Clinical Evaluation and Long-Term Follow-Up of Dogs Having Coronoidectomy for Elbow Incongruity

Puccio, Margaret; Marino, Dominic J.; Stefanacci, Joseph D.; McKenna, Brian

doi:10.5326/0390473

Cited by 35 publications

(52 citation statements)

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“…Apparently arthroscopic treatment of a medial coronoid problem can induce the development of a spur or a calcified body near the medial humeral epicondyle. Considering this, and knowing that osteoarthritis progresses after arthroscopic removal of medial coronoid disease, this finding supports the theory that concomitant epicondylar changes are related to the development of osteoarthritis (27)(28)(29).…”

Section: Discussionsupporting

confidence: 83%

Radiographic findings of the medial humeral epicondyle in 200 canine elbow joints

Bakker¹,

Saunders²,

Gielen³

et al. 2012

Vet Comp Orthop Traumatol

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SummaryObjectives: To determine the frequency and radiographic aspect of medial humeral epicondylar lesions as a primary or concomitant finding and to evaluate the association with osteoarthritis. Methods: Medical records of dogs diagnosed with elbow lameness were reviewed. Inclusion criteria for this study were a complete clinical examination, a complete set of digital radiographs and a final diagnosis made by computed tomography or magnetic resonance imaging and arthroscopy. Changes of the medial humeral epicondyle were recorded and correlated with the radiographic osteoarthritis and final diagnosis. Results: Eighty of the 200 elbows showed changes of the medial humeral epicondyle.In 12 of these 80 elbows, changes of the medial epicondyle were the only findings within the joint, and these elbows were diagnosed with primary flexor enthesopathy. In the remaining 68 elbows, other concomitant elbow pathologies were found. In those cases of concomitant epicondylar changes, high grades of osteoarthritis were recorded, while most elbows with primary flexor enthesopathy showed a low grade of osteoarthritis. Clinical significance: Changes of the medial humeral epicondyle are often considered clinically unimportant and are regarded as an expression of osteoarthritis. This study showed the relatively frequent presence of epicondylar changes of which the majority were considered concomitant to a primary elbow problem. If changes of the medial humeral epicondyle are the only pathologic finding (primary flexor enthesopathy) they should be considered as the cause of lameness and not as a sign of osteoarthritis.

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Section: Discussionsupporting

confidence: 83%

Radiographic findings of the medial humeral epicondyle in 200 canine elbow joints

Bakker¹,

Saunders²,

Gielen³

et al. 2012

Vet Comp Orthop Traumatol

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“…The exact cause of MCD is debated but elbow incongruence has been reported as a primary contributor to pathogenesis of MCD. [3][4][5][6] Management of MCD remains controversial and currently no universally agreed approach exists. Results from reported studies vary but in general, describe a [233][234][235][236][237][238][239][240][241][242][243][244][245] 2009 return to normal function in the short-term with progression of OA in the medium-and long-term.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

“…More aggressive arthroplasty to lower the joint surface of the MCP by motorized shaving during arthroscopic procedures has been advocated to ameliorate the effects of ''medial compartment'' pain associated with joint surface friction. 6,18 Surgical debridement of malaciac cartilage has been advocated to allow assessment of subchondral bone. 17 It has been suggested that ''soft'' and ''yellow'' subchondral bone be debrided until hemorrhage of the underlying bone occurs and it resembles a more normal ''hard'' and ''white'' morphology.…”

