Evaluation of traction stirrup distraction technique to increase the joint space of the shoulder joint in the dog: A cadaveric study

Devesa, V.; Rovesti, Gian Luca; Urrutia, Paula; Sanroman, Fidel; Rodríguez-Quiros, Jesus

doi:10.1016/j.rvsc.2015.03.031

Cited by 4 publications

(8 citation statements)

References 39 publications

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“…Researchers in several studies have reported that joint distraction improves the visibility of the intra‐articular structures 5‐9,13‐14 . In contrast to these studies, no difference was found in our study for visibility or palpability scores of the intra‐articular structures beside visibility score of the supraglenoid tubercle.…”

Section: Discussioncontrasting

confidence: 99%

Effects of shoulder distraction on canine shoulder arthroscopy

et al. 2021

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Objective: To evaluate the use of the Leipzig distractor during canine shoulder arthroscopy. Study design: Experimental, ex vivo. Sample population: Paired shoulder joints from 15 large breed canine cadavers. Methods: Standard lateral shoulder arthroscopy was performed with or without the use of the Leipzig distractor (n = 15 each). Joint space width, procedure time, and visibility and palpability of the intra-articular structures were assessed during the arthroscopy. After the arthroscopic evaluation, each shoulder joint was disarticulated to assess the area and number of iatrogenic articular cartilage injury (IACI) lesions. Sites around the distraction device were assessed for the presence of iatrogenic injury. Results: With shoulder distraction, median joint space width was 4 mm larger (P = .01), IACI area was 9.5 mm 2 lower (P = .003), and there were two fewer total number of IACI lesions (P = .004) compared with nondistracted shoulders. The mean total surgery time was 93 seconds shorter (P = .01) in distracted shoulders. Although distraction was associated with increased visibility of the supraglenoid tubercle (P = .015), no significant differences were found for other intra-articular structures for their visibility and palpability. Unexpected lesions at the sites around the distraction device were not encountered. Conclusion: Use of the distraction device decreased the area and incidence of IACI lesions and shortened the arthroscopy time. However, no improvement was found in the visibility or palpability of the intra-articular structures. Clinical significance: Although additional clinical studies are required to evaluate the effect of the distraction device on pathologic articular conditions and intraoperative manipulation, the use of a shoulder distraction device might improve the outcomes of shoulder arthroscopy by decreasing IACI and arthroscopy time.

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Section: Discussioncontrasting

confidence: 99%

Effects of shoulder distraction on canine shoulder arthroscopy

et al. 2021

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“…In addition, manipulating instruments in this limited space during arthroscopic procedures can damage the articular cartilage; thus, good visibility should improve safety and efficiency in performing arthroscopic exams. Increased joint space may offer better visualization and instrument manipulation as well as reduce cartilage damage [6, 7].…”

Section: Introductionmentioning

confidence: 99%

“…Similarly, the use of distractors to perform arthroscopy in animals was studied in several joints to evaluate the technical feasibility and efficacy [3, 7, 11]; however, to the author’s knowledge, most of these reports were associated with medium to large breed dogs, and they did not perform arthroscopic examinations of hip joint with distractors in toy breed dogs.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a self-retaining distractor for hip joint arthroscopy in toy breed dogs

2019

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BackgroundHip arthroscopy has become a viable option over the last few years for small animal orthopedic diseases, including hip dysplasia, osteoarthritis, and joint evaluation. However, the narrow joint spaces make it difficult to manipulate the instrument, and depth of tissues make it difficult to distract the joint space. In addition, it is very difficult to maintain consistent distraction over time with a manual distraction due to hand fatigue. To overcome these difficulties, distractors are used in human medicine to improve safety and accuracy of arthroscopy. Therefore, in this study, distractor devices were applied to hip joints in small toy breed dogs to evaluate their technical efficacy. Potential iatrogenic neurovascular and articular damage were also evaluated by comparing two techniques for performing hip joint arthroscopy: the self-retaining distractor and external manipulation.ResultsThe mean ± SD of the joint distraction distance was 8.88 ± 3.54 mm in the self-retaining distraction group and 2.37 ± 0.82 mm in the manual traction group. As the joint space increased, surgeons could more easily place an arthroscopy portal and more comfortably manipulate the instrument with a distractor device. Furthermore, the acetabular cartilage damage (p = 0.004) was significantly greater in the external manipulation group, but articular damage to the femoral head (p = 0.940) was similar in both groups.ConclusionThe results of this study revealed that use of a distractor device can be a viable option for performing hip arthroscopy in small animals. The device significantly improved the surgeon’s performance without surgical assistance, and it reduced iatrogenic cartilage damage compared with manual traction. Further study is needed to quantify neurapraxia associated with distractor placement.

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“…This is not the case for distractors that use pins, which should be placed quite close to the joint to be effective. A further advantage of this technique is that it can be used in joints other than the stifle [ 16 – 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…In veterinary medicine, intra-articular pin placement while using an invasive pin distractor in the stifle of two dogs has been described [ 3 ]. However, other studies report no complications, tissue damage or fractures when using an invasive joint distractor in different cadaveric joints [ 13 , 16 – 18 ]. Complications were also not observed in a recent clinical study [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Facilitation of arthroscopic visualization and treatment of meniscal tears using a stifle joint distractor in the dog

Rovesti¹,

Devesa²,

Bertorelli³

et al. 2018

BMC Vet Res

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BackgroundStifle arthroscopy has been described to have high sensitivity and specificity in the evaluation of menisci in dogs, particularly for the medial meniscus. However, the visualization of menisci can be difficult. The use of femoral distractors in human medicine has been described to simplify demanding surgical procedures, such as meniscus transplantation. In veterinary medicine, stifle distraction has been reported to facilitate access to the joint and visualization of intra-articular structures, but there are no studies reporting the use of a stifle distraction technique while performing challenging surgical procedures, such as meniscal suture, in clinical patients.The objective of this study was to evaluate the feasibility, effectiveness and safety of stifle distraction to achieve consistent visualization of menisci and to facilitate performing arthroscopic procedures in clinical patients with stifle disease. Initial arthroscopic evaluation of the stifle joint was performed without distraction in the study population consisting of 13 dogs with naturally occurring stifle disease. The criteria for inclusion was prospectively set as the observation of a frank disease or anomaly of the menisci that could not be further treated or clarified without the risk of damaging the joint cartilage due to the requested manoeuvres. After the first examination, distraction was applied in order to complete the assessment of menisci. After achieving an accurate diagnosis, partial meniscectomy or meniscal repair was performed as needed while maintaining the distraction.ResultsComplete visualization and assessment of menisci were achieved thanks to the use of distraction. This manoeuvre facilitated access to the required area of the involved meniscus, and meniscal treatment could be successfully performed without damaging the articular cartilage. During the follow-up period, no postoperative complication related to the distraction or to the arthroscopic procedure was observed.ConclusionsStifle joint distraction during arthroscopy in dogs improves visualization of both menisci, and particularly the caudal horn of the medial meniscus. Despite being a subjective assessment, it is the authors’ opinion that this procedure also increases the ease of performing challenging procedures like meniscal suture, as it enlarges the space available to reach the correct working angulations.

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Evaluation of traction stirrup distraction technique to increase the joint space of the shoulder joint in the dog: A cadaveric study

Cited by 4 publications

References 39 publications

Effects of shoulder distraction on canine shoulder arthroscopy

Effects of shoulder distraction on canine shoulder arthroscopy

Evaluation of a self-retaining distractor for hip joint arthroscopy in toy breed dogs

Facilitation of arthroscopic visualization and treatment of meniscal tears using a stifle joint distractor in the dog

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