Download PDF
Vet Comp Orthop Traumatol 2015; 28(01): 9-18
DOI: 10.3415/VCOT-13-12-0147
Review Article
Schattauer GmbH

Erosion of the medial compartment of the canine elbow: occurrence, diagnosis and currently available treatment options

E. Coppieters
1   Faculty of Veterinary Medicine, Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Ghent University, Belgium
,
I. Gielen
1   Faculty of Veterinary Medicine, Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Ghent University, Belgium
,
G. Verhoeven
1   Faculty of Veterinary Medicine, Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Ghent University, Belgium
,
D. Van Vynckt
1   Faculty of Veterinary Medicine, Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Ghent University, Belgium
,
B. Van Ryssen
1   Faculty of Veterinary Medicine, Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Ghent University, Belgium
› Author Affiliations
Further Information

Publication History

Received:10 December 2013

Accepted:23 October 2014

Publication Date:
26 December 2017 (online)

    Permissions and Reprints

Summary

Erosion of the medial compartment of the elbow joint refers to full thickness cartilage loss with exposure of the subchondral bone (modified Outerbridge grades 4–5) of the medial part of the humeral condyle (MHC) and the corresponding ulnar contact area. This finding may appear in the absence of an osteochondral fragment or a cartilage flap, or in combination with fragmentation of the medial coronoid process (MCP) or osteochondritis dissecans (OCD) of the MHC. With regard to the prognosis, it is important to diagnose these severe erosions. Imaging of cartilage lesions by means of radiography, ultrasonography, computed tomography or magnetic resonance imaging is challenging in dogs. In contrast, direct arthroscopic inspection provides detailed information about the cartilage.

The treatment of these severe erosions is difficult because of the limited regenerative capacity of cartilage and presumed mechanical or physical triggering factors. Several conservative and surgical treatment methods have been proposed to treat elbows with severe cartilage defects. However, due to irreversible loss of cartilage, the prognosis in these cases remains guarded.