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confidence: 99%

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Subtotal Coronoid Ostectomy for Treatment of Medial Coronoid Disease in 263 Dogs

et al. 2009

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Objective-To document clinical outcomes after subtotal coronoid ostectomy (SCO) for treatment of medial coronoid disease (MCD). Study Design-Prospective clinical study. Animals-Dogs (n ¼ 263) with MCD. Methods-MCD was treated by a combination of SCO via mini-arthrotomy, cage confinement (6 weeks), leash restricted exercise (12 weeks) and pentosan polysulfate administration. Outcomes were assessed by clinical examination in the short-term (324 elbows), owner questionnaires (146 dogs), clinical examination (90 dogs), subjective assessment of gait (110 elbows) and radiographic examination (180 elbows), 4 months to 7 years 7 months after surgery. Results-One intraoperative complication occurred (1 elbow with fissuring of the ulna) and 8.2% elbows had immediate postoperative complications, the most common being wound infection (7%). Improvement in subjective lameness assessment to a score of 0 was noted at 5 weeks in 74.4% of elbows (veterinary) and 45.6% (owner) and at 12 weeks in 71.5% (veterinary), and 91.2% (owner). Subjective assessments of outcomes in the medium-term revealed 81.9% dogs remained sound, with significantly (Po.05) improved daily function scores compared with preoperative values, 83.5% of dogs received no NSAID. Clinical examination revealed good limb function and subjective assessment showed 51% of limbs were free from lameness. Radiographic progression of osteophytosis occurred on average by one grade. Conclusion-Management of MCD using the described management regime, including SCO via mini-arthrotomy, deserves consideration and comparison with existing treatment methods. Clinical Significance-Management of MCD by SCO can be considered when gross fissuring or fragmentation of the MCP is not evident. This technique does not require specialized instrumentation. r Copyright 2009 by The American College of Veterinary Surgeons INTRODUCTION D ISEASE OF the medial aspect of the coronoid process (MCP) of the ulna, medial coronoid disease (MCD), is a component of elbow dysplasia and includes gross fissuring and fragmentation of the MCP, pathology of the overlying cartilage and/or subchondral bone. MCP disease has been reported as a frequently diagnosed cause of thoracic limb lameness in medium to large breed dogs 1,2 and is a common cause of elbow osteoarthritis (OA). The exact cause of MCD is debated but elbow incongruence has been reported as a primary contributor to pathogenesis of MCD. [3][4][5][6] Management of MCD remains controversial and currently no universally agreed approach exists. Results from reported studies vary but in general, describe a [233][234][235][236][237][238][239][240][241][242][243][244][245] 2009 return to normal function in the short-term with progression of OA in the medium-and long-term. 1,4,[7][8][9] Some authors report that surgical intervention does not alter the long-term prognosis and favor solely nonsurgical management. 9Surgical techniques reported for MCD broadly adopt one of two approaches: osteotomy or focal treatment of the MCP, either by arthrotomy or arthr...

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“…Essas alterações levam ao aumento da pressão no processo coronóide, processo ancôneo e consequente NUPA e FPCM (WIND, 1986;GEMMILL et al, 2005 O diagnóstico clínico é frequentemente realizado por exclusão radiográfica de outras causas de osteoartrose, presença de esclerose de osso subcondral em região do processo coronóide medial e dor à palpação na topografia do processo coronóide medial (PUCCIO et al, 2003). Essas dificuldades levam a um atraso na instituição do tratamento definitivo até que achados radiográficos e clínicos avancem para permitir o tratamento adequado (PUCCIO et al, 2003). Puccio et al (2003) indicam que a resolução da claudicação pode ser alcançada com coronoidectomia medial em cães com incongruência do cotovelo, entretanto, progressão para doença articular degenerativa pode ser esperada clinicamente a longo prazo.…”

Section: Incongruência Articularunclassified

Avaliação radiográfica e tomográfica da articulação umerorradioulnar em cães

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Clinical Evaluation and Long-Term Follow-Up of Dogs Having Coronoidectomy for Elbow Incongruity

Cited by 35 publications

References 11 publications

Radiographic findings of the medial humeral epicondyle in 200 canine elbow joints

Radiographic findings of the medial humeral epicondyle in 200 canine elbow joints

Subtotal Coronoid Ostectomy for Treatment of Medial Coronoid Disease in 263 Dogs

Avaliação radiográfica e tomográfica da articulação umerorradioulnar em cães

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