Comparison of needle arthroscopy, traditional arthroscopy, and computed tomography for the evaluation of medial coronoid disease in the canine elbow

Abstract

Objective: To evaluate the diagnostic value of still images of needle arthroscopy (SNAR), still images of traditional arthroscopy (STAR), and computed tomography (CT) to diagnose medial coronoid process (MCP) pathology.Study design: Prospective clinical trial. Animals: Dogs (n = 17) presented for evaluation of elbow dysplasia.Methods: For each case, two SNAR and STAR images of the MCP were reviewed independently and in random order by three board-certified surgeons. Computed tomographic images were reviewed by one board-certified radiologist. Reviewers were blinded to surgical and clinical findings. Surgical findings from real-time TAR with palpation were used as the gold standard.Receiver operating characteristic (ROC) curves and concordance statistics tests for the diagnostic accuracy of MCP fissure, MCP fragment, medial compartment condition, and cartilage score were calculated. Results: Images of 27 elbows joints were reviewed. For MCP fissure detection, areas under the ROC curves for CT (0.84), STAR (0.73), and SNAR (0.57) did not differ. For the detection of MCP fragment, STAR had a larger area under the ROC curve (0.93) compared with SNAR (0.74, P = .015) and CT (0.54, P < .001). Still images of TAR and SNAR had comparable concordance for cartilage score (0.80 and 0.77, respectively) and medial compartment pathology (0.80 and 0.73, respectively). Conclusion: Still images of NAR, STAR, and CT had similar diagnostic value to identify MCP fissures. Still images of TAR was superior to SNAR and CT to identify MCP fragments. Clinical significance: The diagnostic accuracy of SNAR varied on the basis of the coronoid lesion being evaluated.

Accuracy of needle arthroscopy for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture

“…In 2 prior clinical investigations, the potential benefit of full anesthesia over sedation was suggested for elbow and shoulder NA in dogs. 21,22 Needle arthroscopy did not appear to induce clinically appreciable morbidity. In the 14 dogs that underwent NA and SA on separate days, there was no difference in lameness scores before and after NA.…”

“…Further, as the protocol for additional chemical restraint was also not standardized, whether additional sedation (rather than general anesthesia) would have been sufficient for NA is unknown. In 2 prior clinical investigations, the potential benefit of full anesthesia over sedation was suggested for elbow and shoulder NA in dogs 21,22 …”

“…Similar limitations were noted for assessment of fragmented coroniod processes in dogs with NA. 21 Arthroscopic shaving was also permitted with SA but not available for NA. Nevertheless, we were able to assess at least part of the caudal medial meniscus with NA in every case.…”

“…14 Multiple systems are commercially available, such as the Nanoscope (Arthrex, Naples, Florida), Mi-Eye (Trice Medical, Malvern, Pennsylvania), MIDASVu System (IntraVu, Redwood City, California), and Need-leView (Biovision, Milpitas, California), and to date no single NA system is considered superior to another. Needle arthroscopy is relatively new in veterinary medicine, [15][16][17][18][19][20][21][22] and may be a clinically useful tool for assessing menisci prior to any definitive surgery.…”

Review of minimally invasive surgical procedures for assessment and treatment of medial coronoid process disease

“…However, a lower quality of vision, limited fluid inflow and fragility of the device were considered major limitations 3 . Similarly, on comparison of needle arthroscopy, traditional arthroscopy and CT images of the MCP 4 whilst all three were found to have similar diagnostic value, traditional arthroscopic images were superior to needle arthroscopy and CT in identifying MCP fragmentation. This corroborates findings by Groth et al 5 where, for dogs that had a stable MCP fissure diagnosed on arthroscopy, the fissure was only evident in 43% of cases on preoperative CT.…”