Keywords

Elbow - cartilage - arthroscopy - erosion - medial compartment
 

  • References

  • 1 Van Ryssen B, van Bree H. Arthroscopic findings in 100 dogs with elbow lameness. Vet Rec 1997; 140: 360-362.
    CrossrefPubMedGoogle Scholar
  • 2 Morgan J, Wind A, Davidson A. Bone dysplasias in the Labrador Retriever: a radiographic study. J Am Hosp Assoc 1999; 35: 332-340.
    PubMedGoogle Scholar
  • 3 Fitzpatrick N, Smith T, Evans R. et al. Radiographic and arthroscopic findings in the elbow joints of 263 dogs with medial coronoid disease. Vet Surg 2009; 38: 213-223.
    CrossrefPubMedGoogle Scholar
  • 4 Vermote K, Bergenhuyzen A, Gielen I. et al. 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: 43-50.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Fitzpatrick N, Yeadon R, Smith T. 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.
    CrossrefPubMedGoogle Scholar
  • 6 Griffon D. Radio-ulnar incongruity in dogs with medial compartment disease. Proceedings of the 3rd World Veterinary Orthopaedic Congress. 2010. September 15-18 Bologna, Italy: p. 110-112.
    Google Scholar
  • 7 Fitzpatrick N, Yeadon R. Working algorithm for treatment decision making for developmental disease of the medial compartment of the elbow in dogs. Vet Surg 2009; 38: 285-300.
    CrossrefPubMedGoogle Scholar
  • 8 Coppieters E, Samoy Y, Pey P. et al. Case report: Medial compartment disease in a young Large Münsterländer. Vlaams Diergeneesk Tijdschr 2012; 81: 88-92.
    PubMedGoogle Scholar
  • 9 Samoy Y, Gielen I, van Bree H. et al. Dysplastic elbow disease in dogs. Vlaams Diergeneesk Tijdschr 2011; 80: 327-338.
    PubMedGoogle Scholar
  • 10 van Bree H, Van Ryssen B. Diagnostic and surgical arthroscopy in osteochondrosis lesions. Vet Clin North Am Small Anim Pract 1998; 28: 161-189.
    CrossrefPubMedGoogle Scholar
  • 11 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.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Moores A, Benigni L, Lamb C. Computed tomography versus arthroscopy for detection of canine elbow dysplasia lesions. Vet Surg 2008; 37: 390-398.
    CrossrefPubMedGoogle Scholar
  • 13 Sun Y, Feng Y, Zhang C. et al. The regenerative effect of platelet-rich plasma on healing in large osteochondral defects. Int Orthop 2010; 34: 589-597.
    CrossrefPubMedGoogle Scholar
  • 14 Gutbrod A, Guerrero T. Effect of external rotational humeral osteotomy on the contact mechanics of the canine elbow joint. Vet Surg 2012; 41: 845-852.
    CrossrefPubMedGoogle Scholar
  • 15 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. 2012. September 12-15 Bologna, Italy: p. 314-318.
    Google Scholar
  • 16 Conzemius M. Nonconstrained elbow replacement in dogs. Vet Surg 2009; 38: 279-284.
    CrossrefPubMedGoogle Scholar
  • 17 Déjardin L, Guillou R. Total elbow replacement in dogs. In Tobias K, Johnston S. editors Veterinary Surgery Small Animal. St. Louis: Elsevier Saunders; 2012: 752-759.
    Google Scholar
  • 18 Griffon D. Surgical disease of the elbow. In Tobias K, Johnston S. editors Veterinary Surgery Small Animal. St. Louis: Elsevier-Saunders; 2012: 732-751.
    Google Scholar
  • 19 Todhunter R, Spencer A. Chapter 154: Osteoarthritis. In Slatter D. editor Textbook of Small animal Surgery. 3rd ed. Philadelphia: Elsevier Science; 2009: 2208-2246.
    Google Scholar
  • 20 Grondalen J, Grondalen T. Arthrosis in the elbow joint of young rapidly growing dogs. V. A. pathoanatomical investigation. Nord Vet Med 1981; 33: 1-16.
    PubMedGoogle Scholar
  • 21 Olsson S. General and etiologic factors in canine osteochondrosis. Vet Q 1987; 9: 268-278.
    CrossrefPubMedGoogle Scholar
  • 22 Read R, Armstrong S, Okefee J. et al. Fragmentation of the medial coronoid process of the ulna in dogs - a study of 109 cases. J Small Anim Pract 1990; 31: 330-334.
    CrossrefPubMedGoogle Scholar
  • 23 Kirberger R, Fourie S. Elbow dyslasia in the dog: pathophysiology, diagnosis and control. J S Afr Vet Assoc 1998; 69: 43-54.
    CrossrefPubMedGoogle Scholar
