for fragmented medial coronoid process. Vet Radiol Ultrasound 1992; 33: 273-276
• 11 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
• 12 Lau SF, Wolschrijn CF, Hazewinkel HAW. et al. The early development of medial coronoid disease in growing Labrador retrievers: Radiographic, computed tomographic, necropsy and micro-computed tomographic findings. Vet J 2013; 197: 724-730
• 13 Moores AP, Benigni L, Lamb CR. Computed tomography versus arthroscopy for detection of canine elbow dysplasia lesions. Vet Surg 2008; 37: 390-398
• 14 Groth AM, Benigni L, Moores AP. et al. Spectrum of computed tomographic findings in 58 canine elbows with fragmentation of the medial coronoid process. J Small Anim Pract 2009; 50: 15-22
• 15 Van Ryssen B, van Bree H. Arthroscopic findings in 100 dogs with elbow lameness. Vet Rec 1997; 140: 360-362
• 16 Meyer-Lindenberg A, Langhann A, Fehr M. et al. 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: 204-210
• 17 Theyse L, Hazewinkel H, Van Den Brom W. Force plate analyses before and after surgical treatment of unilateral fragmented coronoid process. Vet Comp Orthop Traumatol 2000; 13: 135
• 18 Fitzpatrick N, Smith TJ, Evans RB. et al. Subtotal coronoid ostectomy for treatment of medial coronoid disease in 263 dogs. Vet Surg 2009; 38: 233-245
• 19 Coppieters E, Seghers H, Verhoeven G. et al. Arthroscopic, Computed Tomography, and Radiographic Findings in 25 Dogs With Lameness After Arthroscopic Treatment of Medial Coronoid Disease. Vet Surg 2016; 45: 246-253
• 20 Renner C, Medl N. Computed tomographic assessment of the completeness of arthroscopic subtotal coronoidectomy in dogs with medial coronoid disease. Vet Rec 2022; 190: e1069
• 21 Brunnberg L, Waibl H, Lehmann J. Lahmheit beim Hund: Untersuchen/Erkennen/Behandeln. Kleinmachnow: Procane Claudo Brunnberg;; 2014
• 22 Taroni M, Cabon Q, Fèbre M. et al. Evaluation of the Effect of a Single Intra-articular Injection of Allogeneic Neonatal Mesenchymal Stromal Cells Compared to Oral Non-Steroidal Anti-inflammatory Treatment on the Postoperative Musculoskeletal Status and Gait of Dogs over a 6-Month Period after Tibial Plateau Leveling Osteotomy: A Pilot Study. Front Vet Sci 2017; 4: 83
• 23 Tellheim B, Amort K. Grading primary ED-lesions and elbow osteoarthrosis according to the IEWG protocol. In, 28th annual meeting IEWG. Cape Town SA: 17.09 2014. 31.
• 24 Hazewinkel HA. The organization of an ED-screening program and the use of the certificate. 28th annual meeting IEWG. 17.09 2014 Cape Town SA
• 25 Brooks RA. A quantitative theory of the Hounsfield unit and its application to dual energy scanning. J Comput Assist Tomogr 1977; 1: 487-493
• 26 Adams JE, Mughal Z, Damilakis J. et al. Chapter 12 – Radiology. In: Glorieux FH, Pettifor JM, Jüppner H, Hrsg. Pediatric Bone (Second Edition). San Diego: Academic Press; 2012. ; 277-307
• 27 Bibb R, Eggbeer D, Paterson A. 2 – Medical imaging. In: Bibb R, Eggbeer D, Paterson A, Hrsg. Medical Modelling (Second Edition). Oxford: Woodhead Publishing; 2015: 7-34
• 28 Peter S, Hermann S, Thomas S. et al. Die "Ellbogendysplasie" beim Hund: Eine klinisch-synoptische Betrachtungsweise der verschiedenen Erscheinungsbilder mit aetiopathologischen Ueberlegungen. Fragmentierter Processus coronoideus und weitere Ellbogendysplasie-Formen. Teil II. Veterinär-Spiegel, 2002, 1, 14-27. Veterinär-Spiegel 2002; ISSN 0940-8711
• 29 Allegranzi B, Zayed B, Bischoff P. et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016; 16: e288-e303
• 30 Allegranzi B, Bischoff P, de Jonge S. et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016; 16: e276-e287
• 31 Robinson RO, Herzog W, Nigg BM. Use of force platform variables to quantify the effects of chiropractic manipulation on gait symmetry. J Manipulative Physiol Ther 1987; 10: 172-176
• 32 Voss K, Imhof J, Kaestner S. et al. Force plate gait analysis at the walk and trot in dogs with low-grade hindlimb lameness. Vet Comp Orthop Traumatol 2007; 20: 299-304
• 33 Watson P, Petrie A. Statistics for Veterinary and Animal Science. Wiley-Blackwell; 2013
• 34 Werres C. Antibiotika in der Kleintierchirurgie. Kleintierpraxis 2022; 67: 560-579
• 35 Perry KL, Li L. A retrospective study of the short-term complication rate following 750 elective elbow arthroscopies. Vet Comp Orthop Traumatol 2014; 27: 68-73
• 36 Mussmann K. Ellbogengelenksdysplasie des Hundes: Studie zur bildgebenden Diagnostik und postoperativen Erfolgskontrolle mittels computerisierter Ganganalyse: Ludwig- Maximilians- Universität München; 2009
• 37 Madore E, Huneault L, Moreau M. et al. Comparison of trot kinetics between dogs with stifle or hip arthrosis. Vet Comp Orthop Traumatol 2007; 20: 102-107
• 38 DeCamp CE, Soutas-Little RW, Hauptman J. et al. Kinematic gait analysis of the trot in healthy greyhounds. Am J Vet Res 1993; 54: 627-634
• 39 Alves JC, Santos A, Jorge P. et al. Characterization of Weight-bearing Compensation in Dogs With Bilateral Hip Osteoarthritis. Topics in Companion Animal Medicine 2022; 49: 100655
• 40 Gemmill TJ, Clements DN. Fragmented coronoid process in the dog: is there a role for incongruency?. J Small Anim Pract 2007; 48: 361-368
• 41 Trostel C, McLaughlin R, Pool R. Canine elbow dysplasia: incidence, diagnosis, treatment, and prognosis. Compend Contin Educ Prac Vet 2003; 25: 763-773
• 42 Seidler S, Rhode M, Volk H. et al. Comparative evaluation of radiographic and computed tomographic findings in dogs with bilateral medial coronoid disease (MCD) presenting with unilateral forelimb lameness. PLoS One 2023; 18: e0282656