Histomorphometry of Fragmented Medial Coronoid Process in Dogs: A Comparison of Affected and Normal Coronoid Processes

Danielson, Kelson C.; Fitzpatrick, Noel; Muir, Peter; Manley, Paul A.

doi:10.1111/j.1532-950x.2006.00183.x

Cited by 99 publications

(131 citation statements)

References 25 publications

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“…Histomorphometry of excised portions of the MCP collected from dogs in our study revealed presence of pervasive subchondral microcracks 22 which supports the theoretical advantage of removing a larger portion of the MCP than that identified as grossly diseased by arthroscopic or CT examination. However, clinical outcomes measures are critical to support application of this hypothesis.…”

Section: Rationale For Scosupporting

confidence: 67%

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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Section: Rationale For Scosupporting

confidence: 67%

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

et al. 2009

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“…Danielson's study, 6 medial coronoid specimens from all age groups had diffuse microcrack formation. This finding lends credence to the concept that sudden fragmentation, even in mature dogs is preceded by microcrack formation.…”

Section: Disease Developmentmentioning

confidence: 89%

“…6 These changes typically occur at one of two anatomic sites, either the craniodistal tip of the medial aspect of the coronoid process, or more axially oriented in the region of the radial incisure. Although the precise nature of this fatigue phenomenon remains elusive, several hypotheses encompass the disparate range of recognized pathologic changes, all of which may be attributable to some form of humeroulnar conflict (HUC).…”

Section: Etiopathogenesismentioning

confidence: 99%

“…Importantly, subchondral microcrack formation extends beyond the area of superficial or macroscopic disease. 6 The pattern of visible pathologic change may be dependent on a balance between rate of microcrack formation and healing by fibrous infilling, and on the focal intensity of supraphysiologic forces, which could theoretically radiate outward from a central focus akin to fissure lines created by movement of tectonic plates. Thus shear planes might occur either at the tip, or at the radial incisure, of the MCP depending on the prevalent loading force.…”

Section: Disease Developmentmentioning

confidence: 99%

“…Whereas several diseases may coexist within the same joint, [3][4][5] it has become increasingly apparent from histomorphometric, 6 biomechanical, 2,7,8 and genetic or heritability 9,10 data that there is considerable independence in development of these multifactorial disease processes. This is further complicated by the spectrum of clinical signs and macroscopic pathology associated with any single disease process, 11 which has important implications for treatment and prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Working Algorithm for Treatment Decision Making for Developmental Disease of the Medial Compartment of the Elbow in Dogs

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Histomorphometry of Fragmented Medial Coronoid Process in Dogs: A Comparison of Affected and Normal Coronoid Processes

Abstract: Accumulation of fatigue microdamage in the MCP is important in the pathogenesis of FMCP. The underlying cause of this microdamage accumulation must be identified before treatment plans that will prevent further osteoarthritis of the elbow joint can be designed.

Cited by 99 publications

References 25 publications

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

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

Working Algorithm for Treatment Decision Making for Developmental Disease of the Medial Compartment of the Elbow in Dogs

Operative Arthroscopy

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