  • 24 Olsson S. The early diagnosis of fragmented coronoid process and osteochondritis dissecans of the canine elbow joint. J Am Anim Hosp Assoc 1983; 19: 616-626.
    PubMedGoogle Scholar
  • 25 Wind A. Elbow incongruity and developmental elbow diseases in the dog: Part I. J Am Anim Hosp Assoc 1986; 22: 711-724.
    PubMedGoogle Scholar
  • 26 Seghers H, De Bakker E, Van Vynckt D. et al. Lameness after arthroscopic treatment of FCP: diagnostic findings in 35 dogs. Proceedings of the 3rd World Veterinary Orthopaedic Congress. 2010. September 15-18 Bologna, Italy: 687-688.
    Google Scholar
  • 27 Perry K, Li L. A retrospective study of the short-term complication rate following 750 elective elbow arthroscopies. Vet Comp Orthop Traumatol 2014; 27: 68-73.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Goldhammer M, Smith S, Fitzpatrick N. et al. A comparison of radiographic, arthroscopic and histological measures of articular pathology in the canine elbow joint. Vet J 2010; 186: 96-103.
    CrossrefPubMedGoogle Scholar
  • 29 Bobinac D, Spanjol J, Zoricic S. et al. Changes in articular cartilage and subchondral bone histomorphometry in osteoarthritic knee joint in humans. Bone 2003; 32: 284-290.
    CrossrefPubMedGoogle Scholar
  • 30 Dennis R, Kirberger R, Barr F. et al. Handbook of Small Animal Radiology and Ultrasound. Techniques and Differential Diagnosis. 2nd ed. London: Churchill Livingstone Elsevier; 2010: 1
    Google Scholar
  • 31 Cook C, Cook J. Diagnostic imaging of canine elbow dysplasia: a review. Vet Surg 2009; 38: 144-153.
    CrossrefPubMedGoogle Scholar
  • 32 Knox W, Sehgal C, Wood A. Correlation of ultrasonographic observations with anatomic features and radiography of the elbow joint in dogs. Am J Vet Res 2003; 64: 721-726.
    CrossrefPubMedGoogle Scholar
  • 33 Vandevelde B, Van Ryssen B, Saunders J. et al. Comparison of the ultrasonographic appearance of osteochondrosis in the canine shoulder with radiography, arthrography, and arthroscopy. Vet Radiol Ultrasound 2006; 47: 174-184.
    CrossrefPubMedGoogle Scholar
  • 34 Carpenter L, Schwarz P, Lowry L. et al. Comparison of radiologic imaging techniques for diagnosis of fragmented coronoid process of the cubital joint in dogs. J Am Vet Med Assoc 1993; 203: 78-83.
    PubMedGoogle Scholar
  • 35 Waldt S, Bruegel M, Ganter K. et al. Comparison of multislice CT arthrography and MR arthrography for the detection of articular cartilage lesions of the elbow. Eur Radiol 2005; 15: 784-791.
    CrossrefPubMedGoogle Scholar
  • 36 Shahabpour M, Kichouh M, Laridon E. et al. The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. Europ J Radiol 2008; 65: 194-200.
    CrossrefPubMedGoogle Scholar
  • 37 Samii V, 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 Radiol Ultrasound 2009; 50: 144-150.
    CrossrefPubMedGoogle Scholar
  • 38 Tivers M, Mahoney P, Corr S. Canine stifle positive contrast computed tomography arthrography for assessment of caudal horn meniscal injury: a cadaver study. Vet Surg 2008; 37: 269-277.
    CrossrefPubMedGoogle Scholar
  • 39 Tivers M, Mahoney P, Baines E. 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.
    CrossrefPubMedGoogle Scholar
  • 40 Baeumlin Y, De Rycke L, Van Caelenberg A. et al. Magnetic resonance imaging of the canine elbow: an anatomic study. Vet Surg 2010; 39: 566-573.
    CrossrefPubMedGoogle Scholar
  • 41 Janach K, Breit S, Kunzel W. Assessment of the geometry of the cubital (elbow) joint of dogs by use of magnetic resonance imaging. Am J Vet Res 2006; 67: 211-218.
    CrossrefPubMedGoogle Scholar
  • 42 Thiede R, Lu Y, Markel M. A review of the treatment methods for cartilage defects. Vet Comp Orthop Traumatol 2012; 25: 263-272.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 43 Abatangelo G, Botti P, Del Bue M. et al. Intraarticular sodium hyaluronate injections in the Pond-Nuki experimental-model of osteo-arthritis in dogs 1. Biochemical results. Clin Orthop 1989; 241: 278-285.
    PubMedGoogle Scholar
  • 44 Ghosh P. The pathology of osteoarthritis and the rationale for the use of pentosan polysulfate for its treatment. Semin Arthritis Rheum 1999; 28: 211-267.
    CrossrefPubMedGoogle Scholar
  • 45 Sanderson R, Beata C, Flipo R-M. et al. Systematic review of the management of canine osteoarthritis. Vet Rec 2009; 164: 418-424.
    CrossrefPubMedGoogle Scholar
  • 46 Samoy Y, de Bakker E, Van Vynckt D. et al. Arthroscopic treatment of fragmented coronoid process with severe elbow incongruity. Vet Comp Orthop Traumatol 2013; 26: 27-33.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Hunziker E. Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects. Osteoarthritis Cart 2001; 10: 432-463.
    PubMedGoogle Scholar
  • 48 Fitzpatrick N, Yeadon R, Smith T. 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.
    CrossrefPubMedGoogle Scholar
  • 49 Matsiko A, Levingstone T, O’Brien F. Advanced strategies for articular cartilage defect repair. Materials 2013; 6: 637-668.
    CrossrefPubMedGoogle Scholar
  • 50 Fitzpatrick N. Algorithm of treatment for severe elbow dysplasia. Proceedings of the 16th European Society of Veterinary Orthopaedics and Traumatology Congress. 2012. September 12-15 Bologna, Italy: pg. 160-163.
    Google Scholar
  • 51 Wendelburg K, Beale B. Medium and long term evaluation of sliding humeral osteotomy in dogs. Vet Surg 2014; 43: 804-813.
    CrossrefPubMedGoogle Scholar
  • 52 Preston C, Schulz K, Taylor K. In vitro experimental study of the effect of radial shortening and ulnar osteotomy on contact patterns in the elbow joint of dogs. Am J Vet Res 2001; 62: 1548-1556.
    CrossrefPubMedGoogle Scholar
  • 53 Kranz S, Lesser A. Radiographic evaluation of osteotomized ulnar segments following arthroscopic treatment for canine medial coronoid disease. Vet Comp Orthop Traumatol 2011; 24: 383-388.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 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: 339-346.
    CrossrefPubMedGoogle Scholar
  • 55 Olivieri M. Clinical experience about treatment of medial compartment disease with proximal ulnar osteotomy. Proceedings of the 3rd World Veterinary Congress. 2010. September 15-18 Bologna, Italy: 369.
    Google Scholar
  • 56 Cuddy L, Lewis D, Kim S. et al. Ex vivo contact mechanics and three-dimensional alignment of normal dogs after proximal ulnar rotational osteotomy. Vet Surg 2012; 41: 905-913.
    CrossrefPubMedGoogle Scholar
  • 57 Burton N, Ellis J, Burton K. et al. An ex vivo investigation of the effect of the TATE canine elbow arthroplasty system on kinematics of the elbow. J Small Anim Pract 2013; 54: 240-247.
    CrossrefPubMedGoogle Scholar
  • 58 Déjardin L. Total elbow replacement in dogs. Proceedings of the American College of Veterinary Surgeons Symposium, The Surgical Summit. 2012. November 1-3 National Harbor, USA: 705-709.
    Google Scholar
  • 59 Conzemius MG, Aper RL, Corti LB. Short-term outcome after total elbow arthroplasty in dogs with severe, naturally occurring osteoarthritis. Vet Surg 2003; 32: 545-552.
    CrossrefPubMedGoogle Scholar
  • 60 Allen M. Advances in total joint replacement in small animals. J Small Anim Pract 2012; 53: 495-506.
    CrossrefPubMedGoogle Scholar
  • 61 Franklin S, Schulz K, Karnes J. Theory and development of a unicompartmental resurfacing system for treatment of medial compartment disease of the canine elbow. Vet Surg 2014; 43: 765-773.
    CrossrefPubMedGoogle Scholar
  • 62 Smith Z, Wendelburg K, Tepic S. In vitro biomechanical comparison of load to failure testing of a canine unconstrained medial compartment elbow arthroplasty system and normal canine thoracic limbs. Vet Comp Orthop Traumatol 2013; 26: 356-365.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 63 Dyce J. Arthrodesis in the dog. In practice 1996; 18: 267-279.
    CrossrefPubMedGoogle Scholar
  • 64 Zamprogno H, Hash J, Hulse D. et al. Elbow denervation in dogs: Development of an in vivo surgical procedure and pilot testing. Vet J 2011; 190: 220-224.
    CrossrefPubMedGoogle Scholar
  • 65 Tivers M, Upjohn M, House A. et al. Treatment of extrahepatic congenital portosystemic shunts in dogs - what is the evidence base?. J Small Anim Pract 2012; 53: 3-11.
    CrossrefPubMedGoogle Scholar